Understanding Chronic Pain - If you or someone you know suffers from chronic pain, then you already know the toll that chronic pain can take.
When you have pain that lasts and does not respond to traditional medical therapy, even basic tasks become difficult. Chronic pain can take away your strength and spirit and can put relationships with the people closest to you at risk.
The first step to finding relief and restoring your ability to enjoy activities is to understand what pain is and why we feel it.
This section will help you learn about the different types of pain.
What is Pain? - Pain is the body’s natural response to harm or possible damage. Pain occurs when special nerve endings, called pain receptors or nociceptors, are turned on because of illness or injury (for example, when exposed to trauma, physical pressure, or too much heat or cold) or when chemical changes indicate that body tissues are damaged.
Nerve Fibers Send Pain Messages to the Brain - When a pain receptor is turned on at the site of an injury or illness, it triggers the release of chemicals that send the pain message to the brain. This message is sent across a pain nerve pathway. The pathway begins at the nerve ending and is carried along the nerve fiber to where the nerve enters the spinal cord. When the message reaches the spinal cord, it is transmitted to the brain, which interprets the message as the unpleasant feeling called pain. This unpleasant feeling instantly prompts you to do something to stop the source of pain.
Two Types of Pain - Two types of pain exist: nociceptive and neuropathic. Each is set apart by its cause, how long it lasts, what it feels like, and the types of medical treatment that help it.
Nociceptive pain is caused when special nerve endings – called nociceptors – are irritated. Nociceptive pain is the type of pain you feel when you burn yourself, twist your ankle, or stub your toe. Nociceptive pain is a dull or sharp aching pain, and it can be mild or severe. This type of pain can usually be controlled if the cause of the irritation is removed or medically treated. Nociceptive pain usually responds well to mild pain medications, anti-inflammatory agents, or other drug therapies. Nociceptive pain can be a temporary condition, such as when you have a sprained ankle or a stiff neck, but nociceptive pain can sometimes be a chronic condition. Cancer pain and arthritis pain are common types of chronic nociceptive pain.
Neuropathic pain is caused by a malfunction of the nervous system due to injury, disease, or trauma confined to a small area (for example, trauma caused by surgery). Neuropathic pain can be sharp, intense, and constant; it can also be dull, aching, and throbbing. Some describe it as an extremely painful burning, tingling, shocking, or shooting pain. Neuropathic pain is also very stubborn. It does not usually respond as well as nociceptive pain to standard pain therapies such as mild analgesics and other pain medications.
The Challenge of Chronic Pain - When pain lasts for a long time, it is called chronic pain. Many physicians consider pain to be chronic when it has lasted for six months or longer. Others say that pain is chronic when it lasts one month longer than it should.
Today, chronic pain is one of the most critical healthcare issues in the world. In the United States alone, more than 100 million people suffer with some type of chronic pain. More than half of these chronic pain sufferers are partially or totally disabled. In fact, chronic pain disables more people than cancer or heart disease. Chronic pain takes its toll on personal lives, healthcare resources, and the economy; and it costs the American public more than both cancer and heart disease combined—more than $100 billion in medical expenses and more than $60 billion each year in lost productivity. This has led the United States Congress to declare this decade the “Decade of Pain Control and Research.”
Treatment Options - Chronic pain is rarely relieved with a single therapy or after a single treatment. Finding a way of treating back pain that works—and works well—depends as much on your condition and the options that your physician offers as it does on your willingness to take an active role in your treatment. When you suffer from chronic pain, the pattern, intensity, and frequency of your pain and your response to treatments may be very different from someone else with the same diagnosis. Also, your pain can change—not just over time but also from day to day and hour to hour—according to your activity, mood, stress level, and general health. This is what makes chronic pain such a challenge to treat.
The Chronic Pain Treatment Steps - When traditional treatments do not provide enough relief, primary care physicians often refer their patients to pain physicians. Pain physicians are specialists who study, treat, and help rehabilitate people in pain.
When treating back pain and other types of chronic pain, pain physicians often follow a treatment strategy called the chronic pain treatment steps. This series of treatment steps can help you and your physician decide the best treatment for your pain. It can also help ensure that no potential solution is overlooked.
Remember, though, that the chronic pain treatment steps are only general guidelines and can vary depending on your condition, your response to previous treatments, and the recommendation of your pain physician.
After making an initial diagnosis, your physician will take specific steps to treat your pain. He or she will usually start with the less complicated and less expensive therapies in the treatment steps. These therapies can include medications, physical therapy, TENS, and nerve blocks. Some of these treatments may work at first, but often they do not offer lasting pain relief.
If your pain does not respond to these therapies, pain physicians look at more advanced therapies among the treatment steps. Spinal cord stimulation (SCS) is one of these therapies and is used for treating back pain and other types of chronic pain. For some patients, SCS is a way to regain their quality of life and return to a more normal lifestyle.
Depending upon your diagnosis, medical history, type of pain (neuropathic pain or nociceptive pain), and severity of pain, you may be a candidate for an implantable spinal cord stimulator. Spinal cord stimulators use low levels of electrical energy to partially or completely interrupt the sensation of pain. In cases of severe, chronic stubborn (intractable) pain that do not respond to any other treatment, surgery or neuroablative procedures may be considered.
The important things to remember are that you can find treatments for chronic pain and that your physician and ANS are here to help.
Learning About Chronic Pain - As you consider treatment options for your chronic pain, it’s important that you learn as much as possible about your condition and how the treatments can affect it. You should also consider how well these treatments fit your lifestyle. That way you and your doctor can work together to choose the treatment that is right for you.
Preventive spinal and back care - See and learn how to reduce the risk of chronic back pain.
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