Chronic pain
Chronic Pain | |
---|---|
Other names | Burning pain, dull pain, throbbing pain |
Frequency | 8% to 55.2% in different countries[citation needed] |
Chronic pain or chronic pain syndrome is a type of pain that is also known by other titles such as gradual burning pain, electrical pain, throbbing pain, and nauseating pain. This type of pain is sometimes confused with acute pain[a] and can last from three months to several years; Various diagnostic manuals such as DSM-5 and ICD-11 have proposed several definitions of chronic pain, but the accepted definition is that it is "pain that lasts longer than the expected period of recovery
Creating a pain mechanism prevents possible damage to the body, but chronic pain is a pain without biological value (doesn't have a positive effect). This pain has different divisions;
Chronic pain can cause very severe psychological and physical effects that sometimes continue until the end of life. Analysis of the
.A wide range of treatments are performed for this disease;
Chronic pain is considered a kind of
Classification
The
The
- Primary chronic pain: Defined by 3 months of continuous pain in one or more areas of the body, the origin of which is not understood.
- Chronic cancer pain: pain in one of the body's organs caused by skeletal muscular) is formed.
- Chronic pain post-traumatic or surgery: Pain that occurs 3 months after an injury or surgery, without taking into account infectious conditions and the severity of tissue damage; Also, the person's past pain is not important in this classification.
- Chronic neuropathic pain: pain caused by damage to the somatosensory nervous system.
- Chronic headache and orofacial pain: pain that originates in the head or face, and occurs for 50% or more days over a 3 months period.
- Chronic visceral pain: pain originating in an internal organ.
- Chronic musculoskeletal pain: pain originating in the bones, muscles, joints or connective tissue.
Also, the World Health Organization (WHO) states that optional criteria or codes can be used in the classification of chronic pain for each of the seven categories of chronic pain (for example, "diabetic neuropathic" pain).[14]
Another classification for chronic pain is "nociceptive" (caused by
"Superficial pain" is the result of the activation of pain receptors in the skin or superficial tissues; "Deep somatic pain" is caused by stimulation of pain receptors in ligaments, tendons, bones, blood vessels, fascia, and muscles. (this type of pain is constant but weak)[20] and "deep visceral pain" is pain that originates from one of the body's organs. Deep pain is often very difficult to localize and occurs in multiple areas of the body when injured or inflamed. In the "deep visceral" type, the feeling of pain exists in a place far from the injury, for this reason it is also called vague pain.[20]
Etiology
Chronic pain has many pathophysiological and environmental causes and can occur in cases such as neuropathy of the central nervous system, after cerebral hemorrhage, tissue damage such as extensive burns, inflammation, autoimmune disorders such as rheumatoid arthritis, psychological stress such as headache, migraine or abdominal pain (caused by emotional, psychological or behavioral) and mechanical pain caused by tissue wear and tear such as arthritis.[4] In some cases, chronic pain can be caused by genetic factors which interfere with neuronal differentiation, leading to a permanently lowered threshold for pain.[21]
The pathophysiological etiology of chronic pain remains unclear. Many theories of chronic pain[22][23] fail to clearly explain why the same pathological conditions do not invariably result in chronic pain. Patients' anatomical predisposition to proximal neural compression (in particular of peripheral nerves) may be the answer to this conundrum. Proximal neural lesion at the level of the dorsal root ganglion (DRG) may drive a vicious cycle of chronic pain by causing postural protection of the painful site and consequent neural compression in the same spinal region. Difficulties in diagnosing proximal neural lesion[24] may account for the theoretical perplexity of chronic pain.
Pathophysiology
The mechanism of continuous activation and transmission of pain messages, leads the body to an activity to relieve pain (a
These changes in neural structure can be explained by
Inefficient management of
Management
Chronic pain may originate in the body, or in the brain or spinal cord. It is often difficult to treat. Epidemiological studies have found that 8–11.2% of people in various countries have chronic widespread pain.
