What is chronic pain and how is it diagnosed?

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What is chronic pain?

Those living with chronic pain are all too familiar with that feeling. It takes away your confidence, it’s always lurking in the back of your mind. Picking up the grandkids, shopping, even the simplest of chores becomes a battle between the mind, the body, and your inner determination. One in five adults living in Europe will experience nociceptive or neuropathic pain, and one third of those individuals will experience constant pain.

The pain may come in bursts, initially sharp before starting to subside. It can also be more severe, from constant tingling or numbness to a stinging sensation. In statistical terms, the probability of chronic pain increases as you get older. But chronic pain should not be considered a natural part of the aging process.

Chronic pain is classified into two categories, nociceptive and neuropathic. The first is the type of pain that we have all experienced. Think about the last time you broke a bone, cut yourself or burned yourself cooking; all of these are examples of nociceptive pain.

The second, neuropathic pain, comes from within and is caused by damage to our nervous system. Some patients with this type of pain report sensations like electric shock. It is normally resistant to traditional medications and becomes incredibly debilitating. Both types of pain can prevent patients from being able to sleep, work, or lead a healthy, active life.

What causes chronic pain?

Understanding the causes is essential, since more than 50% of patients with chronic pain can wait up to two years until their pain is controlled. Usually, both categories of pain arise after some type of trauma. That being said, identifying the exact trigger for chronic pain is, in some cases, impossible.

Headache, back pain and arthritis; these conditions fall within the common denominator of nociceptive pain. Now, imagine that the pain is constant, or that it occurs frequently for six months or more. That is precisely what those living with chronic pain have to go through. Because the exact cause varies greatly, each case must be considered on its own circumstances. The pain can be the result of a disease, a condition, a skin lesion, a broken bone; The driver of chronic pain can present itself in many forms.

For chronic neuropathic pain, symptoms can occur anywhere in the body. This only adds to the immense frustration felt by sufferers. Nerves and nerve pathways can become blocked or damaged, leading to acute periods of pain. Our nervous system’s ability to process pain correctly can also become distorted.

a woman holding her hand because of pain

For most people, a cut on the arm or holding hands may initially hurt, but the pain soon subsides. However, those living with neuropathic pain may feel the pain in all parts of their body such as an arm or a leg. They can even feel excruciating pain just by pushing or prodding them slightly.

Diagnosing chronic pain is difficult

Given the complexity of the onset of chronic pain, diagnosis and any subsequent treatment are difficult to tailor to the individual. The reason the diagnosis rate is so low is due to the way our brains process the sensation of pain. What can hurt you in a very significant way, may not hurt your partner in the same way. The same source of pain could also be more severe in children or the elderly.

Everyone’s pain threshold is different. If you were to ask twenty people how they felt when they broke their arm, the answer would always be different. The same would happen if you later asked those same twenty people to rate their pain for you on a scale of 1 to 10. Because there are currently no means of scientifically proving the intensity of pain, there is no choice but to trust the patient towards the diagnosis. Not only do they have to describe to the doctors the intensity of their pain, but they also have to try to describe the source. With neuropathic conditions, this is next to impossible and doesn’t work.

Some methods test for pain emanating from bone or deep tissue. X-rays, MRIs, and CT scans can help with this. To check the integrity of the nerves, patients may also undergo an electrophysiological study. Even a combination of these tests can fail to isolate the exact cause of chronic pain.

Prevalence of chronic pain in Europe

Although the exact number of people living with chronic pain differs from country to country, the numbers are always in the millions: eight million in the UK, ten million in France and sixteen million in Italy. In Spain, of the five million people who suffer from chronic pain, 500,000 have been diagnosed within the neuropathic type.

As for the effectiveness of the treatment, the statistics do not improve. 38% of all Europeans with chronic pain say their pain is not adequately treated, and most have been living with the disease for more than seven years.

Chronic pain has little treatment

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Chronic pain is difficult to diagnose and is incredibly debilitating. The people who live with it can feel that it is the only thing that exists in life. Although all is not lost. Some treatments can help effective pain control. In mild cases, over-the-counter pain relievers are sufficient. For severe pain, codeine or morphine may be prescribed. The risk with opioids is that they have many side effects, and most patients are concerned about the long-term consequences of their use. Nerve blocks or muscle relaxants are also helpful; however, its effectiveness will depend on the type of pain in question.

The main goal of any form of treatment will always be to try to enable the patient to resume their daily activities. Whether it’s going back to work, taking the dog for a walk, or just sleeping through the night.

Despite the actions taken by health professionals, being such a wide spectrum of variables, chronic pain remains, for the most part, untreated. The unrelenting nature of chronic pain often leads to mental disorders. Anxiety and depression are very common, especially when patients feel isolated by their physical disability.

We absolutely need to better understand chronic pain, both for patients suffering now and for those who will be diagnosed in the future. Putting ourselves at worst, chronic pain will never go away. However, in most cases, it can be managed through lifestyle changes, diet, and the help of medical professionals.

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