Chronic Pain

Definition

The definition of chronic pain is pain lasting longer than 3 months. In practice, the term “chronic pain” is used to refer to pain that continues beyond the time normally expected for healing of a torn ligament or broken bone. There are a few examples of chronic pain that occur frequently and usually resolve by themselves. Tennis elbow is one such condition, where the initial injury is a tear or strain of the muscle fibre where it attaches to the outer aspect of the elbow. Usually it is brought on by an overload of muscle tendon junction from either knocking it or repetitive strenuous use. For reasons poorly understood it is common for this condition to last for one to two years. Normally a muscle-tendon tear will heal fully in six to eight weeks, but occasionally may take up to twelve weeks (like a bad ankle sprain).

So what is the pathology (nature or cause of the problem)? Current theories suggest that partial healing occurs, but an ingrowth of blood vessels into the torn tendon leads to ongoing inflammation. Sometimes during an operation no inflammation can be found. Similarly X-rays, ultrasound scans, nuclear bone scans and MRI scans may all appear normal.

Despite all negative tests, the medical profession accepts tennis elbow as legitimate and acknowledge that it can be quite debilitating. Spinal pain, in particular low back pain, is not always equally accepted. There may be a similar pathological process occurring, where all tests may be completely normal and yet pain persists. There may be a stigma associated with pain and in certain circumstances there may be insinuations about the legitimacy of the complaint.

Pain is a very subjective phenomenon and there are still many unanswered questions. For instance, two people with identical pathologies in their spines shown on X-ray may have totally different pain experiences. In both cases the back problem may be sending out a moderate amount of pain signals, but one person may have a higher threshold or tolerance of pain. Factors that affect pain tolerance include sleep disturbance, fatigue, depression, stress, worry, previous pain experience, family/work pressures and medications.

Even when pathology can be seen on an X-ray, frequently it does not cause pain. Over the age of 20 the human body starts to age (also known as degeneration). The skin becomes less supple / elastic and wrinkles can develop. The spine too undergoes changes involving the discs and facet joints, which show up gradually on X-rays and other scans. About 30% of the population show such changes by the age of 30, with early signs of disc space narrowing. By age 40, 50% of the normal population are showing changes, including osteoarthritic changes of the facet joints. It remains unknown why some degenerative joints cause pain yet others may be totally painless.

As the joints degenerate there is a gradual loss in flexibility. It may be that sudden trauma strains an already stiff degenerative joint, in other instances pain comes on gradually – possible related to our Western lifestyle. What we do know is that the longer you have pain, the more it tends to spread to nearby areas – in medical terms we call this sensitisation of the nervous system. Over time it can even spread from one side of the body to the other side and up and down the spine. Once it spreads to wider areas of the body it is often termed Fibromyalgia.

Risk factors

Risk factors for increasing pain include smoking and obesity. Certain occupations can mildly increase the risk of developing pain, but in general there is little correlation with general level of activity or strenuous work.

Myths

There a lot of myths regarding chronic pain – here are a few answers.

  1. Degeneration is always progressive and can only get worse.
    Degeneration is usually painless and thus there is a good chance that the pain will again settle.
  1. If it hurts to move then it is better to rest.
    Too much rest is harmful for the spine. Sometimes the pain will inhibit movement and then a vicious cycle results in progressive stiffness through avoiding activities. Usually it is better to try to stay active.
  1. Regular Chiropractic can reverse degeneration seen on x-rays.
    No medical or other therapy can ever reverse degeneration, but a combination of therapies may help relieve pain and stiffness.
  1. Pain is a sign of damage. Severe pain must mean something is seriously wrong.
    Many conditions cause pain, including muscle cramps and spasm which can be very painful. In these cases there is no actual damage to the muscles, just tightening of the muscles. Stretching the muscles can often be helpful.
  1. Once pain has set in, it will never go away.
    Not true. Often the pain may start for no reason and equally it may just go. It is important even after a long time of pain to try and remain positive. New treatments are always emerging and even though your problem may not have responded to past treatments, there are usually other options. With technology advancing at a rapid rate new therapies are just around the corner. Here at the Brighton Spinal Group we aim to keep up to date with all the latest scientific research and keep you informed as new proven treatments emerge.
Where to from here?

The most important person that can help you is you! If you smoke or are overweight – you need to take control and do something about it… today! There is no point in making excuses or putting things off till next week. You only get one chance at life and we must make the most of it.

Having trouble coping or need some one to help you through the stresses – our trained psychologists can help with sleep problems, stress and over-eating in response to pain.

You’ve heard the term “use it or lose it”. It is true – if we just lie around and rest all day our muscles wither away, our bones become brittle and our joints stiffen up. Regular exercise is important for the back, even if you are feeling sore. The discs and other joints gain their nutrition through small regular movements of the spine. Our bodies tend to stiffen up with age and often it is the stiffness or cramping of the muscles that hurts the most – we need to stretch these. Initially it will hurt but with time it should gradually get easier. Our physical therapists can assist with an exercise program that is achievable. Sometimes the pain is just too great to move much and injections may be needed to reduce the spasm. The injections are rarely a cure – they just reduce the pain and spasm and allow movement which in-turn stimulates the body to heal itself. The bottom line is that the body naturally tries to heal itself and by remaining positive and active we can help.

For those with more generalised pain then more general pain management strategies are appropriate. Some useful links to explore this area further are:
www.paintoolkit.org

Chronic Pain

The definition of chronic pain is pain lasting longer than 3 months. In practice we usually use this term for persisting pain that continues beyond the time we normally expect for healing of a torn ligament or broken bone.

Click to view Handout (PDF) Chronic Pain