A Beginner's Guide to Chronic Pain: Causes, Types, Diagnosis & Treatments
Do you have chronic pain? Then this article is for you, even if you have been recently diagnosed or have been living with pain for many years. We’re going to unpack this beast and explain the main causes, types, symptoms, ways it can be diagnosed and available treatments.
What is pain?
It’s that unpleasant sense that you feel somewhere (and sometimes everywhere) in your body that you probably know TOO well. So we will look at the purpose of pain to answer this question.
Simply put, pain is our internal alarm system that helps us avoid and respond to potentially dangerous situations. When you register pain after placing your hand on a hot stove, that’s the brain's way of persuading you to withdraw. And, of course you do usually by getting your hand out of there - quick smart. Our bodies have special danger detectors – called nociceptors – that can detect something potentially harmful (extreme heat in this case) and the message gets passed into the central nervous system (spinal cord and brain) for processing.
Processing is a broad term for the way information bounces around the brain being analyzed and interpreted. In this processing, it’s the central nervous system's job (subconsciously, and without your awareness) to decide whether the body needs protecting. If the answer is yes, pain will likely follow. This is a normal reaction that protects us from any further harm. However, chronic or persistent pain can occur when this process changes and the nervous system becomes sensitized. The messages start firing all the time, often without any actual danger and the pain just keeps happening.
What causes chronic pain?
Pain is considered chronic or persistent when it has lasted longer than three months (as opposed to acute pain). Chronic pain is complex. If it wasn’t, it probably wouldn’t have lasted so long, and it can have a range of causes.
It can also be triggered by a range of different initial events, including:
Physical Trauma (injuries/surgeries)
If you sprain your ankle or cut your finger, healing will occur. It’s an unstoppable process. But sometimes, even though healing has occurred, pain persists. When I went in for spinal surgery at age 11, I had no idea I would be living with chronic back pain all these years later. I know now my pain isn’t because my back is still damaged, but because my nervous system responded in a way that amplified signals from my back. We now call this nociplastic pain (read about the different types of pain).
Illness
Persistent pain also sometimes comes on following an illness such as a virus. This is likely because illnesses trigger reactions in our immune and nervous systems, and after the illness has subsided, our immune and nervous systems might still remain in a state that makes us more sensitive.
Nerve injury
Nerves can be damaged in a range of ways from injury, compression, accidents, illness, disease and drug misuse. Normally, only nerve endings can trigger nerve impulses and the length of the nerve is simply a cable that transmits that message from point A to point B. But a nerve injury can result in impulses starting at parts of the nerve that normally only conduct messages. This also explains why you might feel pain in the foot when there is a nerve injury in the lower back. That is, the brain assumes the messages came from the nerve endings (in the foot) when in fact they started along the nerve (in the lower back).
Psychological trauma
Another common trigger of persistent pain is psychological trauma, such as that related to a sexual assault or other stressful life event. This is likely because of the reaction of our stress systems, and the impact this has on body systems that influence pain (see our Allostasis blog here) and our blog about psychological trauma and pain.
Chronic pain locations
Pain can occur anywhere in the body. It can be there all the time or come and go. Some common places people may experience pain are:
Musculoskeletal pain
This is a board category that includes pain that is experienced in joints, bones, muscles or the soft tissues. It can include arthritis, fibromyalgia and back pain. Musculoskeletal pain is the most common form of non-cancer pain and affects around 1.71 billion people worldwide with lower back pain being the most prevalent.
Cancer pain
This is pain experienced due to cancer, whether from the tumors themselves, or from surgery, radiation and chemotherapy treatment.
Visceral pain
Pain felt in internal organs and can include pain associated with the digestive system (such as irritable bowel syndrome) or pelvic pain including disorders such as endometriosis and polycystic ovary syndrome (PCOS).
Headaches & migraines
Pain felt in the mouth, jaw or face can be common. About one in five Australians have migraines with a higher prevalence in women.
