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Chronic Pain

 A woman leans forward with her right hand on her side, she looks in pain. The words – Chronic Pain – can be seen

Please note that all content on this website (including, but not limited to, copy, images, commentary, advice, tips, hints, guides, observations) is provided as an informational resource only. It is not a substitute for correct and accurate diagnosis, or recommendation, or treatment by a medical professional. Please ensure that you obtain proper guidance from your GP, or another medical professional. The information provided on this website does not create any patient-medical expert relationship and must not be used in any way as a substitute for such. 

 

When you sustain an injury, or illness, the pain will usually become less severe, as the injury heals however, Chronic Pain is ongoing and usually lasts longer than six months. It is a type of pain that can continue even after the injury, or illness that caused it, has healed, or gone away. 

Studies show that over 28 million adults in the UK may be living with chronic pain – that’s almost half of the adult population. More adults aged 75, or over (62%), experienced pain than those aged 18 to 25 (14.3%).

Chronic pain can occur in almost any part of the body and may be steady, or intermittent, often fluctuating in severity. The frequency of which the pain presents itself, and the time which it lasts, can greatly vary between people. This is why doctors like to build up a detailed picture of pain patterns in order to tailor a plan to the individual.

This poorly understood condition can limit a person’s mobility and reduce flexibility, strength and endurance, which can make daily tasks extremely difficult and challenging.

Often, the causes of chronic pain are difficult to identify, leaving people feeling frustrated and despairing, which can have long term effects on mental health.

A recent survey showed that people living with chronic pain may not be seeking the help they need, due to the misconception that chronic pain cannot be improved and that one just 'lives with it'. The results showed that only 15% of people living with pain had investigated treatments beyond visiting a GP. 

The main goal of treatment is to reduce pain and make it easier to manage, as there is no cure for chronic pain as yet. Medical treatments, medication, lifestyle remedies, or a combination of these methods, can be used to treat the symptoms of chronic pain and make them easier to manage.

the word symptoms over a sunset photograph – a lighthouse stands on the edge of a beach

Symptoms of chronic pain can range from mildly uncomfortable to completely debilitating.

Unlike acute pain, chronic pain doesn’t go away after your initial injury, or illness, has healed. It is often accompanied by anger, depression, anxiety, loss of sexual desire and disability.

Chronic pain is linked with conditions that involve long-term pain, including certain cancers, stroke, fibromyalgia, chronic fatigue syndrome, endometriosis and inflammatory bowel disease. Experts don’t yet understand how, or even, if these conditions are related.

Research suggests that psychological problems alone are not the cause of chronic pain syndrome. Instead, it is linked to abnormalities in the interaction between certain glands, the hypothalamus, pituitary and adrenal glands and the nervous system. Often, chronic pain is not static, it can change and intensify throughout the day.

Symptoms of chronic pain vary from person to person, but may include any, or a combination of:

  • Low back pain
  • Headaches
  • Joint pain
  • Muscle aches
  • Sleep problems
  • Fatigue
  • Burning, or tingling pain, in different parts of the body
  • Jolts of sharp pain.

Not everyone living with chronic pain will experience all of the above symptoms at the same time. It is likely that they will be experienced as different combinations at different times. They can be triggered due to different things, such as increases in stress, or activity.

Causes of Chronic Pain

Sometimes, chronic pain is present without a physical cause, such as an injury, or a medical procedure. It is possible that pain is caused by an illness, or an underlying issue.

Conditions that cause widespread and long-lasting pain are, not surprisingly, often linked to chronic pain syndrome. It’s possible that certain brain chemicals that suppress pain, stop working the way they’re supposed to.

Even when conditions improve with medications, or therapy, some people can still experience chronic pain.

Some of these conditions include:

  • Osteoarthritis – this type of arthritis is generally the result of wear and tear on the body and occurs when the protective cartilage between bones wears away.
  • Rheumatoid arthritis – this is an autoimmune disease that causes painful inflammation in the joints.
  • Back pain – this pain may stem from muscle strains, nerve compression, or arthritis of the spine, called spinal stenosis.
  • Fibromyalgia – this is a neurological condition that causes pain and tenderness in various parts of the body, also known as trigger points.
  • Inflammatory bowel disease – this condition causes chronic inflammation of the digestive tract and can produce intestinal pain and cramping.
  • Surgical trauma – this is pain that presents as a result of a medical procedure, accident, or any other injury to the body.
  • Advanced cancer – cancerous growths cause pain by destroying nearby tissue and pressing on nerves, bones, or organs. Tumours can also release toxic chemicals which cause pain to occur.

