Introduction
Chronic (persistent or long-term) pain lasts longer than twelve weeks or beyond the natural healing time (NHS inform). It can also refer to pain because of another health condition or despite investigations and treatment.
According to NICE, chronic pain affects between one-third and one-half of the UK population (just under 28 million adults). It tends to be more common in women than men, and the three most common types of pain are back pain, headache and joint pain. In England alone, around 15.5 million people (34% of the population) have chronic pain (Versus Arthritis).
Chronic pain can significantly and negatively impact the physical, emotional and mental health and well-being of those living with the condition. It can affect their daily lives, and they may struggle with day-to-day activities such as work, self-care, household chores, hobbies and socialising. Overall, it can lead to poor mental health, social isolation, financial difficulties and a reduced quality of life.
Understanding and managing chronic pain effectively is vitally important to improve the lives of those with the condition and enhance their physical and mental health and well-being. Whether you are suffering from chronic pain or are caring for someone with the condition, this blog post will offer a variety of techniques, strategies and therapies to help manage pain effectively.
Please note: this blog is for information purposes only and should not be taken as medical advice. Always see a healthcare professional where needed.
Understanding Chronic Pain
Everyone feels pain at some point, whether short-term (acute), such as a sprained ankle, or recurrent/intermittent pain, e.g. a toothache. However, some individuals suffer from persistent and long-term pain, which is chronic pain.
People experience chronic pain differently; some may have mild pain, and others severe and excruciating. They may also have ‘flares’ where their pain increases in intensity at certain times, e.g. when stressed or in certain weather conditions.
There are varying types of chronic pain with different causes and triggers, but what all types have in common is the psychological impacts and mental anguish of living with these conditions.
Types of Chronic Pain
There are various types of chronic pain with different causes. Some conditions can affect the whole body (systemic) or parts (localised).
Chronic pain is typically classified into several types based on its characteristics and underlying causes, and there are two main categories:
- Chronic primary pain – is not directly related to any other underlying condition, e.g. chronic primary headache.
- Chronic secondary pain – is associated with an underlying condition, e.g. arthritis.
Some examples of types of chronic pain include:
Head pain
- It occurs when a person has a headache every day for fifteen days of the month or more (The London Clinic).
- They have migraine-like, cluster-like or tension-like features.
- The pain can occur in various parts of the head.
- Symptoms include head pain, tenderness and a feeling of pressure.
Inflammatory pain
- Inflammation occurs because of substances released in the body in response to injuries, disease, germs, allergens or toxic chemicals.
- Symptoms include swelling, sensitivity, pain and stiffness.
- An example of inflammatory pain is rheumatoid arthritis.
Musculoskeletal pain
- ‘Musculoskeletal’ refers to the muscles and skeleton.
- This chronic pain affects a person’s bones, muscles, joints, tendons and ligaments.
- It is caused by overuse, injuries, poor posture or conditions, e.g. osteoarthritis.
- An example is fibromyalgia, which is a complex condition characterised by widespread pain, fatigue, and tender points.
Neuropathic pain
- This type of chronic pain affects a person’s nervous system.
- It is caused by nerve damage or dysfunction.
- Symptoms can include pain that is shooting, burning or feeling like electric shocks.
- Some examples include sciatica and diabetic neuropathy.
Causes and Triggers
Chronic pain is complex and can arise from various causes, such as:
- Injury – some may suffer from chronic pain after an injury, even after healing, such as a back sprain or pulled muscle.
- Surgery – some individuals can face complications after surgery, such as chronic post-surgical pain (CPSP).
- Chronic conditions – people living with long-term health conditions can suffer from chronic pain, e.g. arthritis, fibromyalgia, endometriosis and lupus.
- Diseases – those with certain diseases, such as advanced cancer, can experience ongoing pain.
- Idiopathic causes – unfortunately, in some cases, the causes of chronic pain are not always obvious, e.g. complex regional pain syndrome.
- Psychological factors – this is sometimes known as psychogenic pain caused by stress, anxiety and depression.
Risk factors can increase the likelihood of developing a chronic pain condition. According to NICE, risk factors for chronic pain can include (this list is not exhaustive):
- Age – over 45 years old.
- Sex – female.
- Employment – manual work and unemployment.
- Lifestyle – smoking, alcohol and inactive.
- Clinical – obesity, sleep disorders, surgery and trauma.
- Family history – migraine and fibromyalgia.
‘Triggers’ can exacerbate pain and worsen symptoms. Individuals can have specific ones, depending on their condition. For example:
Stress – “is the body’s reaction to feeling threatened or under pressure ” (NHS). It can worsen pain because of:
- An increase in the stress hormone cortisol, which can cause inflammation and pain.
- It causes muscle tension and spasms.
Insufficient/poor quality sleep – those with chronic pain can find it difficult to sleep. It can make their pain worse as they are not getting adequate rest, and their body cannot repair and recover effectively.
Weather changes – some people can experience increased pain in specific weather conditions, e.g. arthritis in cold and wet weather.
Certain foods – some people may find that certain foods trigger inflammation and worsen pain, e.g. processed foods and sugary snacks.
Over-exertion – if a person pushes themselves too hard physically, it can cause flare-ups and an increase in pain.
Psychological Impact
Alleviate compares chronic pain to an iceberg, i.e. people only see a small part of what a person is going through on the surface – but there is a lot more going on underneath, such as the impacts on their life and their pain experiences. One thing is for sure – it can have significant psychological impacts.
Living with chronic pain can take a significant toll on a person’s mental and emotional health and well-being. Experiencing relentless pain day in and day out can be exhausting, and they may have persistent discomfort, thus limiting their daily activities. They may also have consistently disrupted sleep patterns, which can exacerbate pain and impact their mental health.
Chronic pain can also put significant constraints on a person’s life. It makes it more difficult for them to work, pursue their hobbies, have positive relationships with others and uphold social commitments. They may also become more irritable with others, which can lead to loneliness and social isolation.