Nonopioids
Initially recommended efforts are
Various other nonopioid medicines can be used, depending on whether the pain is a result of tissue damage or is
Psychological treatments, including cognitive behavioral therapy[54][55] and acceptance and commitment therapy[56][57] can be helpful for improving quality of life and reducing pain interference. Brief mindfulness-based treatment approaches have been used, but they are not yet recommended as a first-line treatment.[58] The effectiveness of mindfulness-based pain management (MBPM) has been supported by a range of studies.[6][59][60]
Among older adults psychological interventions can help reduce pain and improve self-efficacy for pain management.[61] Psychological treatments have also been shown to be effective in children and teens with chronic headache or mixed chronic pain conditions.[62]
While exercise has been offered as a method to lessen chronic pain and there is some evidence of benefit, this evidence is tentative.[63] For people living with chronic pain, exercise results in few side effects.[63]
Opioids
In those who have not benefited from other measures and have no history of either
Some people with chronic pain benefit from
Alternative medicine
Alternative medicine refers to health practices or products that are used to treat pain or illness that are not necessarily considered a part of conventional medicine.[67] When dealing with chronic pain, these practices generally fall into the following four categories: biological, mind-body, manipulative body, and energy medicine.[67]
Implementing dietary changes, which is considered a biological-based alternative medicine practice, has been shown to help improve symptoms of chronic pain over time.
Hypnosis, including self-hypnosis, has tentative evidence.[71] Hypnosis, specifically, can offer pain relief for most people and may be a safe alternative to pharmaceutical medication.[72] Evidence does not support hypnosis for chronic pain due to a spinal cord injury.[73]
Preliminary studies have found
Tai chi has been shown to improve pain, stiffness, and quality of life in chronic conditions such as osteoarthritis, low back pain, and osteoporosis.[79][80] Acupuncture has also been found to be an effective and safe treatment in reducing pain and improving quality of life in chronic pain including chronic pelvic pain syndrome.[81][82]
Transcranial magnetic stimulation for reduction of chronic pain is not supported by high quality evidence, and the demonstrated effects are small and short-term.[83]
Spa therapy could potentially improve pain in patients with chronic lower back pain, but more studies are needed to provide stronger evidence of this.[84]
While some studies have investigated the efficacy of St John's Wort or nutmeg for treating neuropathic (nerve) pain, their findings have raised serious concerns about the accuracy of their results.[85]
Myofascial release has been used in some cases of fibromyalgia, chronic low back pain, and tennis elbow but there is not enough evidence to support this as method of treatment.[87]
Epidemiology
Chronic pain varies in different countries affecting anywhere from 8% to 55% of the population. It affects women at a higher rate than men, and chronic pain uses a large amount of healthcare resources around the globe.[88][39]
A large-scale telephone survey of 15 European countries and Israel found that 19% of respondents over 18 years of age had suffered pain for more than 6 months, including the last month, and more than twice in the last week, with pain intensity of 5 or more for the last episode, on a scale of 1 (no pain) to 10 (worst imaginable). 4839 of these respondents with chronic pain were interviewed in-depth. Sixty-six percent scored their pain intensity at moderate (5–7), and 34% at severe (8–10); 46% had constant pain, 56% intermittent; 49% had suffered pain for 2–15 years; and 21% had been diagnosed with depression due to the pain. Sixty-one percent were unable or less able to work outside the home, 19% had lost a job, and 13% had changed jobs due to their pain. Forty percent had inadequate pain management and less than 2% were seeing a pain management specialist.[89]
In the United States, chronic pain has been estimated to occur in approximately 35% of the population, with approximately 50 million Americans experiencing partial or total disability as a consequence.
In Canada it is estimated that approximately 1 in 5 Canadians live with chronic pain and half of those people have lived with chronic pain for 10 years or longer.[95] Chronic pain in Canada also occurs more and is more severe in women and Canada's Indigenous communities.[95]
Outcomes
Sleep disturbance, and insomnia due to medication and illness symptoms are often experienced by those with chronic pain.[96] These conditions can be difficult to treat due to the high potential of medication interactions, especially when the conditions are treated by different doctors.[97]
Severe chronic pain is associated with increased risk of death over a ten-year period, particularly from heart disease and respiratory disease.