The symptoms and causes of chronic pain can interfere with daily life, keeping people from doing things they want and need to do. Studies have also found that people who suffer from chronic pain have abnormally low endorphins in their spinal fluid. Endorphins are chemicals in the body that help to control pain naturally.

Pink tulips on a white background and the word – Types – can be seen

 

There are several types of chronic pain:

Nociceptive Pain

Nociceptive pain is the most common type of pain of chronic pain.

Nociceptive pain is a medical term used to describe the pain from physical damage, or potential damage, to the body. The pain is detected in either the body’s soft tissues, such as muscles and skin, or organs by specialised sensory nerves, known as nociceptors.

Nociceptors detect painful stimuli, sending information to the spinal cord and brain for interpretation and response. Examples might be the pain felt from a sports injury, a dental procedure, or arthritis.

Examples of nociceptive pain:

  • Headaches
  • Pelvic pain not caused by nerve damage
  • Arthritis
  • Fibromyalgia 

Somatic Pain

Somatic pain is a type of nociceptive pain often related to joint injury, or arthritic conditions. Skin, ligaments, tendons, muscles, joints and bones can all cause somatic pain. Muscle pain is also a somatic pain; it can develop as part of certain chronic conditions, including fibromyalgia.

Examples of somatic pain include: 

  • Tension headaches
  • Pelvic pain from joint instability
  • Arthritis
  • Bone fracture
  • Back pain not caused by nerves.

Visceral Pain

Visceral pain is also a type of nociceptive pain.

Visceral pain refers to pain detected within the body’s internal organs. Visceral pain detected by sensory nerves is sent to the spinal cord and brain for interpretation and unlike somatic pain, visceral pain may be felt further away from its actual origin. This is because the nerves within the internal organs are not as widespread as in muscles, or skin, making it challenging to locate what is causing pain and where it is coming from.

Some examples of visceral pain include:

  • Endometriosis
  • Irritable bowel syndrome
  • Bladder pain (such as cystitis)
  • Prostate pain.

Neuropathic Pain

Nerves cause neuropathic pain, but it is different from nociceptive pain in that the nerves are often not functioning 'normally'. The pain is caused by nerve disturbances and spontaneous transmission of pain signals to the spinal cord and brain. It is often described as a sharp, stabbing, shooting, burning, or electrical feeling of pain.

Prompt treatment is vital to treat the symptoms of Neuropathic pain. Receiving care as soon as possible is critical. It may help prevent, or lessen, problems that often accompany neuropathy, such as depression, sleeplessness and diminished functioning.

Examples of neuropathic pain include:

  • Peripheral neuropathy (for example, diabetic neuropathy)
  • Post-mastectomy pain
  • Sciatica
  • Headache
  • Back pain
  • Stomach pain.

Psychogenic Pain

Psychogenic pain is the term for pain caused by a psychological disorder, such as depression, or anxiety. Psychogenic pain is real, though it may require a different treatment approach than other physical types of pain.

Many psychological disorders have physical complications. Because psychogenic pain does not have a physical origin, it is more difficult to treat than nociceptive, or neuropathic pain. Headache, back pain, or stomach pain are some of the most common types of psychogenic pain.

Non-pharmaceutical pain treatments, combined with antidepressants, or other psychological medications, are more effective than traditional painkillers.

Idiopathic Pain

Idiopathic pain is pain that exists when there is no known physical, or psychological cause. It cannot be traced back to a nociceptive, neuropathic, or psychogenic cause. While the cause of the pain may not be detectable with current medical knowledge, it is still real.

The pain is more common in people who have a pre-existing pain disorder including TMJ (temporomandibular joint pain), and fibromyalgia. Its cause is not apparent. Idiopathic pain is often difficult to treat and has characteristic features of the affected part being cool, cyanosed and overly sensitive to touch.

Chronic Back Pain

Often occurring in the lower back, the pain may be caused by an injury, or develop progressively due to arthritis, osteoporosis, or normal wear and tear.

