Chronic Pain

Pain is a sensory and emotional experience that can vary widely among patients and with the same patient at different times. Pain can be divided into two general types: acute and chronic pain. Acute pain, for the most part, results from disease, inflammation, or injury to tissues. This type of pain generally comes on suddenly, such as after trauma or surgery, and is confined to a relatively short period of time and severity. In some instances, acute pain becomes chronic pain. Severe chronic pain is defined as pain lasting longer than six months and has multiple causes, such as failed back surgery, injury, accident, cancer, AIDS, and other nervous system disorders.

Some of the most severe chronic pain is neuropathic in origin, which means that it involves damage to the nervous system. Neuropathic pain can result from injury to the nerves, either in the peripheral or central nervous system. Neuropathic pain can occur in any part of the body and is frequently described as a hot, burning sensation, or a pins and needles type of sensation. It can result from diseases that affect nerves – such as diabetes or from trauma – or it can be a consequence of certain treatments, such as from chemotherapy for cancer. It can also occur without direct injury to nerves as with complex regional pain syndrome, also known as reflex sympathetic dystrophy, or causalgia. Nerves can become hypersensitized as a result of tissue injury and the resulting pain can persist even after the injured tissue has healed.

Statistics

Chronic pain is the number one cause of adult disability in the United States. Chronic pain disables more people than cancer or heart disease and costs the American people more than both combined. The National Pain Foundation estimates that chronic pain costs $100 billion a year in medical bills, lost working days and workers compensation.

Symptoms

Uncontrolled or inadequately controlled pain has a dramatic impact on a person’s quality of life.. Chronic pain patients may suffer progressive physical deterioration due to disturbances in sleep, depression and emotional changes. A subgroup of patients with severe chronic pain who are no longer adequately controlled by systemic analgesic drugs may require the use of intrathecal (IT) analgesic medications. Many of these patients cannot tolerate or no longer respond to narcotic medications and have no other option.

Pain Management

Chronic pain traditionally has been under-diagnosed and under-treated because it is often considered a stubborn symptom of another underlying medical condition or a weakness on the part of the patient. For centuries, opiates have been regarded as the universal treatment for chronic pain. Morphine has been widely dispensed, despite its potentially serious side effects, such as respiratory depression, addiction, tolerance and withdrawal syndrome. Studies also suggest that morphine is often not effective in treating neuropathic pain.

Pain management has increasingly turned to interdisciplinary combinations of techniques customized for each individual’s experiences. The World Health Organization recommends an analgesic ladder for the treatment of cancer pain that starts with nonsteroidal anti-inflammatory drugs and progresses to mild opioids, such as codeine, and then onto stronger opioids such as morphine, hydromorphone, oxycodone, methadone and fentanyl. If these measures do not work, patients are given alternative therapies such as corrective surgery, nerve blocks or epidural injections.

Intrathecal (IT) drug administration is generally reserved for severe chronic pain patients who fail conventional therapies, and involves administering an analgesic drug into the fluid surrounding the spinal cord through a pump.

Other Resources

American Pain Society is a multidisciplinary community that brings together a diverse group of scientists, clinicians and other professionals to increase the knowledge of pain and transform public policy and clinical practice to reduce pain-related suffering

National Pain Foundation Pain Connection is a 501(c)(3) not-for-profit human service agency that provides monthly support groups (in Montgomery, Prince George's, Howard, Anne Arundel and Baltimore Counties), Speakers Series in Silver Spring, supervision, training, newsletter, website, information and referrals and community outreach and education