Living with Chronic Pain

Chronic pain has several different meanings in medicine. If pain persists beyond 3-6 months, chances are it is chronic. A popular alternative definition of chronic pain, involving no arbitrarily fixed durations is "pain that extends beyond the expected period of healing." Unlike acute pain, which is pain that responds to an actual event of the body, chronic pain can be caused by an injury or illness, or it might appear out-of-the-blue. This is one of the reasons chronic pain is difficult to diagnose. Chronic pain may cause other symptoms or conditions, including depression and anxiety. It may also contribute to decreased physical activity given the apprehension of exacerbating pain. Chronic pain frequently carries a stigma, and misperceptions of laziness or pain killer addictions follow. Often misunderstood, chronic pain is very real.

One in ten Americans is expected to suffer from chronic pain at some point in their life. Pain that just will not go away is by far the most common neurological disorder -- a $100 billion-a-year burden on American society, experts say. The initial reaction to serious pain is usually fear (what is wrong with me, and is it curable?), but pain that fails to respond to treatment leads to anxiety, depression, anger and irritability.

Pain is an invisible, subjective symptom. The body of a chronic pain sufferer -- someone with fibromyalgia, for example, or back pain -- usually appears intact. There are no objective tests to detect pain or measure its intensity. You just have to take a person's word for it.

The nervous system is responsible for the two major types of chronic pain. One, called nociceptive pain, ''arises from injury to muscles, tendons and ligaments or in the internal organs. Undamaged nerve cells responding to an injury outside themselves transmit pain signals to the spinal cord and then to the brain. The resulting pain is usually described as deep and throbbing. Examples include chronic low back pain, osteoarthritis, rheumatoid arthritis, fibromyalgia, headaches, interstitial cystitis and chronic pelvic pain.

The second type, neuropathic pain, ''results from abnormal nerve function or direct damage to a nerve.'' Among the causes are shingles, diabetic neuropathy, reflex sympathetic dystrophy, phantom limb pain, radiculopathy, spinal stenosis, multiple sclerosis, Parkinson's disease, stroke and spinal cord injury.

The psychological and social consequences of chronic pain can be enormous. Unremitting pain can rob a person of the ability to enjoy life, maintain important relationships, fulfill spousal and parental responsibilities, perform well at a job or work at all. It is important to treat not only the pain but the psychological repercussions of the pain. Finding the right Doctor, getting counseling, pain therapy and group support are all important aspects of regaining control of your life and dealing with the consequences of living with pain.

Finding the right Doctor to treat your pain and then working with him to get an effective plan for reducing pain is a difficult task, but is the first step in controlling your pain. There are several different lifestyle techniques that can be effective for allowing patients to live a better life with their pain. Probably the most important one is improving the patient's ability to get a good night's sleep. This can be accomplished with both prescription medications and with behavioral modification techniques that the patient uses themselves at home to improve how well they sleep. The other recommendation is making sure that the patient remains as active as possible. Patients generally are going to hurt about the same whether they sit around the house or get up and go out and do some activities. And the more activities they do, the better endurance they'll have to be able to do what they want with their families.