There are two basic types of pain, chronic and acute. Acute pain starts suddenly, in response to a physical cause, such as injury, inflammation, or some disease. It may be associated with anxiety or another type of emotional distress. The pain stops when the condition causing it is treated and resolved.
Chronic pain is defined as pain that lasts longer than 12 weeks. It may start with a particular cause, as acute pain, but doesn’t stop when the inciting cause is resolved. There may be no identifiable cause. Chronic pain is now believed to be a disease itself, causing changes in the nerves involved in pain sensation. It gets worse over time. It’s persistence can adversely affect every part of a person’s life – physical, mental, emotional, and spiritual. More than 76 million people in the United States live with chronic pain. It is estimated that about half are untreated. Sixty percent of people with chronic pain report pain present for more than one year. Five million people admit that they have taken pain medication (prescription and over-the-counter) inappropriately.
Chronic pain can limit mobility, robbing the body of stamina and strength. Daily living can become hard work; favorite activities may no longer be enjoyable. Despair may set in.
An individual may have more than one type of chronic pain. Some of the most common types of chronic pain are headaches, low back pain, arthritis, shingles, and many more. Other health problems are often present with chronic pain, such as sleep disorders, labile moods, depression, fatigue and changes in appetite. Chronic fatigue syndrome, endometriosis, and fibromyalgia are diagnoses frequently associated with chronic pain.
Chronic pain tends to be somewhat resistant to treatment. Early in treatment pain may improve, but it often returns to pre-treatment intensity, and may even be greater than baseline. Usually a combination of several treatment modalities are needed for relief.
The perception of pain is unique to everyone. There are no tests specific to perception of pain, or standardized scales to determine the intensity of pain. The patient’s description of the pain, called a “pain history,” may be all that is available to initiate evaluation of the pain. Some of the frequently used descriptors are: sharp or dull, burning, aching, stabbing, constant or intermittent,and many others. The type, location, and timing of the symptoms are critical to management.
The goal of treatment is to decrease pain and improve function, to enable an individual to participate in his/her own life.
Natural: Exercise should be a part of every treatment plan, and a regular habit. Light to moderate exercise enhances a sense of well-being. It can increase blood flow, and therefore oxygen flow, to muscles, which may relieve some chronic pain. Eating a balanced diet, and getting plenty of sleep are important to manage chronic pain.
Heat and cold therapy: Alternating hot and cold treatments, such as ice and heating pads, can relieve pain associated with superficial muscles and joints. The alternating temperatures affect circulation at the treatment site, creating a flush. Heat expands regional blood vessels, increasing blood flow and carrying the body’s healing substances to the affected site. Ice then constricts the blood vessels, decreasing blood flow out of the region, keeping the healing elements in the tissues being treated.
There are no specific protocols for the duration or frequency of the alternating therapy, but there are guidelines. One suggestion is 2 minutes of heat, 1 minute of ice, repeating the cycle 3 times per treatment session, with 6 treatment sessions per day. Another suggestion is 3 minutes of heat, 2 minutes of ice, with 3-4 cycles per session, 3-4 sessions per day. The best results are achieved by consistency in treatment. Neither a heating pad or ice should come in direct contact with the skin.
Some conditions become worse with alternating heat and cold therapy. It should not be used for rheumatoid arthritis, paralysis, or areas of impaired sensation. Diabetics and pregnant women should consult their doctors before starting therapy. Patients with heart disease or high blood pressure should consult their doctors before using heat.
Magnets: Magnets are increasingly popular with athletes for sports-related and other pain. They are worn like a collar or a wristwatch. Many people see it as quackery, but others believe that changes in cells and body chemistry take place, alleviating pain. Research has found that it is not an effective treatment method.
Electrical Stimulation: There are several treatment modalities that use electrical stimulation for relief of chronic pain.
TENS – Transcutaneous electrical nerve stimulation uses tiny electrical impulses which transmit through skin to muscles. It causes numbness and muscle contractions. It may also affect nerves by blocking pain transmission at the spinal cord. One such MMunit is the Wi Touch Wireless TENS. It’s the first TENS unit with wireless technology. It consists of a gel pad placed on the body site to be treated, usually the low back. A remote control allows the patient to decide when to deliver an impulse to the painful area. Unlike previous units with wires, it can be used anywhere at any time, conveniently and discretely. Patients have rated it at a 4.5 on a scale of 1 to 5, often remarking that it gave better pain relief than they had expected.
Peripheral nerve stimulation consists of electrodes placed surgically, under the skin at the site of concern. The patient can deliver an electric current as needed, via a transmitter.
Spinal cord stimulation consists of electrodes surgically placed near the spinal cord. The patient delivers an electric impulse as needed, via an antenna taped to the skin.
Hypnosis: Hypnosis was recognized as a therapeutic procedure by the American Medical Association in 1958. It’s becoming more common, especially when used with pain medication. How it works is unclear. There is speculation that relaxation in an hypnotized subject relieves the intensity of pain. Altering body chemistry, or a subject becoming more suggestable, have also been proposed as the effective action of hypnosis.
Aspirin is the medication used most often for treatment of chronic pain. It has anti-infLAcetominophen is second only to aspirin in frequency of use for chronic pain. It has no anti-inflamatory action.
Nonsteroidal antiinflammatory drugs (NSAIDs), such as ibuprophen, iNequently used for chronic pain.
Anticonvulsants, used to treat seizures, may have some beneficial ebut the mechanism of action is unknown.
Antidepressants can relieve pain in some subjects. It is unclear if pain relief is due to relief of depression, or if the antidepressant medication relieves pain directly, alleviating the depression.
COX-2 inhibitors: These interfere with production of hormoupuncture:
Nerve Blocks: These use drugs, chemical agents, and surgery to interrupt pain signals between the source and the nervous system’s perception of the pain. There are various names used for the procedures to perform nerve blocks. It may be called a neurectomy, rhizotomy, sympathectomy, and others.
Acupuncture: This tradtional Chinese treatment method uses fine needles inserted into the skin, at particular sites on the body, believed to relieve a remote pain.
Low Power Laser: Also called “cold laser,” uses red light to penetrate tissue to a depth of 1 centimeter, and infrared laser energy to penetrate tissue up to 5 centimeters in depth. The exact methods of action is unclear. Laser has an antiinflammatory effect, as well as reducing edema. It seems to stimulate cell metabolism, as well as vasodilation. One such device is “LaserPlusOne,” which uses a low power laser plus an electrical microcurrent, on many types of pain: back, neck, tendonitis, sprains and more. It’s used by elite athletes to warm up and loosen tight muscles and joints before an event. Studies vary, but the LaserTouchOne provided more relief than subjects anticipated, with lasting results.
Massage: Massage is used not just for patients, but is also used by athletes and other personal use. The Jeanie Rub Massager is a device which can be controled. At slow speeds the massage is relaxing; at higher speeds it can be invigorating.
American Chronic Pain Association, PO Box 850, Rocklin, CA 95677-0850, [email protected], www.theacpa.org, 800-533-3231
National Institute of Neurological Disorders and Stroke (NIH): http://www.ninds.nih.gov/disorders/chronic_pain/detail_chronic_pain.htm
American Academy of Family Physicians: http://www.aafp.orf/afp/2009/0615/p1067.html