Chronic Widespread Pain
Pain Conditions
At Bay State Pain Management, Our Expert Pain Management Specialists Provide Effective Treatments for Chronic Widespread Pain.
Chronic Widespread Pain
Chronic Pain
What is pain?
Pain starts in receptor nerve cells found beneath the skin and in organs throughout the body. When you are sick, injured, or have other type of problems, these receptor cells send messages along nerve pathways to the spinal cord, which then carries the messages to the brain. Pain medicine may be needed to reduce or block these messages before they reach the brain.
Pain can be anything from slightly bothersome, such as a mild headache, to something excruciating and emergent, such as the chest pain that comes with a heart attack or the pain of kidney stones.
What are the different types of pain?
Two major types of pain include the following:
Acute pain. This pain may come from inflammation, tissue damage, injury, illness, or recent surgery. It usually lasts less than a week or two. The pain usually ends after the underlying cause is treated or has been resolved.
Chronic pain. This is pain that lasts for months or even years.
What is chronic pain?
Chronic pain is long standing pain that persists beyond the usual recovery period or occurs along with a chronic health condition, such as arthritis. Chronic pain may be “on” and “off” or continuous. It may affect people to the point that they can’t work, eat properly, take part in physical activity, or enjoy life.
Chronic pain is a major medical condition that can and should be treated.
Chronic pain is one of the most costly health problems in U.S. Increased medical expenses, lost income, lost productivity, compensation payments, and legal charges are some of the economic consequences of chronic pain. Consider the following:
Low back pain is one of the most significant health problems. Back pain is a common cause of activity limitation in adults.
Cancer pain affects most people with advanced cancer.
Arthritis pain affects more than 50 million Americans each year.
Headaches affect millions of U.S. adults. Some of the most common types of chronic headaches are migraines, cluster headaches, and tension headaches.
Other pain disorders such as the neuralgias and neuropathies that affect nerves throughout the body, pain due to central nervous system damage (to the brain and spinal cord), as well as pain where no physical cause can be found (psychogenic pain) increase the total number of reported cases.
Symptoms of chronic pain syndrome
Chronic pain syndrome takes a toll on both your physical and mental health. While the pain can be near-constant, there may be flares of more intense pain due to increases in stress or activity. Symptoms include:
- joint pain
- muscle aches
- burning pain
- fatigue
- sleep problems
- loss of stamina and flexibility, due to decreased activity
- mood problems, including depression, anxiety, and irritability
In one study published in the journal Pain, 60.8 percentTrusted Source of the subjects who reported chronic pain also had depression, most of them with “severe” level symptoms.
Diagnosis of chronic pain syndrome
The first thing your doctor will do is take a thorough medical history. You’ll be asked things like:
- when your pain started
- what it feels like (for example, burning and sharp or dull and aching)
- where it’s located
- if anything makes it better or worse
Because certain conditions can lead to chronic pain syndrome, your doctor may order imaging tests to determine if there is joint or tissue damage that may explain your pain. For example, your doctor may order an MRI to determine if your pain is stemming from a herniated disk, an X-ray to see if you have osteoarthritis, or a blood test to check for rheumatoid arthritis.
Without being able to find a direct cause of your pain — or if they think the pain is disproportionate to the trigger — some doctors will dismiss your symptoms or tell you they are “all in your head.” It’s hard to be proactive when you don’t feel well, but keep investigating alternatives. If need be, talk to your doctor about what you think is causing your pain and ask for the appropriate tests and treatments. Working as a team is your best shot at finding relief.
What causes chronic pain?
There are many causes of chronic pain. It may start from an illness or injury, but remain long after recovery from other symptoms. Or there may be an ongoing cause of pain, such as arthritis or cancer. Many people suffer chronic pain in the absence of any past injury or evidence of illness.
What is the effect of chronic pain?
When pain becomes such a problem that it interferes with your life’s work and normal activities, you may become preoccupied with the pain, and feel depressed and irritable. Depression and irritability often lead to insomnia and weariness, leading to more irritability, depression, and pain. This state, in turn, can lead to suffering, sleeplessness, and sadness. The urge to stop the pain can lead some people to use multiple drugs and may drive others to have repeated surgeries, or resort to questionable treatments. The situation can often be as hard on the family as it is on the person suffering with the pain.
Causes of chronic pain syndrome
Conditions that cause widespread and long-lasting pain are, not surprisingly, often linked to chronic pain syndrome. 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 (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.
- Advanced cancer.
Even when these conditions improve (via medications or therapies), some people can still experience chronic pain. This type of pain is generally caused by a miscommunication between the brain and nervous system. (For unexplained reasons, some people can encounter this kind of pain without any known triggers.)
Chronic pain can change the way neurons (nerve cells in the brain that transmit and process sensory input) behave, making them hypersensitive to pain messages. For example, according to the Arthritis Foundation, 20 percent of people with osteoarthritis who get their knees replaced (and presumably have no more painful joint issues) will still report chronic pain.
