Chronic Pain

Original Editor - Rachael Lowe

Top Contributors - Kim Jackson, Admin, Nikhil Benhur Abburi, Laura Ritchie, Shreya Pavaskar, Thomas Longbottom, Jess Bell, Rachael Lowe, Tarina van der Stockt, Lauren Lopez, Lucinda hampton, Kirenga Bamurange Liliane, Olajumoke Ogunleye, 127.0.0.1, Evan Thomas and George Prudden

Chronic Pain Explained

The factors that predict the development of chronic pain following an acute episode of pain do not relate to any 'biological' factors such as findings on physical examination, or change on X ray, but to what are termed 'psychosocial variables', such as mood, stress and the social situation in which the pain occurs.

When pain persists in spite of medical treatment, as is the case in chronic pain syndromes, the issues become even more complex. The problem is that matters get worse not solely due to progression of the disease (the pathology in the tissues) but to the vicious circle the people find themselves in. A person who has pain, especially on movement, tends to avoid doing things that provoke their symptoms. They rest but unfortunately this is not a helpful treatment as it leads to secondary stiffness and weakness, causing worsening of the symptom that the individual is trying to avoid.

Inability to function leads to a loss of role and self-esteem with the progressive intrusion of other problems such as financial hardship and strained relationships. Tablets may cause side-effects, pain may prevent sleep, and all these difficulties cause worry and low mood which worsens the situation yet further. Treatments will be attempted through desperation rather than evidence of their effectiveness with a high risk of failure. This leads to further worsening of mood which fuels a sense of desperation.

Chronic Pain Management

Modern cognitive behavioural approaches to pain have developed from a number of linked models, all with some efficacy on their own but gaining from being delivered in combination. They have clearly been shown to be the most logical treatment for individuals suffering from chronic musculoskeletal pain, where the pain is accompanied by disability and psychological distress.

In essence, cognitive behavioural approaches aim to improve the way that an individual manages and copes with their pain, rather than finding a biological solution to the putative pathology. The approach is very much related to problem solving and returning control to the sufferer. Many patients state that the pain rules their lives and cannot see how this can change without a medical cure. However, with appropriate instruction in a range of pacing techniques, cognitive therapy to help identify negative thinking patterns and the development of effective challenges, stretching and exercising to improve physical function, careful planning of tasks and daily activities, and the judicious use of relaxation training, many people find the treatment enables them to take back control of their lives, to do more and feel better.