According the American Chronic Pain Association Chronic pain is better described as persistent pain is a condition which can be continuous or recurrent and of sufficient duration and intensity to adversely affect a person’s well-being, level of function, and quality of life.
Chronic or persistent pain can be described as ongoing or recurrent pain, lasting beyond the usual course of acute illness or injury or more than 3 to 6 months, and which adversely affects the individual’s well-being.
A simpler definition for chronic or persistent pain is pain that continues when it should not.
Chronic pain is classified by pathophysiology (the functional changes associated with or resulting from disease or injury) as nociceptive (due to ongoing tissue injury) or neuropathic (resulting from damage to the brain, spinal cord, or peripheral nerves), with mixed or undetermined causes as well.
Pain relievers (analgesics) are generally effective for nociceptive pain but may be less effective for neuropathic pain.
Persistent or chronic pain is prevalent in older adults and the first line of treatment is analgesics including morphine.
The use of analgesics (pain relievers) and other medications is the most common method of chronic pain treatment. Pain medications can be helpful for some patients in chronic pain, but they are not universally effective. In fact, in some individuals, pain medications may worsen their condition or cause unwanted or dangerous side effects.
Medication-related problems would rank fifth among the leading causes of death in the United States if they were considered a disease. Although opioid pain medications can be a useful tool in the treatment of pain, the misuse of opioid (narcotic) pain medications has become a national issue.
In general, thirty percent of hospital admissions among the elderly may be linked to an adverse drug related event or toxic effect from a drug. Nearly one third of all prescribed medications are for patients over the age of 65 years. Unfortunately, many adverse drug effects in older adults are overlooked as age-related changes (general weakness, dizziness, and upset stomach) when in fact the patient is experiencing a medication-related problem.
Some older individuals may be more sensitive to medications, more likely to experience side effects, and more likely to be using multiple drugs with the associated risk of interactions between the drugs.
It is important to remember, each person may respond in a different manner to any medication. Therefore, each person with chronic pain should be medically managed individually, and medication use should be determined by benefit, cost, potential side effects, and the person’s other medical problems.
Opioid Analgesics, the Opioid Dilemma.
Considerable controversy exists about the use of opioids for the treatment of chronic pain of noncancer origin. Many health care professionals think that chronic pain is inadequately treated and that opioids can play an important role in the treatment of all types of chronic pain, including non-cancer pain.
Others caution against the widespread use of opioids, noting problems with tolerance, loss of benefit with time, and escalating usage with decreasing function in some individuals.
The use of opioids (or for that matter any treatment) makes sense when the benefits outweigh the risks and negative side effects. Benefit is suggested when there is a significant increase in the person’s level of functioning, a reduction or elimination of pain complaints, a more positive and hopeful attitude, and when side effects are minimal or controllable.
Opioids are not harmless drugs. The dilemma with the long-term use of opioids is that while opioid treatment may be prescribed to reduce pain and improve function, the treatment may actually result at times in just the opposite.
It is well known that in the opioid naïve (someone new to opioid use) patient, the use of opioids may heighten the risk of accidental death from respiratory depression.
It is well known that prolonged use of opioids may result in problems including tolerance, hyperalgesia (increased pain sensitivity), hormonal effects (decreased testosterone levels, decreased libido and sex drive, irregular menses), depression, impaired sleep patterns, and suppression of the immune system. The long-term use of opioids may also impair functional improvement in an individual’s recovery from surgery or with long-standing musculoskeletal disorders.
The Effects of Cigarette Smoke On Pain
Smoking causes blood vessels to become constricted, smaller and narrower; this restricts the amount of oxygen rich blood flowing to areas of pain. Smoking not only reduces blood flow to your heart but also to other structure such as the skin, bones, and discs. Due to this, you may get accelerated aging leading to degenerative conditions.
The lack of blood supply caused by cigarette smoke is also responsible for increased healing time after surgery.
After a back fusion surgery, smoking cigarettes can increase the risk of your fusion not healing properly. Cigarette smoke triggers the release of pro-inflammatory cytokines, increasing inflammation and intensifying pain. Smoking makes the bones weak and increases the prevalence of osteoporosis, spinal degenerative disease, and impaired bone and wound healing. Symptoms of depression are more commonly seen among smokers
Chronic Pain Types and Treatment.
Chronic Back and Leg Pain
Chronic back and leg pain is described as pain that has been felt in the back or leg for six months or longer. Pain is most often located in the lower back, but it may extend to other areas, such as the thighs, calves, and feet.
Chronic back and leg pain can result from a number of spinal conditions, including:
- Degenerative disc disease
- Lumbar disc herniation
- Failed back surgery syndrome
- Epidural fibrosis
Symptoms of chronic back and leg pain can range from mildly uncomfortable to completely disabling. You may feel a sharp or stabbing pain, a burning sensation, or a dull muscular ache. Affected areas may feel tender or sore to the touch and the pain may increase with movement.
Painful neuropathy is a neurological disorder where people experience severe chronic pain due to nerve damage. Nerves connect the spinal cord to the body and help the brain communicate with skin, muscles, and internal organs.
Painful neuropathies are caused by damage to the nerves. This damage may be a result of:
- Nutritional imbalances
- Illnesses, such as kidney failure or cancer
- Trauma of the nerves
Although there are many different causes of painful neuropathies, they have common symptoms, such as:
- Stabbing or sharp pain
These symptoms most often appear in the hands or feet.
Complex Regional Pain Syndrome (CRPS)
Complex regional pain syndrome is a chronic pain condition that most often affects the arms, legs, hands, or feet. Complex regional pain syndrome is also known as reflex sympathetic dystrophy or causalgia.
Complex regional pain syndrome usually develops in a limb after an injury (such as a broken bone) or surgery that may have involved nerve damage.
The overriding symptom is extreme pain, frequently described as burning. Other symptoms can include:
- Sensitivity to touch
- Skin changes
- Decreased function of the hand/foot
Pain in cancer may arise from tumor compression or infiltration of tissue; from treatments and diagnostic procedures; or from skin, nerve and other changes caused by the body’s immune response or hormones released by the tumor.
Most acute (short-term) pain is caused by treatment or diagnostic procedures, though radiotherapy and chemotherapy may produce painful conditions that persist long after treatment has ended.
At any given time, about half of all patients with malignant cancer are experiencing pain and more than a third of those experience moderate or severe pain that diminishes their quality of life by adversely affecting sleep, social relations and activities of daily living. Pain is more common in the later stages of the illness
Modern Treatment Options for Chronic Pain
Medical Devices. Neurostimulators and Pumps.
Medical devices, such as Medtronic neurostimulators or drug pumps (intrathecal drug delivery systems), are surgically placed devices that modulate pain signals before they reach the brain:
- Neurostimulators – send mild electrical impulses to the spine, masking the perception of pain messages to the brain
- Drug pumps – deliver pain medication directly to the fluid around the spinal cord (called “the intrathecal space”), requiring only a fraction of the medication that would be needed and reduce the side effects of the medication.
Unlike some surgeries, these treatments are reversible. Your doctor can turn it off or surgically remove the system. In addition, you can try these therapies before you receive a permanent implant.