Chronic pain is one of the costliest health problems. The economic consequences of chronic pain include increased medical expenses, loss of income, loss of productivity, compensation payments, and legal fees.

• Low back pain is one of the most important health problems. It is a common cause of activity limitation in adults, especially back pain.
• Cancer pain affects most people with advanced cancer.
• Approximately 15-20% of the population is affected by arthritis.
• Headaches affect millions of adults. Migraines and tension headaches are some of the most common types of chronic headache.
• Neuropathy and other pain disorders affect nerves throughout the body.
• Pain caused by damage to the central nervous system (the brain and spinal cord) as well as pain without a physical cause.

What is the source of the pain?

The pain begins in the receptor nerve cells located under the skin and in the organs of the body. The message is sent along nerve pathways to the spinal cord, which then transmits the message to the brain when you are sick, injured or have a problem. These messages are reduced or blocked by painkillers before they reach the brain.

The pain can be something bothersome, like a mild headache, or very intense, like chest pain that accompanies a heart attack, or pain due to kidney stones. The pain can be acute, that is to say new, subacute, lasting a few weeks or a few months, and chronic, when it lasts more than 3 months. 

Are there different types of pain?

Two types of pain include the following:

• Acute pain. This pain can be from inflammation, tissue damage, injury, disease, or recent surgery. This usually lasts less than a week or two. The pain usually ends after the underlying cause is treated.
• Chronic pain. Pain that persists for months or even years.

What is chronic pain?

Chronic pain is persistent pain that persists beyond the usual recovery period or occurs alongside a chronic health condition, such as arthritis, Chronic pain can be “on” and “off” or continuous. It can affect people to the point that they can no longer work, eat properly, exercise, or enjoy life.

Chronic pain is a major medical condition that can and should be treated.

What is the cause of chronic pain

There are many causes of chronic pain. You may have experienced an illness or injury that you have recovered from for a long time, but the pain remained. Or there may be an ongoing cause of pain, such as arthritis or cancer. Despite a previous injury or signs of illness, many people experience chronic pain.

There are usually three causes of chronic pain:

1. Inflammatory causes: example of rheumatoid arthritis. Peripheral nerve fibers are abnormally sensitive to pain.
2. Neuropathic causes: Neuropathic pain is the consequence of damage to the nerves and nervous system.
3. Central pain due to a central abnormality in the pain control system. This includes, for example, tension headaches, fibromyalgia, somatic chest pain or irritable bowel syndrome.

Pain, sleep and psychological disorders form a triad

When pain becomes such a problem that it interferes with work and normal life activities, you can become the victim of a vicious cycle. Pain can worry you, depress you, and irritate you. Depression and irritability often lead to insomnia and lassitude, resulting in more irritability, depression, and pain.  The urge to stop the pain can lead some people to become addicted to drugs and can lead others to undergo repeated surgeries or resort to questionable treatments. Family members may find the situation as difficult as the sufferer is.

How is chronic pain treated?

The most effective treatment includes symptom relief and support. A multidisciplinary approach is often needed to provide the resources to manage pain.

• Neurologists and Neurosurgeons
• Orthopedists and orthopedic surgeons
• Anesthesiologists
• Oncologists
• Nurses
• Physiotherapists
• Occupational therapists
• Psychologists/psychiatrists

Special pain programs are offered in many hospitals, rehabilitation centers and pain clinics.

Rehabilitation program to manage pain

A rehabilitation program for pain management is designed to meet your needs. The schedule will depend on the specific type of pain and disease. Your active participation and that of your family is essential to the success of the program.

Pain management programs are designed to help you achieve the highest level of functioning and independence possible, while improving your overall quality of life – physically, emotionally and socially. Pain management techniques help reduce your suffering.

To help achieve these goals, pain management programs may include:

• Medical management of chronic pain, including drug management:
  • Over-the-counter medications may include nonsteroidal anti-inflammatory drugs, aspirin, or acetaminophen.
  • Prescription painkillers, including opioids, may be needed to relieve pain more strongly than aspirin. However, these drugs are reserved for more severe types of pain, as they have some potential for abuse and can have unpleasant and potentially very dangerous side effects.
  • Prescription antidepressants can help some people. These medications increase the supply of the naturally produced neurotransmitters serotonin and norepinephrine. Serotonin is an important part of a pain control pathway in the brain.
• Heat and cold treatments to reduce stiffness and pain, especially with joint problems such as arthritis
• Physiotherapy and occupational therapy such as massages and whirlpool baths
• Exercise to reduce spasticity, joint contractures, joint inflammation, spinal alignment problems, or weakening and shrinking of muscles to prevent other problems
• Local electrical stimulation involving the application(s) of brief electrical pulses to nerve endings under the skin to relieve pain
• Injection therapies, such as epidural steroid injection
• Emotional and psychological support for pain, which may include the following:
  • Psychotherapy and group therapy
  • Stress management
  • Training on relaxation methods
  • Meditation
  • Hypnosis
  • Biofeedback

The philosophy common to all of these varied psychological approaches is the belief that you can do something on your own to control pain. This includes changing your attitudes, perception of being a victim, feelings or behaviors associated with pain, or understanding how unconscious forces and past events have contributed to the pain.

Additionally, treatment may include:

• Operation. Surgery may be considered for chronic pain. Surgery can relieve pain, but can also destroy other sensations or become the source of new pain. The relief is not necessarily permanent and the pain may return. There are a variety of operations to relieve pain. 
• Acupuncture. Acupuncture is a 2000-year-old Chinese technique of inserting thin needles under the skin at selected points on the body and has shown promise in treating chronic pain. The needles are manipulated by the practitioner to produce pain relief.

Common dysfunctional beliefs

Pain is synonymous with progressive tissue damage rather than the result of a stable problem. This belief leads to more suffering.

Chronic pain decreases with prolonged rest. This belief encourages passivity

The pain is inexplicable. This belief leads the patient to minimize his ability to reduce pain.