By Dr Attia Anwar
Any pain that lasts longer than three months comes under the category of chronic pain. There is usually a trigger factor like some disease, accident, or injury. Chronic pain continues beyond the time expected for healing.
What happens is that the injury is healed but the pain continues. This pain can range in quality from dull ache to sharp stab. Its intensity can be from mild to extreme. People experience pain in multiple areas at the same time. Although the central nervous system produces pain, it is not all in the head. Pain sensitivity is influenced by multiple factors. So it requires a holistic approach to manage pain. People usually have pain in certain areas of the body, and medical science until now was so divided into organs or systems that people cannot get out of that particular system. If you take a detailed history from the patient, they will tell you that they are having pain in other areas too. A patient with joint pain after injury often complains of occasional headaches. But he is so concerned about immediate issues like the “flat tire of the car” that he ignores other problems. However, educating the patients about the basis of chronic pain and encouraging them to talk can lead to the disclosure of many interrelated things. This interconnectedness of the body will help us to understand the management of chronic pain.
There is a positive role for emotional well-being and using coping strategies with pain to improve quality of life
Pain is a protective mechanism of our body. It protects us from harmful stimuli by avoiding them. It has an immediate nervous connection which alerts us to move from painful stimuli without our conscious efforts. These alert messages are further processed in the thalamus. This processing is based on previous experience, beliefs, expectations, and cultural and social norms. The thalamus sends messages to other parts of the brain and you feel annoyed, irritated, or depressed. This is the reason why people have different responses to pain. The thalamus is part of the brain associated with mood and arousal. So interpretation of pain depends on mood also.
Any health condition that causes chronic pain is difficult to manage. Some individuals are physiologically more prone for developing chronic pain conditions
As far as the management of pain is concerned, pain should be managed in the early stage and people should be pain-free as soon as possible because long-term pain brings changes in the brain. Even if the injury is healed people feel pain due to those changes in the brain. It is difficult to treat this type of pain. So there is no need to tolerate pain or show strength, as it has long-term consequences. Breaking the cycle of pain is important before it becomes chronic.
Modalities for pain reduction are pain medicine, physical therapy, hot, and cold, massage, cognitive behavior therapy, and mind-body techniques like acupuncture and transcutaneous electrical nerve stimulation. There is a positive role for emotional well-being and using coping strategies with pain to improve quality of life. Other things that help in the management of pain are staying active, and pacing daily activity in such a way that pain is not flared. Patients should avoid all those things that increase pain. In coping with pain focus should be on day-to-day activities rather than the complete stoppage of pain. Small wins should be celebrated. Educating patients about disease and injury helps them cope with pain and decreases the element of fear of further injury. Emotional support from family, friends, and support groups is also important.
Any health condition that causes chronic pain is difficult to manage. Some individuals are physiologically more prone to develop chronic pain conditions. This interconnectedness is more than we think. In the last two decades, hundreds of studies have proved that people with chronic pain have physiological differences in the way their brain processes sensory signals. So it shows that while pain originates in the brain, it is not all in their head situation. Neither is it a weakness or psychological issue. Multiple terms like central sensitization syndrome can be used. But the common denominator is the central nervous system. Cancer has the same basic mechanism but it affects different organs. Chronic pain conditions may have the same basic mechanism that manifests differently. Chronic pain conditions like chronic fatigue syndrome, chronic tension headache, chronic low back pain, fibromyalgia, irritable bowel syndrome, and temporomandibular disorder occur so frequently together, that the term chronic overlapping pain conditions is used to identify them. It requires a holistic approach to identify and understand these conditions. If each doctor focuses on their area of specialization problems can be missed. Patients should be encouraged to talk about all their pains not only focusing on the most urgent and devastating problem. Unfortunately, modern medicine has just begun to understand the mechanism and genetic predisposition of these conditions. There is still so much bias attached to chronic pain like it is a personal weakness. Patients with chronic pain should be treated holistically. They should be encouraged to talk about their all problems. Their general health should be considered and then an individualized plan of management with patient participation should be made.
The author Dr. Attia Anwar is a consultant family physician with a postgraduate degree from the Royal College of GP UK. She is a strong advocate of health and well-being and wants patient participation in decision-making regarding health.