People with chronic pain tend to have higher rates of depression[100] and although the exact connection between the comorbidities is unclear, a 2017 study on neuroplasticity found that "injury sensory pathways of body pains have been shown to share the same brain regions involved in mood management."[101] Chronic pain can contribute to decreased physical activity due to fear of making the pain worse. Pain intensity, pain control, and resilience to pain can be influenced by different levels and types of social support that a person with chronic pain receives, and are also influenced by the person's socioeconomic status.[102]
Chronic pain of different causes has been characterized as a disease that affects brain structure and function. MRI studies have shown abnormal anatomical[103] and functional connectivity, even during rest[104][105] involving areas related to the processing of pain. Also, persistent pain has been shown to cause grey matter loss, which is reversible once the pain has resolved.[106][107]
One approach to predicting a person's experience of chronic pain is the biopsychosocial model, according to which an individual's experience of chronic pain may be affected by a complex mixture of their biology, psychology, and their social environment.[108]
Psychology
Personality
Two of the most frequent personality profiles found in people with chronic pain by the Minnesota Multiphasic Personality Inventory (MMPI) are the conversion V and the neurotic triad. The conversion V personality expresses exaggerated concern over body feelings, develops bodily symptoms in response to stress, and often fails to recognize their own emotional state, including depression. The neurotic triad personality also expresses exaggerated concern over body feelings and develops bodily symptoms in response to stress, but is demanding and complaining.[109]
Some investigators have argued that it is this neuroticism that causes acute pain to turn chronic, but clinical evidence points the other way, to chronic pain causing neuroticism. When long term pain is relieved by therapeutic intervention, scores on the neurotic triad and anxiety fall, often to normal levels.[110][111][112][113] Self-esteem, often low in people with chronic pain, also shows improvement once pain has resolved.[113]
It has been suggested that catastrophizing might play a role in the experience of pain. Pain catastrophizing is the tendency to describe a pain experience in more exaggerated terms than the average person, to think a great deal more about the pain when it occurs, or to feel more helpless about the experience.[114] People who score highly on measures of catastrophization are likely to rate a pain experience as more intense than those who score low on such measures. It is often reasoned that the tendency to catastrophize causes the person to experience the pain as more intense. One suggestion is that catastrophizing influences pain perception through altering attention and anticipation, and heightening emotional responses to pain.[115] However, at least some aspects of catastrophization may be the product of an intense pain experience, rather than its cause. That is, the more intense the pain feels to the person, the more likely they are to have thoughts about it that fit the definition of catastrophization.[116]
Comorbidity with trauma
Individuals with post-traumatic stress disorder (PTSD) have a high comorbidity with chronic pain.[117] Patients with both PTSD and chronic pain report higher severity of pain than those who do not have a PTSD comorbidity.[118][119]
Comorbidity with depression
People with chronic pain may also have symptoms of depression.[120][121] In 2017, the British Medical Association found that 49% of people with chronic pain had depression.[122]
Effect on cognition
Chronic pain's impact on cognition is an under-researched area, but several tentative conclusions have been published. Most people with chronic pain complain of cognitive impairment, such as forgetfulness, difficulty with attention, and difficulty completing tasks. Objective testing has found that people in chronic pain tend to experience impairment in attention, memory, mental flexibility, verbal ability, speed of response in a cognitive task, and speed in executing structured tasks.[123] A review of studies in 2018 reports a relationship between people in chronic pain and abnormal results in test of memory, attention, and processing speed.[124]
Prognosis
Chronic pain leads to a significant decrease in quality of life, decreased productivity, decreased wages, worsening of other chronic diseases, and mental disorders such as depression, anxiety, and
Current treatments for chronic pain can reduce pain by 30%.[131] This reduction in pain can significantly improve patients' performance and quality of life. However, the general and long-term prognosis of chronic pain shows decreased function and quality of life.[132] Also, this disease causes many complications and increases the possibility of death of patients and suffering from other chronic diseases and obesity.[4] Similarly, patients with chronic pain who require opioids often develop drug tolerance over time, and this increase in the amount of the dose taken to be effective increases the risk of side effects and death.[4]
Mental disorders can amplify pain signals and make symptoms more severe.
