What is Chronic Pain?
Chronic pain explained by Denver, Golden, Aurora, Boulder, Broomfield, Jefferson, and Littleton Colorado’s top pain doctors
Chronic pain is generally categorized as pain that is persistent and constant for three months or more, although some physicians and scientists disagree on this definition. The pain may vary in intensity, frequency, and debility. Chronic pain is associated with regions such as the spine, joints, neck, and pelvis. Headaches, nerve, and muscle pain can also be termed chronic.
Causes of Chronic Pain
There are a variety of sources of chronic pain including infections, injuries, trauma, or diseases, such as nerve damage and cancer. Chronic pain that is not linked to any injury or condition can occur. These cases may be explained by inflammation of nervous, muscular, or other tissues.
There are many risk factors, such as psychiatric conditions, including depression, anxiety, stress, and emotional problems, all of which are associated with a decreased inability to adequately regulate the sensation of pain as the body naturally would. This increases the probability of developing a chronically painful condition.
Physicians often diagnose chronic pain if the patient reports a significant effect on their functional status or quality of life (QOL). QOL scales are typically used to diagnose chronic pain, as well as the potential for response to treatment and rate of decline of the patient.
Treatments for Chronic Pain
There are a range of treatments available for chronic pain conditions. For example, adhesiolysis treats scar tissue that accumulates around spinal nerves, causing inflammation and chronic neck or back pain. It involves inserting a needle and catheter in the epidural space of the spine near the nerve. Once the needle and catheter are placed correctly, local anesthetics and corticosteroids are injected in order to inhibit inflammation and pain. Compounds such as hyaluronidase may also be injected to break up the scar tissue.
Nerve blocks (e.g., sympathetic lumbar block, medial branch block, or superior hypogastric plexus block) are similar procedures in which anesthetics and steroids are delivered to inflamed or damaged nerves. Nerve blocks effectively treat many neck- and back-related chronic pain cases.
If chronic pain is associated with inflammation of spinal nerves, steroid injections may be effective. Cervical inflammation can be treated with injections between vertebrae in the neck. For other regions of the spine, epidural injection (as with adhesiolysis) of steroids is applied. Steroids inhibit inflammation effectively, and can be accompanied by local anesthetics, as with nerve blocks. The benefits of these injections are that they are not time-consuming, and result in medium- to long-term relief from chronic pain.
Radiofrequency ablation (RFA) involves the insertion of a probe that selectively destroys nerve tissue that sends chronic pain signals to the brain, with radiofrequency, or electro-thermal, impulses. RFA is a minimally invasive procedure, and achieves long-term relief from chronic pain in over 90% of cases.
Some chronic pain conditions are caused by the collapse (or fracture) of one or more vertebrae, which is associated with advanced age and motor vehicle accidents. This can be treated by vertebroplasty or kyphoplasty. These are procedures that involve the insertion of a needle through the skin and collapsed vertebrae. Vertebroplasty involves injecting medical cement through the needle, to restore the structure of the affected spinal bones. In kyphoplasty procedures, one or two inflatable balloons are inserted through the needle in place of cement and inflated to replicate the original height of the bone.
As cement leakage may cause spinal damage and inflammation, kyphoplasty is increasingly preferred by surgeons. However, vertebroplasty may be more effective in improving spinal reshaping after fractures. Kyphoplasty, on the other hand, may be associated with better recovery times and chronic pain relief. Both procedures are associated with significant reduction of chronic pain, taking effect 48 hours post-surgery or less.
Opioids are drugs, such as morphine, codeine, and fentanyl, prescribed to treat chronic pain associated with cancer or serious injury. Opioids are some of the most effective pharmacological options to inhibit pain, but are not recommended in the long-term due to their risks of abuse, dependence, and side effects. Physicians and pain specialists should discuss and test other treatment methods with patients before resorting to opioid use, and monitor patients on courses of opioids carefully. If drug tolerance to an opioid is observed, a professional may have to recommend an alternative treatment.