Back pain has become an epidemic in the UK. It is a leading cause of disability and loss of mobility. Chronic back pain presents in people who are older, due to wear and tear of the muscles, bones and disk, but can also result from a prior injury. In most cases, it is not caused by anything serious and the pain varies.

Common causes of chronic back pain include:

  • Slipped, or bulging discs, typically caused by twisting, or lifting injuries.
  • Spinal stenosis involving the narrowing of the spinal canal and compression of nerves
  • Compression fractures, commonly associated with osteoporosis
  • Soft-tissue damage caused by strain, or trauma, to back muscles, ligaments, or tendons
  • Spinal fractures
  • Structural deformities, such as scoliosis (the abnormal sideways curvature of the spine), or lordosis (the excessive inward curve of the lower back).
Grey chair and side table below the words, living with the condition

Living with chronic pain makes day-to-day life incredibly challenging. It can affect every single part of a person’s life, including hygiene, eating, relationships and sleeping. The psychological implications of chronic pain are extensive, causing depression, anxiety and irritability.

Research shows that people have found relaxation to be an effective treatment for chronic pain, whilst others find medication to be beneficial.

It is important to remember that people live with varying levels of severity with chronic pain, only a small percent of people are rendered unable to maintain a good quality of life. In reality, many people continue to live healthy, productive lives despite living with pain.

Develop Coping Skills

People living with chronic pain tend to develop coping skills to be able to continue their day to day lives. This can include massage, holistic approaches, monitoring triggers and adjusting lifestyles to help effectively manage pain.

Exercise

Exercise and chronic pain can become a damaging cycle if not approached properly. One may not exercise due to the pain, which in turn then causes the body to become less mobile and stiff, causing pain to worsen. Try talking to a doctor, or a physical therapist, about a safe exercise program right for you. Exercises, such as Yoga and Tai Chi, are methods that can help keep you mobile whilst also helping you relax.

When living with chronic pain, exercise helps keep muscles active and joints flexible, which can help ease the symptoms and effects of chronic pain.

Find the Right Medication

It may be necessary to try several medications before finding the best one for managing the pain. While it can be frustrating to try different prescriptions, sampling a variety may ultimately lead to better pain control. While most pain medications are safe and effective when taken correctly, you should only take medicines after you’ve consulted with your local doctor.

Learn to Relax

Stress causes muscle tension, which can increase the amount of pain being felt. Allowing muscles to relax, reduces strain and decreases pain sensations. Relaxation is a pain management tool that can be used on its own, or in combination with other treatments.

Unfortunately, there is no instruction manual for living a life with chronic illness and facing the limitations and challenges. It may be a case of trial and error and combining different techniques before something that works for the individual is found. 

Light bulbs with filaments that say – help, support, assistance and guidance

It is quite normal to have feelings of anger, frustration, despair and loss following the diagnosis of chronic pain. These feelings can be associated with the loss of the old self and contemplating themselves with constant pain for the rest of their lives.

People living with chronic pain sometimes opt to join a support group. Others go to their GPs, or consultants advise them about a local group, or one specific to their condition.

There are specialist Pain Clinics available for assessment and possible pain management; they can advise on living a fuller life despite the pain.

Consultants, or doctors, at clinics may prescribe drugs, or give injections to try to control pain; other clinics have psychologists, physiotherapists and occupational therapists.

Pain clinics offer a wide range of treatments and support; these treatments may include:

  • Medicine
  • Pain-relief injections
  • Manual therapy
  • Exercise
  • TENS machines
  • Complementary therapy
  • Psychological therapy

Some people receiving treatment at a pain clinic may be offered a Pain Management Programme (PMP).

A PMP (Pain Management Programme) differs from other treatments provided in Pain Clinics. Pain relief is not the primary goal; improvements in pain following participation within the programme is the goal. Here is more information about alternative treatment methods and how you can get them through the NHS. 

If you contact your GP about your chronic pain, they may:

  • Carry out a physical examination
  • Discuss your pain history
  • Identify where the pain is coming from
  • Record your level of pain
  • Check for signs of any illness that could be causing your pain, or making it worse
  • Ask how your pain is affecting your life.

The GP may suggest trying some painkillers for short-term pain relief. However, painkillers are generally not considered a primary way to manage long-term pain.

