Understanding chronic pain: Causes, management and hope
Chronic pain is a complex and often debilitating condition that affects 1 in 5 people worldwide. In the UK, an estimated 28 million people live with chronic pain. Of those 28 million, 12% have a significant impact on their daily functioning.
Chronic pain differs from acute pain, which is a normal response to injury or illness and typically resolves as the underlying issue heals. Chronic pain persists for weeks, months, or even years. Here, I will explore the causes, management strategies, and hope that individuals living with chronic pain can find in the ongoing research in pain management and where to find help and support.
What is chronic pain?
Chronic pain is a persistent pain that lasts for 12 weeks or more, it can result from various underlying causes such as injury, trauma or medical condition. Chronic pain can manifest in different forms, such as neuropathic pain, musculoskeletal pain, headaches, pelvic pain, abdominal pain, and much more, making it a broad and complex condition.
What are the causes?
1. Underlying medical conditions
Chronic pain can be a result of medical conditions like arthritis, fibromyalgia, neuropathy, and endometriosis. These conditions often lead to persistent pain due to ongoing inflammation or damage to tissues. However, in some cases, the condition can be treated and tissues are no longer damaged but the pain can persist.
Some individuals experience chronic pain as a result of traumatic injuries, such as car accidents, falls, or sports-related injuries. Even after the initial trauma has healed, pain may persist. Psychological trauma from an injury can play a huge factor in how much pain a person can experience.
3. Nervous system disorders
Conditions like complex regional pain syndrome (CRPS) or phantom limb pain can cause chronic pain due to dysfunction in the nervous system – this is also called central sensitisation. This fault in the nervous system is explained for all chronic pain conditions but can be particularly important when experiencing nervous system disorders.
4. Musculoskeletal issues
Poor posture, stress, obesity, and lack of exercise can contribute to chronic pain. However, it's important to acknowledge this isn't the cause, but a contributing factor.
5. Psychological factors
Mental health issues like depression and anxiety can exacerbate chronic pain and, in some cases, for example, trauma or long-standing stress even be a primary cause.
What can I do about it?
Managing chronic pain is a multifaceted challenge, which often needs a multidisciplinary approach, meaning different health approaches such as cognitive behavioural therapy, physiotherapy, and consultant and nurse care.
Here are some common approaches to pain management:
1. Psychological therapy
Cognitive-behavioural therapy (CBT) and other psychological interventions can help individuals cope with and manage chronic pain by addressing the psychological impact living with chronic pain can have on our lives. CBT is evidence-based and recommended by NICE (National Institute of Clinical Governance) for pain management.
Physiotherapy therapy can help improve muscle strength, flexibility, and posture, which can reduce pain and prevent further injuries.
3. Pain management programmes
These can be multidisciplinary with different health professionals (e.g. CBT and Physio)
4. Lifestyle changes
Adopting a healthy lifestyle that includes regular exercise, a balanced diet, and stress management techniques can have a positive impact on chronic pain.
In some cases, medical interventions such as nerve blocks, radiofrequency denervation, or spinal cord stimulation may be considered to manage chronic pain. However, these are often not a long-term solution to chronic pain.
Recent research has shown that long-term medication for chronic pain is not effective due to the tolerance effect and side effects. There are many side effects that long-term medication can carry. Medications can include non-steroidal anti-inflammatory drugs (NSAIDs), opioids, and other prescription medications that may be used to alleviate pain. However, the long-term use of opioids carries risks and should be carefully monitored.
What is the hope for chronic pain?
While living with chronic pain can be challenging, and can impact all areas of life, there is hope and help out there. Ongoing research into the neurological and psychological aspects of pain may lead to breakthroughs in understanding and treatment. Meaning, that we are now moving away from interventions and medication and looking at a person as a whole and treating chronic pain holistically using psychological therapy and physiotherapy.
Support groups, pain management clinics, and healthcare providers with specialised training in chronic pain are becoming more accessible.
In summary, chronic pain is a complex and persistent condition that affects individuals in various ways and can be extremely debilitating. There is a lot of help and support for you out there. If you or someone you know is living with chronic pain, seek the help of a health professional to explore the most suitable options for managing chronic pain and move from surviving to thriving in life.
For more information, you can contact me, a chronic pain specialist and CBT therapist. I can give you access to a free workbook to get you started on managing your pain.