Chronic pain is a pain that persists over time (6 months or longer) and typically results from long-standing (chronic) medical conditions or damage to the body.
Chronic pain may be divided into "nociceptive" (caused by activation of nociceptors), and "neuropathic" (caused by damage to or malfunction of the nervous system).
Nociceptive pain may be divided into "superficial" and "deep", and deep pain into "deep somatic" and "visceral". Superficial pain is initiated by activation of nociceptors in the skin or superficial tissues. Deep somatic pain is initiated by stimulation of nociceptors in ligaments, tendons, bones, blood vessels, fasciae and muscles, and is dull, aching, poorly-localized pain. Visceral pain originates in the viscera (organs). Visceral pain may be well-localized, but often it is extremely difficult to locate, and several visceral regions produce "referred" pain when damaged or inflamed, where the sensation is located in an area distant from the site of pathology or injury.
Neuropathic pain is divided into "peripheral" (originating in the peripheral nervous system) and "central" (originating in the brain or spinal cord). Peripheral neuropathic pain is often described as "burning", "tingling", "electrical", "stabbing", or "pins and needles". With chronic pain, signals of pain remain active in the nervous system for months or even years. This can take both a physical and emotional toll on a person.
Why pain can become worse
• There is a "wind-up phenomenon" that causes untreated pain to get worse. Nerve fibers transmitting the painful impulses to the brain become "trained" to deliver pain signals better. Just like muscles become stronger for sports with training, the nerves become more effective at sending pain signals to the brain. The intensity of the signals increases over and above what is needed to get the affected person's attention. To make matters even worse, the brain becomes more sensitive to the pain. So the pain feels much worse even though the injury or illness is not worsening. At this point, pain may be termed chronic pain. And it is no longer helpful as a signal of illness.
The goal in treating pain
• When a doctor is consulted, the goal for both patient and the doctor is to no longer have chronic pain. The patient wants the cause of their pain to be found and cured so that he or she can resume normal life without needing medication or further visits to health care professionals.
Treating lifelong pain
• Unfortunately, many illnesses do not have known cures. The treatment of illnesses such as diabetes and high blood pressure is often lifelong. In these chronic illnesses, as in the treatment of chronic pain, the person's goal is to live as normally as possible. Sometimes medication is needed for the rest of a person's life in order to achieve that goal.
A sensible view of addiction
• Chronic pain is no different from diabetes or high blood pressure. If a person needs to be on pain medicine for the rest of his or her life, they should not be said to be "addicted" to pain medicine any more than a person with diabetes who needs to be on insulin for the rest of his or her life should be said to be "addicted" to insulin.
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This page was last updated on December 5, 2023