It’s hard to know where to turn to when you’re suffering from chronic pain. However, there is a lot of self-help advice available from a variety of organisations. They are there to support people living with long-term pain. Here are some support groups and websites within the UK:

 

The word – Glossary – can be seen above a pile of scrabble tiles

Acupressure – complementary medicine technique uses pressure on specific points along the body to help with pain management

Acute pain – pain that can be extremely intense, but lasts for only a short period. Acute pain also has a diagnosable cause and gets better with treatment

Adrenal glands – the adrenal glands are endocrine glands that produce a variety of hormones, including adrenaline and steroid aldosterone and cortisol. They are found above the kidneys

Antidepressant – medication typically used to treat symptoms of depression, but also commonly prescribed to help manage chronic pain and some of its symptoms, such as insomnia

Arthritis – is a common condition that causes pain and swelling (inflammation) in the joints. Common symptoms of arthritis include pain, swelling and stiffness in 1, or more, joints

Autoimmune Disease – is a condition in which your immune system mistakenly attacks your body. The immune system normally guards against germs like bacteria and viruses

Central nervous system (CNS) – body system that includes the brain and spinal cord. Your doctor may mention your CNS when discussing how pain occurs, or the cause of your chronic pain

Chronic pain – pain that continues over many months, or even years, and may worsen with time. Chronic pain often persists long after an injury has healed; it may be minor, or extreme

Complementary medicine – treatment that falls outside the standard medical approaches. Complementary medicine techniques for pain may include acupuncture, herbs, chiropractic care and yoga

Computed tomography (CT) scan – a diagnostic procedure using X-ray technology and a computer that may help diagnose your pain

Endometriosis – a long-term condition where tissue similar to the lining of the womb grows in other places, such as the ovaries and fallopian tubes. Symptoms include pain in your lower tummy, or back (pelvic pain), severe period pain and pain during or after sex

Endorphins – interact with the opiate receptors in the brain to reduce our perception of pain and act similarly to drugs, such as morphine and codeine. Endorphins will block pain signals and help to curb anxiety and depressio

Fibromyalgia – condition causes pain all over the body, including muscle pain and stiffness; fatigue is another common symptom of this chronic pain condition

Hypothalamus – is a small region of the brain. The hypothalamus plays a crucial role in many important functions, including releasing hormones and regulating body temperature

Irritable Bowel Syndrome: Irritable bowel syndrome (IBS) is a common disorder that affects the large intestine. Signs and symptoms include cramping, abdominal pain, bloating, gas and diarrhea, or constipation

Joints – is an articulation between two bones in the body and are broadly classified by the tissue which connects the bones

Ligaments  a short band of tough, flexible fibrous connective tissue that connects two bones, or cartilages, or holds together a joint

Magnetic resonance imaging (MRI) – this diagnostic procedure, using magnetic fields, radio waves and a computer, may be used to determine the source of pain

Occupational therapist – are health care professionals who utilise evidence-based practice, research, scientific evidence and a holistic perspective to promote a patients' functional ability to fulfill their daily routines and roles

Osteoarthritis is the most common type of arthritis. When the smooth cushion between bones breaks down, joints can get painful, swollen and hard to move. It can affect any joint, but it often occurs in hands, knees, hips, lower back and neck

Osteoporosis – is a health condition that weakens bones, making them fragile and more likely to break

Physiotherapists – help people affected by injury, illness, or disability, through movement and exercise, manual therapy, education and advice

Pituitary – the major endocrine gland, a pea-sized body attached to the brain's base, is important in controlling growth and development and the functioning of the other endocrine glands

Psychologists is a person who studies normal and abnormal mental states, perceptual, cognitive, emotional and social processes and behavior by experimenting with, and observing, interpreting and recording how individuals relate to one another and their environments

Slipped, or bulging discs – also called a prolapsed, or herniated disc, is where a soft cushion of tissue between the bones in your spine pushes out of place

Tendons – or sinews are a tough band of fibrous connective tissue that connects muscle to bone and is capable of withstanding tension

Transcutaneous electrical nerve stimulation (TENS) – is a pain management technique that uses small amounts of electricity delivered through electrodes placed on the skin

Yoga – complementary medicine technique exercises the mind and body with meditation, postures and breathing techniques to help manage pain