Chronic pain is a disease that is too often not diagnosed properly. It is persistent, debilitating and not always related to specific injury. Chronic pain may last for months or years and serves no apparent biological function.
> What Causes Chronic Pain <
Chronic pain often starts as acute pain, in response to a particular injury or illness, but lasts beyond the normal healing time. Sometimes treatment to cure one disease may lead to chronic pain in a completely different organ. For example, radiation to treat cancer affects all tissue near the tumor and may damage nerves, bones or other organs. Other times, the pain has no apparent cause at all.
Diagnosis can be difficult, as pain is usually considered a symptom of another condition rather than a disease in itself. When pain does not subside after successful treatment of its cause, or when there is no obvious cause, the pain itself becomes the disease.
When chronic pain is the result of a chronic illness, like fibromyalgia, arthritis or the progression of incurable cancer, it is more likely to be recognized and diagnosed correctly. In these cases, doctors are able to see the cause of the pain
In general, chronic pain is defined as pain that lasts longer than three to six months, regardless of the cause.
> Current Treatment Options for Chronic Pain <
The longer pain lasts the better the nerves get at transmitting it, and the more sensitive the brain becomes to pain signals. Therefore, it is important to begin treatment quickly. Some doctors are wary of prescribing doses of pain medication that are larger than is considered "normal." Pain specialists are often better able to understand and treat chronic pain.
Common treatments for chronic pain include:
* Over-the-counter (OTC) Pain Relievers
If the pain is persistent but not severe, OTC medications like aspirin, acetaminophen (Tylenol) or naproxen sodium (Aleve) may be sufficient to relieve the pain. Although OTC pain relievers are safe, long-term use does increase potential side effects. Patients should consult with a doctor before using OTC pain medications for more than a couple of weeks.
*Opioids
Several opioids, including morphine, codeine and oxycodone, are highly effective for chronic pain relief. Other opiods may not be appropriate to treat chronic pain.
Many patients are concerned about becoming addicted, and many doctors are reluctant to prescribe high opioid doses, but addiction is rare in patients who did not display addictive behavior before treatment. Used correctly, opioids are a safe and effective treatment.
* Antidepressants
Some antidepressants, especially tricyclics, are surprisingly effective at relieving certain types of chronic nerve pain. Unlike opioids, tricyclics are not immediate action pain relievers. They must often be taken for several weeks before significant pain relief occurs.
Another class of antidepressants, serotonin and norepinephrine reuptake inhibitors (SNRIs), also treat chronic nerve pain. One SNRI, Cymbalta is FDA approved to treat fibromyalgia and peripheral neuropathy. SNRIs are somewhat less effective than tricyclics, but have fewer side effects.
* Antiseizure Medications
Some drugs originally developed to treat seizure disorders, like epilepsy, have proven effective against nerve pain. Most are not officially approved for chronic pain treatment, but they are often prescribed "off label" to treat conditions like diabetic neuropathy (peripheral nerve damage caused by diabetes), trigeminal neuralgia (sudden jabs of extreme pain in or around the face) or phantom pains (pain that feels like it is coming from a limb that has been amputated).
Certain types of nerve pain appear to respond best to specific drugs. For example, Neurontin (gabapentin) is commonly prescribed for phantom pains, and Tegretol (carbamazepine) works particularly well for trigeminal neuralgia.
* Nerve Block
Nerves can be prevented from signaling by injecting medication directly into the area around them. These injections usually combine a local anesthetic for pain relief with a corticosteroid to treat inflammation.
An epidural is one type of nerve block, commonly used to treat back and neck pain.
> Promising Pain Treatments on the Horizon <
* Electroacupuncture
Studies suggest that the endorphin levels in the spinal fluid of chronic pain sufferers are too low. Endorphins act as the body's own painkillers, so researchers are looking at ways to activate production of these neurochemicals. One promising method is electroacupuncture, which involves using wired acupuncture needles to deliver electrical stimulation to nerve endings.
* Proteins
Recent research has linked increased levels of a protein called excitatory amino acid transporter 2 (EAAT2) to relief from chronic pain from bowel disorders. High levels of EAAT2 prevent a neurotransmitter called glutamate from sending pain signals. This treatment may be effective only for bowel disorders, not other types of chronic pain.
Chronic pain was once considered a mental disorder. Today we know that is untrue, and researchers continue to work towards finding better methods of control.
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Additional Resources on the Web:
National Institute of Neurological Disorders and Stroke: NINDS Chronic Pain Information Page
National Cancer Institute: Pain Control: Support for People with Cancer
American Chronic Pain Association