Chronic pain is a blanket term for several conditions caused by injury or illness, which lead to consistent pain, numbness, fatigue, and psychological distress for at least 12 weeks. The sensation of acute pain typically alerts the person to a problem; chronic pain, which lasts for longer, suggests an underlying cause, but the cause may not have a treatment to fully alleviate, or get rid of, the pain. An estimated 100 million Americans experience chronic pain, lasting six months or more.
What Is Chronic Pain?
Pain is a personal, subjective experience. In order to understand each individual’s experience of pain, doctors must ask its location, type of sensation, and frequency.
Descriptions of pain often include:
- Dull aches
- Numbness, leading to aches
- General soreness
Other conditions, like depression, anxiety, insomnia, appetite changes, environmental stress, exposure to chemicals, and general physical health, can affect how a person experiences pain.
Illnesses in which the main symptom is chronic pain include:
- Chronic fatigue syndrome
- Inflammatory bowel disease
- Interstitial cystitis
- Temporomandibular joint dysfunction (TMJ)
- Back pain: 27 percent
- Migraine or severe headache: 15 percent
- Neck pain: 15 percent
- Facial aches or pain: 4 percent
Other kinds of pain include nerve damage from injury or illness, body pain caused by cancer, pain from arthritis, and post-surgical pain, including dental surgery. Psychogenic pain is a condition in which the individual experiences pain, but it does not have a specific underlying cause that can be diagnosed.
The Voices of Chronic Pain Survey from 2006 found that:
- 51 percent of respondents felt they had little to no control over their pain
- 60 percent of respondents stated that, even with treatment, they experienced breakthrough pain one or more times per day
- 59 percent reported that their struggle to control their pain seriously impacted their quality of life
- 77 percent reported feeling depressed
- 70 percent reported trouble concentrating
- 74 percent stated their physical energy was impacted by their experience of pain
- 86 percent reported an inability to sleep well
Women are more likely to experience and report pain, especially headaches, jaw pain, neck, and lower back pain. Compared to men, women are twice as likely to experience migraines or severe headaches as well as face or jaw pain. People who are overweight or in poor physical health are more likely to experience chronic pain.
Back pain is the leading cause of disability among American adults, 45 and older; 26 million Americans between the ages of 20 and 64 experience frequent back pain requiring rest or treatment. About 28 percent of adults with low back pain report limited activity because of this chronic condition, which contributes to reduced happiness. Adults reporting low back pain were three times as likely to also report fair or poor health and four times as likely to report psychological distress. The worsened mental and emotional condition can make the experience of chronic pain worse.
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Conventional Approaches to Treating Chronic Pain
When a person experiences acute pain, nerve endings in the affected area send signals to the brain that there is a problem. By treating the wound or illness, the pain goes away. For serious acute pain, such as from broken bones, medication to treat the pain may be prescribed. This medication may include opioid drugs, depending on the severity of the pain and how long the pain is expected to last.
With chronic pain, nerves do not stop sending pain signals, and the brain does not stop processing an experience of pain in the body. Since there is no obvious cause that can be treated, medical professionals focus on treating the experience of pain; this means prescription drugs, physical therapy, and, increasingly, complementary treatments like herbs, massage, meditation, acupuncture, and more.
Medications typically prescribed to treat chronic pain include:
- Over-the-counter painkillers, such as acetaminophen, aspirin, and ibuprofen, which may be prescribed at larger-than-OTC doses by a doctor
- Opioid painkillers, including hydrocodone, oxycodone, morphine, or codeine
- Adjuvant analgesics, like antidepressants or anticonvulsants
A physician will assess their patient’s level of pain and then determine an appropriate course of treatment. Chronic pain that does not respond to OTC medicines may lead to an opioid prescription. While physicians are increasingly working with individual patients to find other ways to manage pain without large doses of addictive narcotic painkillers, this is still one of the primary ways people get access to these intoxicating drugs. People who have chronic pain conditions may have their drugs stolen by friends or family members who struggle with opioid addiction.
Easier Access to Opioids Caused the Opioid Epidemic
In the 1990s, physicians were criticized for their fear of prescribing opioid drugs outside of cancer treatment. The complaints and lobbying led many doctors to relax their prescribing practices, and pharmaceutical companies began advertising medications like hydrocodone and oxycodone to treat pain. Even forms of pain that would eventually heal – like postsurgical pain – were treated with prescription narcotics. This led to a flood of opioid prescriptions.
From 1999 to 2010, the number of opioid painkiller prescriptions quadrupled. By 2012, there were 259 million prescriptions for opioids written, which is enough for every adult in the country to have their own bottle of opioids. In 2015, of the reported 20.5 million Americans ages 12 and older struggling with a substance use disorder, 2 million struggled specifically with prescription narcotics, and 591,000 struggled with heroin addiction. About 25 percent of those who develop a substance use disorder due to prescription painkillers will eventually turn to heroin; it is cheaper and easier to acquire than prescription narcotics. The Centers for Disease Control and Prevention (CDC) reported that 91 Americans die every day because of opioid overdoses.
Treating chronic pain is extremely important, but increasing the number of opioid prescriptions may not be the best approach to these conditions. Among those who take narcotic prescriptions for at least three months to manage long-term pain, half will still be taking these drugs five years later even if the chronic pain has gone away.
There is little data on the long-term effectiveness of opioid treatment to manage chronic pain conditions. Taking these drugs with appropriate supervision from a physician appears to work very well for some, but for thousands of others struggling with chronic pain, taking these drugs does more harm than good. In fact, for some people, taking opioids can lead to hyperalgesia, or the experience of more intense pain, especially when not taking medication.
Other Approaches to Managing Chronic Pain
Prescription opioids are an important part of treating serious health issues, but they are not the only approach to managing chronic pain. For many, they are not the best approach.
Those who struggle with chronic pain should speak with their doctors about other treatments, including:
- Deep breathing or meditation practices to calm the mind
- Stress reduction for daily life
- Simple exercise like yoga to reduce stress and improve physical health
- Physical therapy
- Treatment for insomnia, anxiety, or depression
- Cutting back on intoxicating substances, including alcohol and caffeine
- Other dietary changes
- Support groups for those with chronic pain
- Biofeedback techniques
- Massage, acupuncture, herbal compresses, or other localized treatments
Combining approaches to chronic pain management can improve one’s life overall. Improving mood and satisfaction can ease the overall experience of pain, and cultivating health through physical therapy or increased exercise releases endorphins and helps to heal internal injuries like muscle strains, which in turn reduces pain. Managing mental health and changing one’s diet, especially when chronic pain is related to gastrointestinal disorders, will also reduce pain sensations.
A diagnosis from a medical professional to identify the type of chronic pain is important. Including therapies alongside prescription medicines can help the person change their lifestyle to manage pain rather than just focusing on short-term solutions.
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