Chronic pain is any pain that lasts more than 12 weeks, ranging from a dull continuous pain to more severe pain caused by significant illnesses or injuries.
The pain itself can be debilitating and impact a person’s ability to live a normal life. People who suffer from chronic pain may face difficulty sleeping or focusing at work.
The problem of chronic pain is widespread and affects a large number of people. According to the Journal of Neuroscience, chronic pain is a major problem in the United States, afflicting more than 100 million Americans. Because pain itself can be difficult to diagnose, as it does not necessarily have any outward symptoms, doctors face challenges in providing long-term relief for their patients. They must begin to look for clues as to what is causing the pain, and begin treatments to mitigate the chronic pain symptoms.
Chronic Pain CausesChronic pain can be difficult to diagnose. According to Medline Plus, there are a variety of reasons that someone may suffer from chronic pain. These include:
- Acute injuries, such as a sprained ankle that causes pain and takes a longer period of time to recover
- Acute illness, such as a complicated case of the MRSA infection that may require multiple treatments
- Chronic illnesses, such as rheumatoid arthritis, that cause chronic pain as a symptom of their diagnosis
- Congenital deformities that cannot be surgically corrected, including back and spine deformities
- Altered nervous systems that incorrectly receive pain signals even when no injury or source of pain is present
Sometimes, chronic pain cannot be diagnosed, leaving doctors with no way of knowing what exactly causes the pain. In these cases, doctors are left finding ways to treat pain as a symptom instead of identifying its root cause. For some individuals, this may mean implementing pain management strategies on a long-term basis.
Signs and SymptomsA person suffering from chronic pain can become exhausted by the experience, and experience emotional and mental changes as a result. Lasting pain can range anywhere from mild to excruciating, come intermittently or constantly, and be anywhere from slightly inconvenient to debilitating. Chronic pain can feel like a burning sensation, electrical surges, shooting pains, or aches. Soreness, tightness, and stiffness can be underlying pain when an individual suffers this condition consistently.
The most common ways individuals experience chronic pain include:
- Joint pain
- Backaches or neck pain
- Shoulder problems
- Sinus pain
- Pelvic pain
- Nerve or muscle pain
- Pain after injury
Current estimates suggest that around 20 percent of the population suffer from chronic pain for some period of their lives. If the condition continues or worsens over a very long period of time, the individual may fall into depression or begin to suffer anxiety regarding when the next bout with pain will come. These emotions can reduce the amount of natural painkillers in the brain, like oxytocin, serotonin, and dopamine, which can increase the number or severity of pain “flare-ups.” Some researchers have found that chronic pain can weaken the immune system, making pain worse and exposing the individual to an increased risk of suffering from other illnesses.
The symptoms of chronic pain often extend beyond just the pain itself. When a person experiences this consistent level of pain, other aspects of life are affected. Common symptoms related to chronic pain include:
- Sleeplessness and fatigue
- Greater need to rest after regular activities or an inability to partake in many activities
- Weakened immune system, resulting in more frequent illnesses and infections
- Depression, anxiety, and mood swings
- Decreased appetite or nausea
Each person experiences pain differently and at different intensities. The most important thing for people who suffer from chronic pain conditions is to get the pain under control. In addition to alternative methods of controlling pain, physicians often use a variety of prescription medications to help patients reduce and manage pain.
Common Prescription Medications to Treat Chronic Pain
Prescription medication alone helps about 58 percent of people suffering from chronic pain. These medications typically include:
- Over-the-counter pain relievers: Doctors sometimes advise patients to take specific doses of over-the-counter pain medications, like acetaminophen, ibuprofen, naproxen, or NSAIDs. Though they are available over the counter, these medications often lead to side effects with long-term use, such as liver damage with chronic use of acetaminophen.
- Prescription pain medication: These medications include oxycodone and hydrocodone-based drugs. Vicodin, OxyContin, codeine, morphine, and Percocet are commonly prescribed opioid medications, and these drugs can be highly addictive.
- Antidepressants: Some medical studies have shown that antidepressants can lessen chronic pain by increasing availability of the body’s natural neurotransmitters. Tricyclic antidepressants appear to be better at aiding in pain relief than other types; these include amitriptyline, doxepin, and clomipramine.
- Anticonvulsants: Some chronic pain conditions can be aided by drugs normally prescribed to patients with epilepsy, such as phenytoin, gabapentin, or pregabalin. While it is not wholly clear why these drugs lessen chronic pain, experts believe anticonvulsants may disrupt how pain signals flow within the body.
Chronic pain can be treated in a variety of ways, depending on the patient’s history and the source of the pain. In most cases, doctors work their way through a series of interventions and mild medications before they prescribe narcotic medication to their patients. Whenever possible, doctors want to prescribe the least harmful solution that is most effective.