Acupuncture is a treatment originating in traditional Chinese medicine. This procedure involves the placement of sterile needles in the area(s) of the body where the pain is perceived, and any other regions that may be associated with the pain. Acupuncture, if performed properly by a competent and reputable professional, is effective in reducing chronic pain and stiffness. Acupuncture is associated with the release of endorphins that regulate pain perception. There are many types of acupuncture available today, such as traditional acupuncture, manual or finger acupuncture, laser acupuncture and electroacupuncture, which involves the application of electrically charged needles or pads.
Chronic pain is usually classed as pain that persists for at least three months or more. The pain may range from mild to severe, continuous to episodic, or annoying to debilitating. The most common forms of chronic pain are back pain, headaches, neck pain, pelvic pain, and joint pain.
Chronic pain is caused by injury, trauma, or conditions such as cancer. There are many risk factors for chronic pain, including psychiatric conditions, which can affect the ability to regulate pain perception.
There are many treatment options for chronic pain, for example minimally invasive procedures such as adhesiolysis, steroid and local anesthetic spinal injections, kyphoplasty/vertebroplasty, and radiofrequency ablation. Opioids can be considered to treat certain chronic pain cases, but are associated with high risks of addiction and tolerance. A quality of life scale is often used in diagnosing chronic pain.
- Abdi S, Datta S, Trescot AM, Schultz DM, Adlaka R, Atluri SL, Smith HS, Manchikanti L. Epidural steroids in the management of chronic spinal pain: a systematic review. Pain Physician. 2007;10(1):185-212.
- Cheng J, Pope JE, Dalton JE, Cheng O, Bensitel A. Comparative outcomes of cooled versus traditional radiofrequency ablation of the lateral branches for sacroiliac joint pain. Clin J Pain. 2013;29(2):132-137.
- Choi E, Nahm FS, Lee PB. Evaluation of prognostic predictors of percutaneous adhesiolysisusing a Racz catheter for post lumbar surgery syndrome or spinal stenosis. Pain Physician. 2013;16(5):E531-536.
- Garcea G, Thomasset S, Berry DP, Tordoff S. Percutaneous splanchnic nerve radiofrequency ablation for chronic abdominal pain. ANZ J Surg. 2005;75(8):640-644.
- Glazov G, Yelland M, Emery J. Low-dose laser acupuncture for non-specific chronic low back pain: a double-blind randomised controlled trial. Acupunct Med. 2013; in press.
- Goz V, Errico TJ, Weinreb JH, Koehler SM, Hecht AC, Lafage V, Qureshi SA. Vertebroplasty and kyphoplasty: national outcomes and trends in utilization from 2005 through 2010. Spine J. 2013;in press.
- Li LH, Sun TS, Liu Z, Zhang JZ, Zhang Y, Cai YH, Wang H. Comparison of unipedicular and bipedicular percutaneous kyphoplasty for treating osteoporotic vertebral compression fractures: a meta-analysis. Chin Med J (Engl). 2013;126(20):3956-3961.
- Manchikanti L, Cash KA, McManus CD, Pampati V. Assessment of effectiveness of percutaneous adhesiolysis in managing chronic low back pain secondary to lumbar central spinal canal stenosis. Int J Med Sci. 2013;10(1):50-59.
- Manchikanti L, Cash KA, Pampati V, Wargo BW, Malla Y. Management of chronic pain of cervical disc herniation and radiculitis with fluoroscopic cervical interlaminar epidural injections. Int J Med Sci. 2012;9(6):424-434.
- Park Y, Ahn JK, Sohn Y, Jee H, Lee JH, Kim J, Park KD. Treatment effects of ultrasound guide selective nerve root block for lower cervical radicular pain: A retrospective study of 1-Year follow-up. Ann Rehabil Med. 2013;37(5):658-667.
- Von Korff MR. Long-term use of opioids for complex chronic pain. Best Pract Res Clin Rheumatol. 2013;27(5):663-672.
- Wasserman RA, Brummett CM, Goesling J, Tsodikov A, Hassett AL. Characteristics of chronic pain patients who take opioids and persistently report high pain intensity. Reg Anesth Pain Med. 2013; in press.