Often people living with one pain condition can then go on to develop another in a different part of the body and this is because of the complex interrelationship between the body's neuro-immune systems. If one gets fired up there can be a knock-on effect to other systems.
If we haven't mentioned your pain location/condition, please don’t feel left out – we’re working on new courses all the time, and we’d love to hear from you. Please get in touch with us if you would like to know more about your condition or suggest a topic for an upcoming article.
Symptoms & impacts of living with chronic pain
While everyone's experience living with pain is different, there are some common impacts. We could probably have a list a mile long here because chronic pain can be extremely debilitating affecting your physical, psychological and social well being. What can also make it isolating and hard for others to understand is that many of these impacts are not visible.
We can think of the effects of chronic pain as being similar to an iceberg in the ocean. Above the water are the more obvious physical symptoms. These can include, and are not limited to, joint pain, muscle aches and/or stiffness, reduced mobility and flexibility, fatigue and brain fog. Immediately under the surface there are the disruptions that chronic pain causes to a person's daily life, such as disruptions to their ability to work, to travel, to participate in school or social activities, and difficulty with necessary tasks such as household chores, lifting, or exercising. And deeper under the surface are the flow-on effects, such as relationship strain, financial difficulty, medication side-effects, sleep problems and decreased mental wellbeing, which could show up as depression, anxiety and low mood.
The biopsychosocial model of pain was developed to incorporate all of these impacts and to acknowledge that pain is complex and needs to be individualized for effective management.
How is chronic pain diagnosed?
A health professional will ask many questions to determine the impact and effects of your pain and take a detailed clinical assessment including your medical history and perhaps undertake a physical exam. If you've been in pain for longer than 3 months, that's chronic pain. While chronic pain won't show up on a test (because there may be no injury or damage triggering the pain - you have a sensitized central nervous system), you still may be recommended to have a number of tests such as scans, blood tests, x-rays and other images.
This is to address some of the other many and complex contributing factors to pain. Some conditions, such as fibromyalgia have a range of diagnostic criteria that need to be met for a diagnosis. The main thing to remember is that your symptoms are very real and should be taken seriously by whomever you speak with about your pain.
What is the most common way to treat chronic pain?
By far the most common treatment for chronic pain is still medication. Over half the people seeking help for chronic pain are prescribed analgesics (compared to only one in five of patients without chronic pain) and, of this, people living with chronic pain are one third more likely to be prescribed opioids. There are also many other types of medications that may be trialed. Medication in the short-term can be useful.
The use of medication for long term chronic pain is controversial, and requires a thoughtful approach, because of concerns about side effects, long-term efficacy, functional outcomes, and the potential for dependency. Also because medication does not address the cause, it should not be a substitute for care that is more likely to be beneficial in the long run.
If not medication, then what?
There are MANY possible helpful ways to help you manage pain and move towards recovery. Non-pharmaceutical techniques for pain management include physical therapy, movement (including graduated activity/pacing), psychological therapies via evidence based techniques such as Cognitive Behavioral Therapy (CBT), Mindfulness-Based Stress Reduction (MBSR), Acceptance and Commitment Therapy (ACT), Pain Reprocessing Therapy (PRT).
These approaches can not only help you cope and improve function, but can also help improve pain by improving the functioning of your body systems that can be disrupted by stress and by improving the tolerance and conditioning of your body.
Unfortunately there is no simple solution because chronic pain is so complex and everyone’s experience is different. The important thing is that you are in the driver's seat. You can be the one setting and achieving the goals and your treatment might require a combination of approaches. While there is no ‘one-thing’ or ‘magic-pill’ (sorry, we really wish there was!), managing pain works best when tailored to you and your lifestyle in ways that support you to live well, despite the pain.
Living with chronic pain can be overwhelming. Surrounding yourself with a supportive and informed team can help. Here at MoreGoodDays® we want to help. We work with you to help unpack your condition, symptoms and provide science-backed solutions so you are supported to figure out what works best for you.
Finally, if you are more of a visual person, this is an excellent video that summarizes chronic pain in under 5 minutes.
