Understand the chronic pain!

Chronic pain has been always difficult to manage for different reasons including a very complex and multi-factorial pathophysiology, which is still poorly understood, very limited treatment options, and not very sufficient conclusive research in the field of chronic pain. Because of the complex relationship between the central and the peripheral nervous system as well as the body’s hormones, chronic pain requires a multidisciplinary treatment approach. Chronic pain is different from the acute one, which is much easier to deal with because it has a well-known definite cause, however, chronic pain is usually very special and there isn’t a clear cause for it and no single treatment will cure it. Unfortunately, not every chronic pain patient understands the dilemma of his/her pain condition, therefore when they get referred to the pain clinic they go with very high and unrealistic expectations.

In this short article, we will try to shed light on this very important problem helping chronic pain patients to understand the nature of their pain and advising them how to deal with it.

Discussion

First of all, in answering the question, how common is chronic pain? One will be interested to know that more than 20% of the Western population suffers from chronic pain and less than 2% of them attend pain clinics. This cost the budget of the National health service over £ 200 billion in Europe and £ 150 billion in the U.S.A [1]. In England, more than 15 million people (about 20% of the entire population) have a chronic pain condition and it is expected for this number to increase over the next ten years. Care of people with chronic pain conditions accounts for about 70% of the money spent on health and social care in England [2].

It is also interesting to know that chronic pain is not just a symptom but it is a syndrome of more than one illness. Chronic pain has more than one aspect including, physical, psychological, and socioeconomic aspects. In other words, chronic pain affects the patient’s physical and psychological health with a very negative impact on his/her general health and their normal daily activities as well as their society’s socioeconomic status [1].

Now, what is chronic pain? Chronic pain is simply any pain that remains untreated for more than 12 weeks [3]. It can be associated with an obvious reason, like a history of serious physical injury, severe infection that was difficult to treat, or a chronic disease like osteo, or rheumatoid arthritis [4]. An advanced cancer could be also very painful [5]. However, having a chronic painful situation with an unknown (idiopathic or psychosomatic) cause is not uncommon [6]. The most common types of chronic pain are; back pain, mainly the lower part of the patient’s back, headaches, and neck and arm pains [7-9].

Finally, what are the treatment options for chronic pain? Treating chronic pain is not simple but could be quite complex and long-term. A multi-model pain management approach is the most common protocol in most pain clinics [10]. This should include interventional, pharmacological, physical as well as psychological management with the help of more than one clinician at the same time. Getting chronic pain patients back on track is usually the ultimate goal of their treatment. To help the patients get to a satisfactory stage of their treatment so they can go back to their normal life as soon and as much as possible, these patients are expected to help their doctors by understanding their complex pain condition, and by having a positive attitude toward their long-term pain management.

Conclusion

Chronic pain patients should understand the complexity of their pain situation which is still very challenging to science and subsequently to their pain doctors, and it is up to their doctors to explain this fact to them. In very simple terms, the patient should be well informed about the possible cause or causes of their pain if known, the very limited treatment options available, and most importantly the maximum expectation out of the suggested treatment. Trying to get the patients back to their normal or near-normal daily activities should be the target of their treatment. The adverse effects of their analgesia especially the aberrant drug-related behaviour should be clearly explained to them because they might have a negative impact on their life.

Encouraging the patients to remain as active as they can is very important. This might be easy to say but difficult to do, but it is true that it does really help get things slowly easier for everybody including; the patients, their relatives as well and their treating staff.

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