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Chronic pain management

What is chronic pain?

Chronic pain is long-term pain lasting for longer than six months. The pain can be mild or excruciating, be continuous or may come-and-go, it may cause discomfort or may be debilitating.

With chronic pain, signals of pain remain active in the nervous system for weeks, months, or even years. This can take both a physical and emotional toll on a person.

The most common sources of chronic pain are headaches, joint pain, pain from injury, and back aches. Other kinds of chronic pain include tendonitis, sinus pain, carpal tunnel syndrome, and pain affecting specific parts of the body, such as the shoulders, pelvis, and neck. Generalised muscle or nerve pain can also develop into a chronic condition.

Chronic pain may originate with an initial trauma/injury or infection, or there may be an ongoing cause of pain. However, some people suffer chronic pain in the absence of any past injury or evidence of body damage.

The emotional toll of chronic pain also can make pain worse. Anxiety, stress, depression, anger and fatigue interact in complex ways with chronic pain and may decrease the body's production of natural painkillers. Also, such negative feelings may increase the level of substances that amplify sensations of pain, causing a vicious cycle of pain for the person. Even the body's most basic defences may be compromised. There is considerable evidence that unrelenting pain can suppress the immune system.

Because of the mind-body links associated with chronic pain, effective treatment requires addressing psychological as well as physical aspects of the condition.

What are the symptoms of chronic pain?

The symptoms of chronic pain include:

  • Mild to severe pain that does not go away.
  • Pain that may be described as shooting, burning, aching, or electrical.
  • Feeling of discomfort, soreness, tightness, or stiffness.

Pain is not a symptom that exists alone. Other problems associated with pain include:

  • Fatigue.
  • Sleeplessness.
  • Withdrawal from activity and increased need to rest.
  • Weakened immune system.
  • Changes in mood including hopelessness, fear, depression, irritability, anxiety, and stress.
  • Disability.

What is chronic pain?

General somatic pain (pain from the outer body)

  • Pains from your skin and muscles are easily localised by the brain because these pains are common. You have experienced general somatic pain since childhood when you have fallen or been hit by a person or an object. Normally, somatic pain gets better in a few days.
  • Some people develop pain that never goes away. Fibromyalgia and chronic back pain are in this category.
  • General somatic pain is often treated with non-steroidal anti-inflammatory drugs ( NSAIDs) such as ibuprofen or naproxen and/or with paracetamol. Sometimes, opioids, such as codeine or morphine, may be needed.

Visceral pain (pain from the internal organs)

  • Pain in your internal organs is more difficult for you to pinpoint because your brain doesn't get much experience feeling pain from internal organs. The connections from pain sensors in your internal organs to your brain are less sophisticated than the nerve connections from your outer body.
  • You have experienced some visceral pains. Pain from acid indigestion or constipation is easy to recognise. These pains are easily treated and get better quickly either on their own or with treatment using non-prescription medicines.
  • The pain from chronic pancreatitis (an inflammation of the pancreas) or chronic active hepatitis (an inflammation of the liver) can last a long time and be difficult to treat.
  • Visceral pain from gallstones or appendicitis, for example, can be treated with surgery. Other visceral pains can be treated with various non-opioid pain medications. Sometimes opioids may be needed.
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