A multimodal treatment approach is important for better pain control and outcomes, as well as minimizing the need for high-risk treatments such as opioid medications. Managing comorbid depression and anxiety is critical in reducing chronic pain.[4][136] Also, patients with chronic pain should be carefully monitored for severe depression and any suicidal thoughts and plans.[4][137] Periodic referral of the patient to the doctor for physical examination and to check the effectiveness of treatment 2 is necessary, and the rapid and correct treatment and management of chronic pain can prevent the occurrence of potential negative consequences on the patient's life and increase in healthcare costs.[4]
Social and personal impacts
Social support
Social support has important consequences for individuals with chronic pain. In particular, pain intensity, pain control, and resiliency to pain have been implicated as outcomes influenced by different levels and types of social support. Much of this research has focused on emotional, instrumental, tangible and informational social support. People with persistent pain conditions tend to rely on their social support as a coping mechanism and therefore have better outcomes when they are a part of larger more supportive social networks. Across a majority of studies investigated, there was a direct significant association between social activities or social support and pain. Higher levels of pain were associated with a decrease in social activities, lower levels of social support, and reduced social functioning.[138][139]
Racial disparities
Evidence exists for unconscious biases and negative stereotyping against
Perceptions of injustice
Similar to the damaging effects seen with catastrophizing, perceived injustice is thought to contribute to the severity and duration of chronic pain.[143] Pain-related injustice perception has been conceptualized as a cognitive appraisal reflecting the severity and irreparability of pain- or injury-related loss (e.g., "I just want my life back"), and externalizing blame and unfairness ("I am suffering because of someone else's negligence.").[144] It has been suggested that understanding problems with top down processing/cognitive appraisals can be used to better understand and treat this problem.[145]
Chronic pain and COVID-19
COVID-19 has disrupted the lives of many, leading to major physical, psychological and socioeconomic impacts in the general population.[146] Social distancing practices defining the response to the pandemic alter familiar patterns of social interaction, creating the conditions for what some psychologists are describing as a period of collective grief.[147] Individuals with chronic pain tend to embody an ambiguous status, at times expressing that their type of suffering places them between and outside of conventional medicine.[148] With a large proportion of the global population enduring prolonged periods of social isolation and distress, one study found that people with chronic pain from COVID-19 experienced more empathy towards their suffering during the pandemic.[146]
Effect of chronic pain in the workplace
In the workplace, chronic pain conditions are a significant problem for both the person with the condition and the organization; a problem only expected to increase in many countries due to an aging workforce.[108] In light of this, it may be helpful for organizations to consider the social environment of their workplace, and how it may be working to ease or worsen chronic pain issues for employees.[108] As an example of how the social environment can affect chronic pain, some research has found that high levels of socially prescribed perfectionism (perfectionism induced by external pressure from others, such as a supervisor) can interact with the guilt felt by a person with chronic pain, thereby increasing job tension, and decreasing job satisfaction.[108]
See also
- Childhood chronic pain
- Dopaminergic pathways
- List of investigational analgesics
- Neurodegeneration
- Neuroinflammation
Notes
- ^ Doctors define acute pain as pain associated with a cause that can be relieved by treating the cause. In the general sense, acute pain means pain that decreases or stops when the disease improves.[7]
- ^ Doctors define acute pain as pain associated with a cause that can be relieved by treating the cause. In the general sense, acute pain means pain that decreases or stops when the disease improves.[7]
- ^ The continuous sending of messages from one body part causes its somatotopic area to become larger than the normal state, and the brain of the area attaches more and abnormal energy and importance to the tissue stimuli of that part of the body.[29]
References
- PMID 14620787.
- S2CID 3087450.
- ISBN 978-0683304626.
- ^ PMID 31971706.
- ^ "Chronic Pain Syndrome Differential Diagnoses". emedicine.medscape.com. 2020-01-14. Retrieved 2024-01-24.
- ^ ISSN 1358-0574.
- ^ a b "Acute Pain Causes, Symptoms, and Treatments | UPMC". UPMC | Life Changing Medicine. Retrieved 2024-01-24.
- ISBN 978-0-683-30462-6.
- ISBN 978-0-8493-0926-7.
- ISSN 2662-7531.
- ISBN 978-0-443-05683-3.
- PMID 26174215.
- ^ "Terminology | International Association for the Study of Pain". International Association for the Study of Pain (IASP). Retrieved 2024-01-14.
- ^ S2CID 58462501.
- ^ PMID 25844555.
- ISBN 978-0-443-05683-3.
- ISBN 978-0931092053.
- PMID 26180859.
- PMID 15352654. Archived from the original(PDF) on 2010-01-07. Retrieved 2010-05-03.
- ^ ISBN 978-0443056833.
- PMID 25164209.
- PMID 18952143.
- S2CID 56824408.
- PMID 8284339.
- ^ ISBN 978-622-6445-63-4.
- ^ Hansson P (1998). Nociceptive and neurogenic pain. Pharmacia & Upjon AB. pp. 52–63.
- ^ ISSN 2455-3891.
- ^ S2CID 31591435.
- ^ .
- S2CID 22012269.
- PMID 22748562.
- ^ PMID 23792284.
- ISBN 978-1900151856.
the reduction of suffering and enhanced quality of life .
- ISBN 978-0443056833.
- ISBN 978-0849309267.
- S2CID 24730085.
- PMID 16616276.
- S2CID 32719708.
- ^ PMID 28815801.
- ^ PMID 25952062.
- ^ PMID 25376546.
- ^ PMID 25581341.
- S2CID 207538295.
- ^ PMID 28483845.
- ^ "Acetaminophen Monograph for Professionals". Drugs.com. Retrieved 2020-06-30.
- PMID 22193214.
- PMID 24799483.
- PMID 26003103.
- ^ PMID 26146793.
- ^ PMID 25841257.
