A patient with chronic pain in the lower back

Understanding Chronic Pain

Many of the patients we care for experience some type of pain. Sometimes the source and intensity of the pain are immediately obvious, like in the case of large physical wounds. Other times, we need to rely on what the patient tells us to know the best course of treatment.

Pain is subjective, and each person handles and experiences it differently. As health care professionals, it’s not our job to judge whether or not someone is handling their pain in a way that we feel is normal. Our duty is to try to minimize and treat the pain that they are experiencing appropriately.

That responsibility can become much more difficult when it comes to the treatment and management of chronic pain. Here’s what you as a health care professional should understand about chronic pain, so we can provide the best care to our patients who suffer from it. 

What is Chronic Pain?

Acute pain becomes chronic pain when it lasts for three to six months or longer, or if it lasts longer than what would be normal or expected for healing. Chronic pain can last for months or years.

There are many causes of chronic pain, and you’ll encounter patients with this type of pain in every specialty. Some causes of chronic pain include the following conditions:

  • Low-back pain
  • Headaches or migraines
  • Fibromyalgia
  • Nerve damage
  • Cancer
  • Endometriosis
  • Side effects from surgery
  • Carpal tunnel syndrome
  • Arthritis 

A patient can have more than one cause behind their chronic pain. Sometimes, the cause of chronic pain might not even be known or the patient is unable to get a diagnosis. Understand that just because a patient doesn’t have a diagnosis, it doesn’t mean they’re pain-free. 

Often the pain is a constant feeling that patients learn to live with. It can flare up at any time, with or without triggers like stress or physical activity. Sometimes it starts off infrequent and builds up over time. 

Every patient’s experience will be difficult. It’s important to get as comprehensive a medical history as possible about when the pain started, how it’s evolved, what triggers it or makes it better, and any other details that can help with treatment. 

What’s Chronic Pain Syndrome?

For about 25% of patients, the chronic pain turns into chronic pain syndrome (CPS). With CPS, chronic pain isn’t the only symptom patients will have. They also have symptoms of issues like depression and anxiety that add additional interference with everyday activities. 

Because chronic pain can come from so many sources, there’s still a lot we don’t know about the condition. This holds true with chronic pain syndrome. It usually comes from an identifiable source, but because of how subjective pain is and how much it relies on what patients tell us, researchers are still attempting to understand chronic pain and CPS. 

People who are at the highest risk for chronic pain developing into CPS are those with a history of mental health issues. But CPS can affect anyone with chronic pain, especially if it lasts for a long time and the negative impact begins taking a toll on their mental wellbeing. 

Why Is Understanding Chronic Pain Important?

The impact of chronic pain is far-reaching. A 2012 survey found that approximately 25 million adults in the United States lived with pain every day for at least three months. Other studies estimate that about 90% of adults who report chronic pain have had it for two years or longer.

It’s estimated to have cost the United States economy around $635 billion, not only in health care treatments but in the time lost by people with chronic pain as it affects their ability to work and function normally.

This condition is a costly issue, especially for the patients who are affected by it. It affects their sleep, their ability to work or participate in activities, and can affect their mental and emotional health. 

How Do We Treat Chronic Pain?

Treatment for chronic pain is not always focused on completely stopping the pain with the understanding that that’s sometimes not possible. Instead, effective treatment usually focuses on helping to manage the pain and improve the patient’s quality of life

No one treatment or type of treatment normally works. It often takes a variety of interventions, ranging from opioid and non-opioid medications to holistic or complementary therapies, like acupuncture or yoga. Using different types of treatments and management techniques is especially important to prevent overuse of medications, particularly opioids. 

A basic guideline from the American College of Physicians encourages treatment for certain conditions, like low-back pain or osteoarthritis, to focus on methods that don’t involve medications. Some of these methods include:

  • Acupuncture
  • Yoga
  • Mindfulness training
  • Tai chi
  • Biofeedback
  • Spinal or joint manipulation
  • Meditation
  • Massage therapy

For medication-based treatment, there are other options besides opioids. Depending on symptoms and the patient’s primary concerns with their condition, they could try taking antidepressants or antianxiety medications. 

As with any illness or patient, an important part of treatment is the respect we give our patients and the dignity we help preserve. Chronic pain can be mentally and emotionally weighing as well as physically so for the patients who experience it. Take time to listen to patients as they share their experiences with their pain, and advocate for them to get the treatment they need.