Chronic pain affects millions of people every day and can be devastating to one’s quality of life. However, having chronic pain does not have to be debilitating. There are a number of ways to manage chronic pain with minimal disruption to daily life. Below are various types of chronic pain syndromes and the ailments that are associated with them.
What Is Pain?
Pain is an unpleasant sensation that occurs in response to stimuli, usually an injury or illness. Most pain is acute, meaning that it lasts for a short period of time and has a definitive cause. Once the underlying problem is resolved, the pain will subside shortly thereafter. Some pain can be chronic, with symptoms that last for a long period of time and develop without a definitive cause, which makes treatment difficult.
What makes pain unique from any other sign or symptom of illness or injury is that it is highly individual in nature. We all feel pain in different ways. There is no non-subjective test for measuring pain because we all report it differently. One person’s mild pain may be unbearable to another. As a result, pain is most commonly measured using the Visual Analog Scale, which asks patients to self-rate their own pain on a scale of 1-10.
Types of Chronic Pain
Nociceptive Pain: This type of pain occurs when specific pain receptors are stimulated as a result of potential or actual tissue damage. These receptors detect chemicals that are released from damaged cells or as a result of temperature changes, stretching or vibration. Additionally, there are two types of nociceptive pain: somatic and visceral.
Somatic: This type of pain is felt on the skin along with the muscles, bones and joints. This type of pain is how the body feels inflammation, like from an injury or cut. Somatic pain is sharp pain that is localized to the injured area. Pain caused by a lack of oxygen to tissue — known as ischemia — is also a type of somatic pain.
Examples of chronic somatic pain include:
- Arthritis
- Fibromyalgia
- Back pain
- Pelvic pain (caused by joint instability, not nerve damage)
- Muscular ischemia
- Osteoporosis
- Cancers affecting the bones or skin
Visceral: Visceral pain originates from the organs of the major body cavities. The pain receptors within the major body cavities sense inflammation, ischemia or stretch around one or more organs. As this pain comes from the body cavity as a whole — for example deep aching whole-abdomen pain from an infection — it can be more challenging to identify the origin of the condition based on pain alone.
Examples of chronic visceral pain include:
- Endometriosis or menstrual pain
- Infections affecting organ systems
- Cancer of internal organs
- Irritable bowel syndrome (IBS)
- Prostate pain (such as in the case of benign prostate hyperplasia)
- Bladder pain (such as in the case of cystitis)
Neuropathic Pain: This type of pain is not caused by pain receptors, but by the nerves themselves. There are two primary types of neuropathic pain: peripheral and central.
Peripheral: This type of pain originates from the nerves of your arms and legs, outside of your brain and spinal cord. This can be the result of diseases that affect the spinal nerve roots (outside of the cord) and extremity nerves, or following an amputation, crush or burn. It can also be the result of long term compressive disorders such as carpal tunnel syndrome. Unlike nociceptive pain, there are no specific pain receptors involved. Peripheral pain can be very intense, to the point where it prevents any use of the impacted limb.
Examples of peripheral neuropathic pain include:
- Complex regional pain syndrome
- Nerve entrapment or compression (such as carpal tunnel syndrome)
- Sympathetically maintained pain
- Toxic exposure
- Post-radiation effects
- Trigeminal neuralgia
- Post-traumatic neuroma formation or neuralgia
- Chemotherapy-induced neuropathy
Central: Central pain originates directly from your brain and spinal cord. This can be the result of a chronic disease, such as multiple sclerosis, or following a stroke or radiation from cancer treatment. In this case, a major part of your spinal cord or brain can be affected, which may lead to the development of symptoms in a whole part of your body or through a sequence of nerves. It may also be accompanied by sensory or motor dysfunction that is more extensive than with peripheral nerve pain syndromes.
Examples of central neuropathic pain syndromes include:
- Multiple sclerosis
- Parkinson’s disease
- Post-radiation myelopathy
- Syringomyelia
- Post-stroke pain
Other Forms Of Chronic Pain
Psychogenic: This type of pain is associated with mental illness. While there may not be a physical cause to this pain that can be treated, it remains very real to the patient. Psychogenic pain is often difficult to treat using traditional methods, although treatment of the underlying mental health problem can improve symptoms.
Some examples include:
- Depressive disorders
- Anxiety disorders
- Somatoform disorders
Idiopathic: This type of pain cannot be traced to any known cause. Those who are most susceptible to idiopathic pain typically already have some type of chronic condition that can manifest with pain, such as temporomandibular joint disease or fibromyalgia. However, this pain is distinct from any disease-caused etiology. Because idiopathic pain is not well understood, treatment can be difficult.
Types of Treatment
The treatment of acute or chronic pain depends upon its cause. Chronic pain management can be a bit more difficult because the cause of the pain may be unknown or related to a chronic issue that cannot be cured, such as multiple sclerosis. Pain type may also provide clues as to its appropriate treatment. For example, those experiencing psychogenic pain won’t benefit as much from pain relievers as they would from antidepressants or anti-anxiety medications, while those with neuropathic pain may not benefit as much from opioids as they would from nerve pain medications, such as gabapentin.
It’s important to remember that there is no single treatment for pain that is appropriate for everyone. There is often quite a bit of trial and error before the right treatment strategy for each individual patient can be found.
Common treatment methods include:
- Over the counter pain relievers, such as Tylenol
- Non-steroidal anti-inflammatories (NSAIDs), such as ibuprofen or naproxen
- Nerve pain medications, such as gabapentin
- Anti-spasm medications, such as cyclobenzaprine or valium
- Opioids
- Non-pharmacologic treatments include:
- Hypnosis
- Biofeedback
- Relaxation training
- Cognitive behavioral therapy
Complementary Remedies and Alternative Therapies
There are a number of complementary or alternative therapies available for managing chronic pain. The effectiveness of these treatments varies as many have not been verified by high-quality clinical trials yet. While most are regarded as safe or low risk, they should always be discussed with your doctor first.
These therapies include:
- Massage
- Acupuncture
- Aromatherapy
- Homeopathy
Chronic pain can be quite frustrating. The goals of managing chronic pain is to ease symptoms to the point where they are not the primary focus of daily life. With the right combination of pharmacologic and nonpharmacologic treatments it is possible for people with chronic pain to experience a good quality of life.
Resource Links:
- Cohen SP, Mao J. “Neuropathic pain: mechanisms and their clinical implications” BMJ. 2014;348:f7656
- Blyth FM, Noguchi N. “Chronic musculoskeletal pain and its impact on older people” Best Pract Res Clin Rheumatol. 2017;31(2):160-168
- Nalamachu S. “An overview of pain management: the clinical efficacy and value of treatment” Am J Manag Care. 2013;19(14 Suppl):s261-6
- Guerts JW, Williams PC, Lockwood C, van Kleef M, Jleijnen J, Dirksen C. “Patient expectations for management of chronic non-cancer pain: A systematic review” Health Expect. 2017;20(6):1201-1217
