Chronic pain can be a real nuisance, not only for the patients who experience it, but also for the doctors treating them. The former are simply suffering from chronic pain in a unique way, and for medics, this problem often causes a headache due to the fact that it is not easy to choose the optimal treatment that gives the patient relief. Where does chronic pain come from and how to deal with it?
Chronic painmakes it impossible for many people to function normally - doctors consider it a disease that not only can, but also needs to be treated. Anyone can experience this problem, but especially chronic pain is often seen in the elderly.
Despite the fact that more and more is said about chronic pain, both its definition and the statistics on the prevalence of this problem are ambiguous.
There are really different criteria for when it is actually possible to diagnose chronic pain.
According to some authors, this problem can be found after the patient's pain symptoms persist for more than 3 months, and according to others, only when the pain persists for more than six months.
As mentioned above - which is caused by, for example, ambiguous criteria for diagnosis - there are also no exact statistics on the frequency of chronic pain. It is estimated that this type of problem may affect 1 in 10 people from the general population, in other sources one can come across the opinion that symptoms of chronic pain may occur in even more than half of the world's population.
It should be remembered that although pain seems to be extremely unfavorable for many people, in practice it is not quite so. Feeling it is supposed to make a person avoid factors that are dangerous to him - as an example we can give a situation where someone puts his hand to the fire. In such a case, the resulting pain causes the limb to retract reflexively - so it prevents the occurrence of burns.
Chronic pain: causes
Long-term pain can be caused by various types of disease - the most common causes of chronic pain include:
- rheumatoid inflammationjoints
- cancer
- inflammatory bowel diseases
- conditions after injuries or surgery
- endometriosis
- fibromyalgia
- osteoarthritis
- chronic fatigue syndrome
- Lyme disease
- muscle or tendon strain
The above-mentioned are just a few examples of diseases that may be responsible for chronic pain - in practice, however, many more disease entities may result in patients constantly experiencing different intensity of pain.
Nevertheless, a situation where the source of the ailments experienced by the patient is not possible is possible - in such a situation it is possible to speak of primary chronic pain (i.e. where pain is the main problem of the patient and where it is impossible to detect no deviations that would be responsible for its occurrence).
Chronic pain: risk factors
Certain groups of patients are particularly at risk of developing chronic pain. They include mainly:
- patients suffering from various chronic diseases (both those mentioned above, such as arthritis, and other entities, such as, for example, ischemic heart disease or diabetes)
- women
- elderly (over 65)
- obese people
- cigarette smokers
Chronic pain: types
It would seem that chronic pain is simply related to the sensation of pain. In practice, however, chronic pain is unequal to chronic pain and there are several types of this abnormality.
We can mention here, for example, the aforementioned primary chronic pain, the causes of which - even despite the performance of many various diagnostic tests - cannot be found.
Other distinguished types of chronic pain are:
- chronic pain accompanying cancer
- posttraumatic chronic pain
- chronic neuropathic pain
- chronic headache
- chronic visceral pain
- chronic musculoskeletal pain
Chronic pain: symptoms
The basic symptom of chronic pain is, of course, pain, but different patients who theoretically struggle with the same problem - that is, with continuous pain for a long time - may in fact complain of a slightly different type of symptoms.
For example, visceral pain can be located in a specific place in the body, and it also happens that this pain is diffuse and the patient is notable to determine where exactly it hurts.
In the case of neuropathic pain, patients may complain of such ailments as, for example, burning or stinging sensations or feelings resembling electric current passing through the body.
Chronic pain also varies in intensity in different patients: some patients struggle with pain all the time, while in others the periods when they feel pain are intertwined with times when they do not feel this ailment .
The pain itself associated with the problem in question may significantly hinder the patient's normal functioning, whether at home, at work or in any other environment. Unfortunately, the truth is that chronic pain usually leads to additional ailments in patients. Examples of them include:
- feeling of breakdown and general fatigue
- decrease in activity
- depressed mood
- sleep problems
- irritability
- loss of appetite
Chronic pain is sometimes so severe that it leads to the appearance of mental disorders (e.g. depressive disorders) in patients.
It also happens that a patient who is constantly in pain may even have thoughts of suicide.
All of the above-mentioned difficulties that patients suffering from chronic pain may face, illustrate perfectly how serious the problem is and how important it is to treat it properly. Before its implementation, however, it is necessary to carry out appropriate diagnostic tests first.
Chronic pain: diagnosis
It is really impossible to list here all the tests that can be performed in search of the causes of chronic pain.
The situation is somewhat easier when the patient has some known risk factors for its occurrence, such as, for example, recent major surgery or being burdened with a disease that contributes to the appearance of pain (e.g. rheumatoid arthritis).
It is definitely more difficult when chronic pain develops in a person who does not suffer from any of the conditions that could potentially be the underlying problem. In this case, the medical history is extremely important, thanks to which it is possible to narrow down the list of necessary tests.
Various laboratory tests (including blood levels of antibodies related to autoimmune diseases) and imaging tests (thanks to which you candetect possible neoplastic changes or any deformations of the structures of the skeletal system in the patient.
Chronic Pain: Treatment
Due to chronic pain, the patient may, inter alia, limit your activity or avoid contact even with your loved ones - so there is no doubt that this problem simply absolutely requires treatment.
Probably the first possible therapeutic option is the possibility of using painkillers, but in practice they are always recommended to patients with great caution. This is necessary, among others because of the risk of developing side effects after these drugs, but also because some painkillers - especially those with strong effects - may lead to the development of addiction.
Treatment of chronic pain may be based on prescribing various types of painkillers to the patient.
Initially, attempts are made to use agents from the group of non-steroidal anti-inflammatory drugs, such as ibuprofen.
When they are ineffective, drugs from other groups are recommended, such as opioid analgesics (including tramadol and morphine). These measures should be used with extreme caution in people who have a tendency to abuse or addiction to psychoactive substances.
In some types of chronic pain - e.g. in neuropathic pain - slightly different preparations are used, because i.a. agents belonging to antidepressants or anticonvulsants.
Treatment of chronic pain is not only pharmacotherapy, but also definitely a different kind of influence.
Various treatments are used, incl. electrostimulation, blockades or decompression of nerve fibers.
There are also reports of possible beneficial effects on alleviating pain such as acupuncture (not confirmed in scientific research and not consistent with EBM) or rehabilitation exercises.
Sometimes - e.g. in people with chronic fatigue syndrome - psychotherapy is sometimes recommended.
Recently, more and more has been said about the possibility of using medical marijuana preparations to relieve chronic pain.