What Is Chronic Pain?

Chronic pain explained by San Antonio, Austin, Houston, Dallas Texas top pain doctors

Chronic pain is pain that persists for a considerable period of time without abating. Currently, this period is defined as three months or more, although this may differ depending on the diagnostic criteria of certain conditions. Chronic pain may be mild, moderate, or severe. It may last for hours or more, or occur in regular episodes. Chronic pain may result in low-level effects, such as irritation, or lead to full functional impairment (i.e. the inability to rise and take part in a normal life).

There are many types of chronic pain, many of which have a high prevalence or incidence. These include:

  • Many types of headache, including cluster-type headaches and migraine
  • Pelvic pain
  • Back pain
  • Neck pain
  • Complex regional pain syndrome
  • Muscular pain

Causes Of Chronic Pain

Chronic pain is associated with a wide range of illnesses and disorders. These include:

  • Arthritis (including rheumatoid arthritis, osteoarthritis, and juvenile arthritis)
  • Osteoporosis
  • Cancer
  • Herpes zoster infection (or shingles)
  • Diabetes
  • Fibromyalgia
  • Trigeminal neuralgia
  • Vertebral disc herniation
  • Spinal stenosis

Chronic pain may also be a result of injury, accident, or trauma. Many of the factors induce pain through the release of excess inflammatory molecules into nervous tissue (and other types of tissue, such as those of joints in the case of arthritis) which results in consistent pain. In some cases, mechanical damage to a nerve leads to chronic pain. Some rare cases have no identifiable explanation, which is known as idiopathic chronic pain.

Chronic pain is diagnosed through examination and interview by a physician. The physician may also use rating scales to measure self-reports of pain and the effect of this on the patient’s quality of life and functional status.

Treatments For Chronic Pain 

Chronic pain may be treated by a range of therapies and interventions. These may be chosen through discussion with your pain specialist about your specific condition, treatment needs, and expectations from treatment.

Acupuncture is derived from traditional Chinese medicine. This procedure involves the placement of fine sterile needles through the skin into the area(s) affected by chronic pain. It is thought that acupuncture stimulates the release of endorphins, thus relieving pain and possibly stress. Acupuncture may be performed using conventional steel needles, or more recently introduced methods, including lasers and pads carrying electric impulses.

Steroid injections are injections delivered directly to spinal nerves. They may be epidural (a region surrounding the spinal cord) which may address chronic back pain (caused by conditions such as disc herniation). Cervical steroid injections are mostly performed to treat neck pain. Steroids are drugs that can control inflammation. These injections may also contain local anesthetics, such as bupivacaine, that reduce pain. Steroid injections are minimally invasive. They may however need to be repeated to achieve optimal pain relief.

A nerve block is a similar procedure, in which nerves associated with a chronic pain condition are numbed with an injection of local anesthetics, possibly in combination with steroids. Nerve blocks may be performed depending on which disorder is responsible for chronic pain. For example, a lumbar sympathetic block may treat a case of chronic leg pain associated with complex regional pain syndrome.

Opioids are powerful analgesics (pain-killers). They are a class of drugs that contains the popular and widespread drug, morphine. They are effective in severe, treatment-resistant cases of chronic pain. However, they are also associated with risks such as tolerance and addiction. Ideally, patients are supplied with education on the benefits and risks of opioid use by their physician or pain specialist before considering taking this type of medication. Patients who use opioids must be closely monitored for signs of adverse reactions, side effects, and the possibility of addiction.

In some cases, chronic pain may be traced to scar tissue located on or near enough to a nerve to result in direct damage or excess inflammation. This may be treated by a procedure call adhesiolysis, (or lysis of adhesions). This is performed by administering chemicals to break up the scar tissue through a catheter. Local anesthetics or steroids may also be injected at this point.  Adhesiolysis may be performed on spinal nerve scars or other types of adhesions in order to provide long-term pain relief.

Some cases of chronic pain may be addressed by the temporary disruption of nervous tissue associated with consistent intense pain. This may be achieved with a procedure called radiofrequency ablation. A needle-like probe is inserted under local anesthetic to disrupt the nerve with radiofrequency waves (or thermoelectric energy). This procedure is not very invasive. Radiofrequency ablation is safe and effective for many patients with chronic pain. Typical side-effects include mild infection and slight bleeding at the probe insertion site.

Advanced osteoporosis, or the thinning of bones over time, may result in damage to the vertebrae, or bones of the spine. Osteoporosis may erode the vertical height of one or more of these, resulting in a collapse, or loss of vertebral height, and possible nerve damage. In some cases, vertebrae may fracture or break into pieces. This may be addressed by vertebroplasty, in which the missing bone is replaced by medical-grade acrylic cement. This is injected into the bone under anesthetic. Kyphoplasty is a newer form of this procedure in which one or two small balloons are first inserted through the needle and blown up once within the vertebra. This improves the visibility and accessibility of the fracture or collapse while injecting cement. The side effects of kyphoplasty or vertebroplasty are similar to those of radiofrequency ablation, and may also include cement leakage. Kyphoplasty is associated with reductions in leakage, however.

Conclusion

Chronic pain is pain that is consistent for approximately three months, or more based on the illness or disorder that may be the underlying cause. There are many types of chronic pain, including headaches, joint pain, and leg pain. It may be associated with specific conditions or with accidental injury. Chronic pain is diagnosed by examination, patient interviews, and various rating scales.

There are many effective treatments for chronic pain available, which the patient may decide on based on their individual case and needs. These include steroid injections, vertebroplasty, or radiofrequency ablation.

At Texas Pain our goal is to relieve your pain and improve function to increase your quality of life.
Give us a call today at 713-458-4530.

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