- S2CID 699847.
- S2CID 35809874.
- PMID 32623724.
- PMID 23091394.
- PMID 23175199.
- S2CID 32151525.
- PMID 26818413.
- PMID 30523705.
- S2CID 4917280.
- S2CID 33688569.
- PMID 29801109.
- PMID 30270423.
- ^ PMID 28436583.
- PMID 28715848.
- PMID 25267983.
- PMID 29793599.
- ^ S2CID 6632695.
- S2CID 208452418.
- PMID 19875591.
- ^ PMID 16939848.
- S2CID 40604946.
- S2CID 72334198.
- PMID 25432061.
- PMID 28806817.
- PMID 27660328.
- ^ "[115] Cannabinoids for Chronic Pain | Therapeutics Initiative". Therapeutics Initiative. 23 November 2018.
- ^ S2CID 3443248.
- S2CID 44165877.
- PMID 26383108.
- PMID 27125299.
- PMID 29198932.
- S2CID 12344832.
- PMID 29652088.
- PMID 31517832.
- PMID 30938843.
- S2CID 49486200.
- S2CID 206486404.
- ^ Harstall C, Ospina M (June 2003). "How Prevalent Is Chronic Pain?" (PDF). Pain Clinical Updates. XI (2). International Association for the Study of Pain: 1–4. Archived from the original (PDF) on 2017-06-23.
- S2CID 22834242.
- ^ "Chronic Pain Syndrome: Practice Essentials, Etiology, Patient Education". eMedicine. February 18, 2022.
- PMID 23918913.
- ^ Institute of Medicine of the National Academies Report (2011). Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington DC: The National Academies Press.
- ^ A Call to Revolutionize Chronic Pain Care in America: An Opportunity in Health Care Reform. The Mayday Fund. 2009.
- S2CID 27177431.
- ^ a b Health Canada (2019-08-08). "Canadian Pain Task Force Report: June 2019". aem. Retrieved 2020-06-30.
- PMID 21056246.
- ^ Research, Center for Drug Evaluation and (2020-03-17). "Drug Interactions: What You Should Know". FDA.
- ^ S2CID 22222751.
- PMID 16207340.
- S2CID 53212649.
- PMID 28706741.
- ^ "Effective Coping of Chronic Pain Varies With Psychosocial Resource Profiles". APA Journals Article Spotlight. American Psychological Association. 2019-09-20. Archived from the original on 2020-06-09. Retrieved 2021-02-15.
- PMID 19038215.
- PMID 18256259.
- PMID 20800649.
- S2CID 45515001.
- PMID 21593339.
- ^ .
- ISBN 978-1585622757.
- PMID 17112364.
- PMID 9648998.
- PMID 7846260.
- ^ ISBN 0140256709.
- S2CID 19059827.
- PMID 14960499.
- S2CID 43047540.
- S2CID 205291405.
- PMID 23398939.
- PMID 29038680.
- PMID 28706741.
- .
- ^ "Chronic pain: supporting safer prescribing of analgesics" (PDF). British Medical Association. 2017.
- ^ Kreitler S, Niv D (2007). "Cognitive impairment in chronic pain". Pain: Clinical Updates. XV (4): 1–4. Archived from the original (pdf) on 2018-10-30. Retrieved 2019-01-06.
- PMID 28719507.
- S2CID 11637917.
- PMID 30140853.
- PMID 16820551.
- PMID 16557558.
- S2CID 40299987.
- PMID 21412369.
- S2CID 24727112.
- S2CID 11875257.
- PMID 10846154.
- S2CID 42887748.
- PMID 11996877.
- ^ S2CID 30586505.
- ^ PMID 30208405.
- PMID 24547805.
- PMID 12547052.
- ^ S2CID 32634889.
- ^ PMID 24547799.
- ^ "4 Ways Racism in Health Care Is Still a Problem Today". ThoughtCo. Retrieved May 12, 2018.
- S2CID 143450160.
- S2CID 23897737.
- PMID 29451429.
- ^ PMID 34162393.
- ^ Weir K (June 2020). "Grieving Life and Loss". Monitor on Psychology. 51 (4).
- JSTOR 3805289.
Further reading
- Dowell D, Haegerich TM, Chou R (April 2016). "CDC Guideline for Prescribing Opioids for Chronic Pain – United States, 2016". JAMA. 315 (15): 1624–1645. PMID 26977696.
External links
- Chronic Pain Syndromes at Curlie
- International Association for the Study of Pain Archived 2021-05-01 at the Wayback Machine
- Media related to pain at Wikimedia Commons