Despite this, according to the Journal of Neuropsychiatric Disease and Treatment, oxycodone remains one of the strongest opioid pain management options available to manage chronic pain. This suggests that opioids remain a highly effective strategy to treat chronic pain. However, there are other treatment options available. The National Institute of Health lists other treatment options for chronic pain:
- Medication that is prescribed by a doctor or available over the counter, such as acetaminophen or ibuprofen
- Acupuncture, a popular alternative medicine strategy where needles are inserted in specific points throughout the body
- Electrical stimulation where the nervous system is stimulated to correct any imbalances
- Nerve blocks that interrupt pain signals that are sent to the brain
- Psychotherapy that involves a wide range of cognitive therapies, usually led by a therapist or counselor
- Relaxation therapies, such as massage, may help patients by distracting them and releasing muscle tension
- Biofeedback where electrodes are attached to the body to send information to a monitor that signals when it received the message
- Behavior modification that includes pain management strategies, allowing individuals to deal with pain without medication
Nobody wants to live in discomfort and pain. This makes prescription medications a popular choice for managing moderate to severe pain. In many cases, the prescriptions used are opioids, highly addictive pharmaceuticals derived from opiates.
When people start taking opioids to relieve their pain, the treatment usually works. These pharmaceutical medications are strong enough to help individuals feel better quite quickly. Over time, it is natural for the body to develop a tolerance for opioids that makes it difficult for that same small dose to have the same effect. In order for the pain to be managed in the same way, larger doses of the medication must be taken.
The development of opioid tolerance naturally leads to individuals taking larger doses or heavily relying on the medications to feel better. This can be extremely dangerous, as it can lead to misuse, whether intentional or not. A recent research study published in Substance Abuse Treatment, Prevention, and Policy reported that the widespread misuse of prescription opioids cause around 17,000 poisoning fatalities annually in the US.
Commonly Abused Prescription Pharmaceuticals for Pain Management
The most commonly abused prescription pharmaceuticals are opioids, sometimes referred to as narcotics, and other medications that interact with the central nervous system. These medications are all designed to provide pain management for moderate to severe pain. The most common of these pharmaceuticals include:
- Vicodin (hydrocodone): This drug is an opioid pain medication combined with acetaminophen. It is frequently available in a wide range of strengths as a pill and a liquid.
- OxyContin (oxycodone): One of the most commonly misused pain management medications, it is a synthesized opiate available in immediate and controlled release versions.
- Percocet (acetaminophen and oxycodone): This medication combines oxycodone and acetaminophen to treat moderate to intense pain.
- Opana (oxymorphone): This drug is a derivative of oxycodone. It is available as a pill and through rectal administration.
- Dilaudid (hydromorphone): This opioid pain reliever treats moderate to severe pain. It can potentially cause breathing issues for those who take it.
- Valium (diazepam): This prescription medication is utilized for a wide range of medical reasons, including anxiety disorders. Unlike many of the other medications presented, diazepam is not an opioid, it is a benzodiazepine that changes brain chemistry.
- Nembutal (pentobarbital sodium): This drug is a barbiturate that slows down the brain and nervous system functions. Some people are prescribed pentobarbital sodium to manage insomnia or prior to surgical procedures.
Avoiding Addiction Due to Chronic Pain
Because of how the body naturally responds over time to opioids, it is easy to end up in a situation where prescriptions are being misused. One way to combat this phenomenon is to be diligent in trying other treatment options for chronic pain first. If one of these medications is utilized to treat chronic pain, patients and doctors need to keep evaluating the situation to determine if a reliance or tolerance problem occurs.
The first step is to remain honest with the prescribing physician about the effectiveness of these drugs. If for some reason the drugs failed to be effective or if an increased dosage is required to achieve the same effect, it is important to let the physician know. The doctor may be able to prescribe something else.
There are a variety of treatment options available for those suffering from the misuse of pain management medications prescribed for chronic pain. Inpatient and outpatient treatment centers maintain specialized knowledge and training in how to help clients overcome these types of issues. They can be extremely effective in addressing addiction issues that may occur alongside chronic pain issues.
The Journal of Pain and Symptom Management found that psychological therapy is effective for those managing certain types of pain without the usage of pharmaceutical medication. Some treatment centers rely on cognitive therapy, but most rely on a combination of therapies, including some medications. This combination is able to help individuals with overcoming reliance on medications and managing the original source of pain.
Treating reliance on pharmaceutical medications for pain management for those with chronic pain can be difficult. According to the Journal of Neuroscience, the loss of pain-relieving effects and paradoxical pain are major challenges to providing treatment. People do not want to stop taking medication and pain to return. It is normal to feel hesitant about giving up a treatment option that has provided some relief.
The fact that these medications can also cause more pain by changing the way the brain and central nervous system function also complicates treatment. What may have started as a way to manage the pain associated with a badly sprained ankle may cause other types of pain to emerge. Sometimes, this situation makes it difficult for those trying to identify and treat the source of the pain.
Alternative Methods of Pain Management
With so many people invested in making chronic pain sufferers feel better, alternative methods of pain management are being developed to offer people new ways to cope. A research study published in JMIR Serious Games highlighted the possible impacts of using applied gaming as a possible coping strategy for those impacted by chronic pain. While the research itself is still relatively new, researchers are finding that pleasurable activities, such as playing video games, may offer relief to those suffering from chronic pain.