Pain is a common complaint reported to health practitioners. It is estimated that over 10 million people in the UK are dealing with chronic pain. Often, chronic pain can start from acute pain. So, what management strategies do we have for living with chronic pain?
Difference between acute and chronic pain
Pain warns your brain of potential harm or damage. Think of it as your alarm system that protects you from danger and harm. Our brain is constantly scanning for possible hazards, which means that once it’s switched on, it is reluctant to turn it off.
Generally, acute pain is what you feel when you get hurt, e.g., break a bone, fall from a height, or develop inflammation in your appendix secondary to acute appendicitis. Usually, acute pain is when your alarm system functions as it should, letting you know of potential damage or hurt so you can take action.
However, chronic pain is different. When you have pain for a long time, your alarm system starts to malfunction or become hypersensitive. Think of it as a home alarm system that doesn’t work correctly. For example, the alarm system activates when a leaf blows across the front gate. Similarly, our alarm system can fire on humans even though we have no impending harm or damage.
Sometimes, acute pain can become chronic. If acute pain is not controlled well, then the constant firing of the alarm system can change the wiring. This change can lead to a hypersensitised alarm system. We often term this change neuroplasticity. Although the original injury (damage to your back or shoulder) has healed, the nerve wiring has changed so much that it keeps firing. Your brain strengthens these nerve pathways, making it harder to switch off.
Other times, chronic pain can occur without an initial insult or damage. These cases develop secondary to diseases such as osteoarthritis, multiple sclerosis, trapping of nerves (sciatica, carpal tunnel syndrome), and any autoimmune or inflammatory arthritis condition.
Dealing with chronic pain: how does it present?
Chronic pain can generally be varied. Depending on the triggering cause, it can be sharp, dull, stabbing, burning, or shooting.
In some cases, chronic pain is termed ‘hyperalgesia,’ which means the volume is turned up or amplified. So, mild damage can lead to high pain levels.
Alternatively, we use ‘allodynia’ to mean pain from something that isn’t usually painful. For example, just touching the skin can stimulate your alarm system.
Some people think people with chronic pain are ‘faking’ their pain or making it up. Instead, we need to consider chronic pain as a malfunctioning alarm system rather than ‘all in your head. ‘
Finally, chronic pain can present with other symptoms such as anxiety, depression, reduced appetite, fatigue, and poor sleep.
Diagnosing chronic pain
It is essential to see your doctor to determine whether your pain is due to ongoing damage (such as inflammation or infection) or secondary to a malfunctioning alarm system. This assessment is the key to dealing with chronic pain.
Your doctor will assess you and perform basic investigations, such as a blood test, X-rays, or MRIs, to determine whether the damage is still occurring.
Living with chronic pain: treatment options
Overall, treatment can be complex, making dealing with chronic pain a challenge.
First, it is crucial to understand what living with chronic pain means and how you can manage it better. Remember, you can turn down the volume by thinking about chronic pain differently and working on turning down the volume. Conversely, you should expect something other than a ‘quick’ fix with a treatment, injection, or surgery. Be careful of advice from practitioners who say that they have a cure for your chronic pain.
Second, medications help turn down nerves’ firing. Examples of drugs used include:
Opioid pain medication
Opioids, also known as narcotics, are potent painkillers that reduce pain sensation. They attach to the brain and spinal receptors and change how the brain interprets pain.
Examples of opioids include codeine, oxycodone, and morphine. Overall, these drugs work well for acute pain but are not so practical for chronic pain. We should use it with caution as a group due to its addictive potential. We know that continuous use of opioids for more than three days increases the risk of addiction.
Overall, we should be reducing the use of opioids. Generally, we should aim to start non-opioid medication first.
Non-opioid pain medications
Topical medications in gel or patch form can effectively tone down the alarm system. Some medicines can be bought over the counter (voltarol gel), while others need to be prescribed. In addition, how they work is different depending on the drug used. For example, lidocaine patches are an anaesthetic that blocks nerve signals, while capsaicin cream causes skin irritation, reducing pain perception.
Simple tablets such as paracetamol or ibuprofen are effective for some people. We use them alone or together with other medications. However, you must be aware of side effects, particularly ibuprofen.
Finally, another group of drugs called nerve stabilisers reduces the excitability of the alarm system. These drugs include anti-depressants and anti-convulsants. Examples include amitriptyline, duloxetine, gabapentin, and pregabalin. Again, it would be best if you spoke to your doctor about the possibility of using these drugs to control pain.
Other treatment options for living with chronic pain
Additional treatments such as massage therapy, exercise therapy, acupuncture, and counselling can work to control the alarm system.
Typical skin treatment techniques work by desensitising the sensory nerves in the skin. Some of these techniques include:
- Regular massage and touching of the painful area every 2-3 hours
- Massage with a toothcomb or electric brush to desensitise further
- Use different textures (velvet, wool, washing sponge, velcro). First, pick one texture you can’t bear and use for 2 minutes, then choose a texture you can tolerate and use for 2 minutes. Repeat five times once every day.
- Hand immersion. Place your hand in a container containing dried beans, rice, lentils, couscous, or something unbearable. Move your fingers around the texture for 5 minutes and repeat every day. If the texture becomes bearable, move to another texture.
- Mirror therapy is where you watch yourself move in a mirror to show the brain there is no injury.
Also, making significant lifestyle changes such as losing weight, stopping smoking, eating better, and getting more sleep will help.
A recent study published by the JAMA found that a program called RESTORE improved chronic pain compared to a placebo. These programs combined education, sensory massage, and touching and visualising movement using a mirror.
Finally, it is essential to understand that anxiety or depression may be the direct result of chronic pain and can turn up the volume. Relaxation techniques and getting help with your mental health can improve your ability to live with chronic pain.
Living with chronic pain: Frequently asked questions?
Is it all in your head?
No. We know that people feel pain. Chronic pain is a malfunction of the pain alarm system. It is not just imagined. Why some people develop chronic pain, and others don’t, is a mystery but might be related to genetics and other co-existing factors, such as the presence of depression or anxiety.
Is pain a sign of healing or more damage?
Acute pain secondary to recognised damage (such as a fall from a height) is a sign of a problem. Generally, the more the pain, the greater the damage. However, the relationship between injury and pain in chronic pain has malfunctioned. So, high levels of chronic pain can occur even with minimal damage.
Exercise causes pain: should I stop?
It depends on the level of pain during and after exercise. If you have only low-level pain, we recommend you continue, as exercise can dampen the alarm system. However, if the pain is high-level, we suggest not pushing through, as this action might sensitise the alarm system further.
What happens if chronic pain is left untreated?
If left untreated, chronic pain can worsen symptoms, making it more challenging to live with chronic pain. Also, this secondary effect leads to anxiety or depression, making the alarm system more sensitive. We know that people with chronic pain have a lower quality of life and worse health outcomes.
Does obesity increase the risk of developing chronic pain?
Yes, we think so. One recent study found that excessive abdominal fat is strongly associated with an increased risk of chronic tendon and joint pain. Moreover, this effect was stronger in women than men. Fat produces this effect through an increase in body inflammation. So, losing weight by reducing body fat may decrease chronic musculoskeletal pain.
Final word from Sportdoctorlondon about dealing with chronic pain
What is chronic pain? It is any condition that leads to a malfunctioning pain alarm system. It would help to be careful of practitioners who promise a quick fix. Generally, we recommend a multi-disciplinary approach incorporating medical assessment, medications, counselling, and other treatment modalities.
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