What is chronic pain?

There are two types of pain: Acute pain and chronic pain. Acute pain is usually temporary pain that is related to a specific cause; for example, a sprained ankle, sunburn, a fracture, or other trauma or illness. It is your body's way of "signaling" to you that something is not right. Chronic pain, on the other hand, is pain which lasts far beyond the point where it could be considered useful. For example, pain from arthritis, from the neck or back, or from "trigger points", can last months beyond the initial injury or onset of the condition. In some cases, the body may be signaling a serious underlying condition; more often than not, the pain is there without informing the body of any specific problem.

What's the difference whether the pain is acute pain or chronic pain?

The pain may be just as uncomfortable but the tactics for dealing with it by necessity change in chronic pain. In chronic pain, at times the underlying cause becomes secondary. Whereas acute pain may affect sleep, appetite, activity level, and mood, chronic pain can have complex and adverse effects on all of these as well as on one's ability to work, one's finances, and one's social situation. Chronic pain can cause stress between family members and can make people feel "bad" about themselves. This may complicate the picture by causing anxiety, depression, and daily tension. Even so, there are effective techniques for reducing symptoms and returning as much as possible to a normal lifestyle.

How can chronic pain be treated?

Treatment options include medications, physical therapy modalities, exercise, biofeedback, cognitive behavioral therapy, injections, acupuncture, and hypnosis. These are each discussed individually in more detail.

Multidisciplinary Management
of Chronic Pain

What medications are beneficial?

Obviously, all medications should always be discussed with a physician because of possible side effects and drug interactions. Groups of drugs which can be effective include:

1) Non-steroidal anti-inflammatory Drugs (NSAID'S): These are drugs which, like aspirin, are useful in reducing inflammation when that represents asigeificant component of the patient's ongoing pain. These mediGatiorns are also as effective as the milder narcotics in directly reducing pain. They block production of certain chemicals which produce pain sigmals in the body. Drugs in this category include aspirin, Motrin. Advil, Naprosyn, Indocin, Clinoril. Dolobid. Orudis, Voltaren, Nalfon. Disalcid, Feldene. and many others.

2) NBICOtic medications: These have very little role in chronic pain whereas they are useful in acute pain, post-surgical pain, and cancer pain. In these three populations, the risk of addiction is minimal and the drugs are effective in blocking pain signals. In chronic pain syndromes, these drugs are frequently disappointing in their effect and the patient develops a tolerance for the dosage and is lulled into taking a higher dosage. This pattern, in combination with the sense of desperation caused by ongoing pain, causes a potential for drug dependence. Even when narcotics are used in chronic pain, they should be taken in anticipation of the return of the pain rather than as a "reward" for the return of the pain. It is easier to prevent significant pain than to treat intolerable pain.