Pain is a natural sense, and as much as we try to avoid it, it’s also an inevitable part of life. When it functions properly, pain allows us to reorient and navigate the world in a more sensible fashion. We learn that some things are a bad idea, because the pain outweighs any feasible benefit. But pain can backfire a little bit, as well. An innocuous example is the red pepper, which contains a plant chemical called capsaicin, the cause of “spiciness”. Researchers surmise that the reason this chemical was produced was to ward off mammals who might eat the pepper and crush its seeds. Yet instead of causing us to shy away, spicy food is inarguably popular all over the world.
Chronic pain is another example of pain gone awry. While most pain serves a purpose, chronic pain does not. The pain of an acute injury – such as a broken bone – exists to prevent us from doing anything that might interfere with the healing process. But in cases of chronic pain, the pain is present without adequate healing, or it exists due to a problem with the nervous system. Chronic pain has more than just one cause and identifying that cause can help doctors figure out a better plan of action for their patients.
What Causes Chronic Pain?
Chronic pain is usually caused by a number of factors working together to produce a problem. The most common factors are:
Age – an aging body is most at risk for developing chronic pain, as well as more severe pain. A number of factors associated with aging, such as poorer healing and circulation, as well as hormonal changes may explain why aging and pain sometimes go hand in hand.
Prior injuries – research suggests that pain itself is a good indicator of chronic pain – experiencing severe pain on more than one occasion may “prime” the brain for chronic pain, highlighting the importance of early pain management even in cases of acute pain to prevent the brain and body from struggling with a lingering ache for months and years to come.
Lifestyle – many different lifestyle choices account for a higher prevalence of chronic pain, including smoking, drinking, obesity, and sedentary living. These lifestyle choices place greater strain on the body, either by straining the organs, putting more pressure on the joints, or weakening the muscle that could help take pressure off the joints and spine, both of which are the most common points of chronic pain. Malnutrition, or eating food with mostly low nutritional content can also worsen pain.
Mental health – episodes of anxiety and depression are associated with higher levels of perceived pain as well as a greater prevalence of chronic pain. It seems that pain is more common or appears to be more severe when the mind is struggling with negative thinking, as well.
Workplace issues – poor posture, sedentary work, high heels, poor lifting technique, arduous working conditions, inadequate protection against the elements, lack of sunshine and lack of sleep due to stress and overworking all contribute to the development and worsening of chronic pain.
Genetics – certain conditions associated with chronic pain and poor spine health (such as fibromyalgia, chronic fatigue, scoliosis, erythromelalgia and more) are certainly genetic and share a genetic link. But it could be that other forms of chronic pain – including postoperative chronic pain, or the development of certain forms of arthritis – are also heavily linked to genetics.
While pain management has been a facet of medicine since time immemorial, it is only with the more recent discovery of genes that scientists have been able to work on identifying the root causes of aberrant forms of pain. We have a long way to go before we can eliminate chronic pain but understanding how it develops can help us manage it. As of today, most treatment options for chronic pain can be surmised as pharmacological and non-pharmacological. These include:
Non-Opioid Over-the-Counter Medication
These are medicines you can purchase without a prescription, for relief from minor pain and inflammation, including swelling joints or an aching knee. Also known as non-opioid analgesics (painkillers), these include acetaminophen (paracetamol), and non-steroidal anti-inflammatories (aspirin, ibuprofen, naproxen).
Acetaminophen works on pathways in the nervous system, relieving pain without an anti-inflammatory effect. NSAIDs, on the other hand, are commonly prescribed for arthritis (an inflammation of the joints) and are also useful in lowering fevers while producing a similar painkilling effect. These drugs are not addictive, but they can lead to adverse effects if taken beyond the given guidelines.
Non-Opioid Prescription Medication
While not typically prescribed for the treatment of pain, there are certain prescription drugs that help deal with specific cases of chronic pain based on a number of factors. Pain coupled with convulsions may be treated using muscle relaxants and antiepileptic drugs, and antipsychotics have also shown to be promising in the treatment of chronic pain. These drugs cannot be purchased legally without a prescription, so if you’re expressing interest in trying them, consult your doctor to see whether they would provide any sort of benefit in your case.
Antidepressants can also potentially relieve pain, especially if a patient is presenting with symptoms of depressive thinking as a result of, or in conjunction with their chronic pain.
Opioid Prescription Medication
Opioid medication is no longer as heavily recommended for patients presenting with pain-related diseases, particularly chronic pain. While opioid medication is still valuable in the treatment of terminal pain and in hospice care, the potential for addiction as well as the fact that tolerance levels may decrease the effectiveness of the drug in the long-term means opioid medication may not be effective in the treatment of long-term chronic pain. Common opioids include Vicodin, codeine, morphine, and fentanyl.
Past drug treatment, there are a wide variety of non-surgical treatment options that include various forms of minimally-invasive treatment, such as nerve blocks. Nerve blocks are highly versatile and can mitigate or even eliminate chronic pain in a portion of the body through multiple sessions.
Nerve blocks involve injecting an anesthetic right into the root cause of the issue. A local anesthetic is first applied to make the injection less uncomfortable, and x-ray imaging is used to guide a longer needle to a very precise point, such as into the spinal fluid around a nerve root.
Nerve blocks are also used as diagnostic tools to further identify the root cause of a patient’s pain, by systematically numbing certain nerves. Nerve blocks aren’t permanent but can lead to lasting relief.
Epidural Steroid Injections
Similar to a nerve block, an epidural steroid injection utilizes a corticosteroid (cortisone), injecting it into the epidural section around the spinal cord. This can relieve lower body pain, around the back and legs.
The body responds well to physical movement and exercise, strengthening the musculature around the joints and spine, taking pressure off the joints, and regularly releasing endorphins after exercise, which further reduce discomfort and pain. Physical therapy alone can help rehabilitate a patient with chronic pain in some cases, although most of the time it is utilized in conjunction with other treatment methods to get the best results.
An important point to remember is that pain management is usually multimodal – that means doctors and specialists prefer to utilize a variety of treatment approaches to combat a patient’s chronic pain, rather than relying on a single silver bullet. Physical therapy, medication, and medical interventions such as nerve blocks may be utilized simultaneously to help a patient heavily reduce their chronic pain.