Treatment for chronic pain syndrome
Chronic pain can be perplexing, but it is treatable. Some options include:
Medical
- Drugs to relieve pain. These can be anti-inflammatories, steroids, muscle relaxers, antidepressants that also have pain-relieving qualities and, in severe cases, opioids (this is a last resort).
- Physical therapy to increase flexibility and range of motion.
- Nerve blocks to interrupt pain signals.
- Psychological/behavior therapy. While they may not have a big impact on pain, some psychological therapies can have a positive effect on mood. For example, cognitive behavior therapy (a type of talk therapy that helps you reframe negative thinking) has been shown to be effective in boosting mood, even up to a year after treatment ends. In another study, biofeedback was beneficial in reducing muscle tension and depression and improving coping with chronic pain. Biofeedback is a type of therapy which teaches you to use your mind to control bodily reactions, like rapid breathing.
Alternative
- Acupuncture. According to an analysis of studies, acupuncture reduced pain levels in 50 percent Trusted Sourceof those who tried it, compared with a 30 percent pain reduction in those who did not receive acupuncture.
- Hypnosis. Research reports that 71 percent of subjects with irritable bowel syndrome (IBS) reported much-improved symptoms after a course of hypnosis. These effects extended up to five years post treatment.
- Yoga. Because it helps to relax muscles, encourages deep, restorative breathing and increases mindfulness, researchTrusted Source shows that yoga can be beneficial in reducing the depression and anxiety that comes with chronic pain, thus improving your quality of life.
Chronic pain affects all parts of your life. The most effective treatment includes symptom relief and support. A multidisciplinary approach to pain management is often required to provide the needed interventions to help manage the pain. Pain management programs are usually done on an outpatient basis. Many skilled professionals are part of the pain management rehabilitation team, including:
Neurologists and neurosurgeons
Primary care providers
Orthopedists and orthopedic surgeons
Anesthesiologists
Oncologists
Physiatrists
Nurses
Physical therapists
Occupational therapists
Psychologists/psychiatrists
Social workers
Case managers
Vocational counselors
Special pain programs are located in many hospitals, rehab facilities, and pain clinics.
The pain management rehab program
A pain management rehabilitation program is designed to meet your needs. The program will depend on the specific type of pain, disease, or condition. Active involvement by you and your family is vital to the success of the program.
The goal of a pain management program is to help you return to the highest level of function and independence possible, while improving your overall quality of life—physically, emotionally, and socially. Pain management techniques help reduce your suffering.
To help reach these goals, pain management programs may include:
Medical management of chronic pain, including medicine management:
Over-the-counter (OTC) medicines may include nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, or acetaminophen.
Prescription pain medicines, including opioids, may be needed to provide stronger pain relief. However, these drugs are reserved for more severe types of pain, as they have some potential for abuse. They may also have unpleasant and potentially dangerous side effects.
Prescription antidepressants can help some people. These medicines increase the supply of the naturally produced neurotransmitters, serotonin and norepinephrine. Serotonin is an important part of a pain-controlling pathway in the brain.
Adjuvant medicines may be advised to help control the side effects or to help increase the pain-relieving effects of pain medicines.
Heat and cold treatments to reduce stiffness and pain, especially with joint problems such as arthritis
Physical and occupational therapy such as massage and whirlpool treatments
Exercise to prevent further problems and reduce spasticity, joint contractures, joint inflammation, spinal alignment problems, or muscle weakening and shrinking
Local electrical stimulation involving application(s) of brief pulses of electricity to nerve endings under the skin to provide pain relief
Injection therapies, such as epidural steroid injection
Emotional and psychological support, which may include:
Psychotherapy and group therapy
Stress management
Relaxation training
Meditation
Hypnosis
Biofeedback
Behavior changes
The philosophy common to all of the psychological approaches to pain management is the belief that you can do things on your own to control pain. This includes changing your attitudes, your perception of being a victim, your feelings, or your behaviors associated with pain. It also may include understanding how unconscious forces and past events have contributed to your pain. These goals may be accomplished with:
Patient and family education and counseling
Alternative medicine and therapy treatments, as appropriate
In addition, treatment may include the following:
Surgery may be considered. But although surgery can bring release from pain, it may also destroy other sensations or become the source of new pain. Relief is not necessarily permanent and pain may return. There are a variety of operations to relieve pain. Consult your doctor or more information.
Acupuncture, a 2,000-year-old Chinese technique of inserting fine needles under the skin at selected points in the body, has shown some promise in the treatment of chronic pain. Needles are manipulated by the practitioner to produce pain relief.
Pain Conditions
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You don’t have to live with pain. Physician at Bay State Pain Associates can pinpoint the problem and develop a personalized treatment plan to address conditions.
