Chronic Pain Overview
Chronic pain, which may vary in intensity from a mild ache to excruciating, debilitating symptoms, lasts longer than six months. Pain signals from the nervous system can linger for years, causing unbearable stress both physically and emotionally.
Unfortunately, this is a common malady with millions of Americans agonizing over chronic pain. Even more troublesome is that the cause is not always found, i.e. the pain may not be from trauma or an obvious cause.
The most common sites for chronic pain are:
- Carpal Tunnel
- Secondary to trauma
As the pain progresses and lingers, our coping mechanisms and immune system deteriorates so that the problem is also associated with:
- Tension and stress
- Lethargy and fatigue
Doctors Who Treat Chronic Pain
As your chronic pain is diagnosed, treated and managed, you may encounter the following team of doctors and specialists. Having a team of doctors or specialists with varied expertise will more accurately help diagnose the possibility of having chronic pain.
Pain Management Specialist – Doctors that treat chronic pain with both traditional pain medications and alternative therapies like acupuncture and massage therapy. Doctors here focus on diagnosis, treatment and therapy for sufferers.
Other team specialists could include:
- Psychologists – Trained professionals who focus on the health and well-being of individuals and families; they assess and treat emotional and psychological disorders like depression or mood conditions (prevalent in those with chronic pain)
- Psychiatrists – Doctors who focus on the health, diagnosis and treatment of mental, emotional and addictive disorders. They use medications as well as psychotherapy.
- Orthopedists – Doctors who specialize in the health, diagnosis and treatment of the musculoskeletal system.
- Gastroenterologists – Physicians who specialize in the health, diagnosis and treatment of digestive system conditions
- Rheumatologists – Doctors who specialize in the health or disorders with inflammation of joints and muscular pain
- Neurologists – Specialize in the health, diagnosis and treatment of nervous system disorders including sensation, reflexes, balance and motion.
- Neurosurgeons – Doctors who operate on nerves within the neurological system (most commonly with the spinal cord)
How to Prepare for Your Chronic Pain Doctor Visit
Having made your appointment with a healthcare provider, there are certain actions that you need to take in order to maximize the benefit of your [condition] doctor visit:
- All past medical conditions or illnesses along with dates
- All medications including vitamins, herbs, supplements
- Pain log
- List of specific Pain or sensitive points and when they became tender
- Any other symptoms
Preparation for Diagnostic Tests
- Preparation will depend on the body part that is being scanned.
- Some areas need no preparation. Forthe pelvis, one must drink 6 glasses of water and not urinate so that the bladder is full. Other areas need for you to fast for up to 6 hours prior to the examination.
- Fast for 4-6 hours prior to the examination.
- Arrange for transportation home.
- Inform the examiner of the following conditions: Pregnancy, Epilepsy, Asthma, Kidney problems, Diabetes, History of severe allergies
- Bring reading material.
- Limit fluids prior to exam.
- Inform the doctor if you are pregnant, nursing or have had x-rays with dye in the previous 4 days.
- Avoid solid foods from midnight prior to the examination
- Wear loose, comfortable clothing that lacks any metal
The following must be removed prior to an MRI:
- Hearing aids
- Hair pins, clasps
- Underwire bras
Unless otherwise instructed, one may continue a normal to light diet and all medications
- Discontinue any aspirin compound or anticoagulant for one-week prior.
- Fast from midnight on day of exam except medications with a sip of water.
- Arrange transportation for homebound trip.
- Consume only clear liquids the day prior to the exam.
- Avoid red liquids.
- Take a laxative the day prior to the exam.
- Arrange transportation for homebound trip.
Questions to Ask Your Doctor About Chronic Pain
From your initial diagnosis throughout your treatment and care, you will have questions about your chronic pain. Below is a list of questions to discuss with your doctor so you can make informed decisions about your condition.
Questions About My Diagnosis
- What is the cause of my pain?
- Is it associated with any condition?
- Will it get worse?
- Is the pain a signal of a serious problem?
Questions About My Treatment
- What treatment do you advise for pain management? Is this treatment addicting or have adverse side effects?
- Why did you choose this treatment option? Are there other treatment options?
- How long will it be before I see relief?
- Should I avoid pregnancy during the treatment?
- Are there herbs or supplements that can help me? Are there alternative therapies?
- Will physical therapy help?
- Are there studies I can enroll in?
Questions About My Lifestyle and Family
- Are there activities that caused my pain? Are there activities that I should avoid?
- Are there exercises that would alleviate my pain?
- What can I do to prevent a recurrence or to speed recovery?
- Are there foods that I should avoid?
- Could my work have caused the pain? Can I still perform my work duties?
- May I still drive?
- How can I get a better night’s rest?
- Would pregnancy worsen my condition?
Common Tests or Labs to Diagnose Chronic Pain
The first steps toward diagnosing chronic pain are to evaluate the history of complaints and symptoms along with a complete and thorough physical examination.
Additional tests (depending on the area of pain) include:
|Test||Why Test?||What Happens?||Result|
|Ultrasound|| Masses, cysts and abnormal vasculature can be visualized.
|High-frequency sound waves are used which pulse from a transducer over a body area where gel has been applied. The sound wave is recorded with images formed by the echoes displayed on a monitor||Scans will show whether there is an area of concern.|
|To confirm the diagnosis of food allergy when the history, diet diary, and elimination diet suggest a food allergy.||A contrast dye is injected into the spinal canal, making X-ray visualization more accurate.||The resulting image enables nerve compression to be detected from fractures of the vertebrae or herniated discs.|
|Shows areas of increased or decreased bone turnover
|A trace amount of radioactive material is injected into the bloodstream, which migrates to the bones, highlighting any abnormal areas such as fracture, infection, bone disorders.||Scanner images are collected on a computer, which senses areas of abnormal bone metabolism or blood flow.
|Identifies disc problems that may require surgery||The specific disc that is suspected of causing pain is designated and contrast dye is injected into it. X-rays are then taken which see the damaged areas outlined by the dye.||Test will show if there is damage on discs.|
|CAT scan (aka computed axial tomography)
|Non-invasive test which visualizes internal organs, bones, blood vessels, and soft tissue.
Growths, strictures, bleeding, and irregularities are visualized
|After lying flat on your back on the CT exam table, straps and pillows may be applied to maintain position.
The table then moves through the scanner as images are obtained. The table may make several passes.
The procedure takes approximately 30 minutes and is usually painless.
|No abnormal growths or irregularities|
|MRI (aka magnetic resonance imaging)||Detects any masses, growths, strictures, or irregularities of soft tissue, internal organs, bones, and blood vessels||You are asked to lie on your back on a table with your head, torso, and arms strapped down to prevent movement. The table then slides into a tunnel-like space that contains a magnet.
You may hear banging or tapping noises from the magnet movement but there is often piped in music to soothe you and mask the noise.
Images are taken in body cross sections.
The test usually takes 30-60 minutes and is painless.
|No inflammation of joints, ligaments and tendons|
|Analysis of the esophagus, stomach and duodenum.
|Passing a thin, flexible fiber-optic instrument through the mouth, into the stomach to visualize any abnormal areas. This is usually performed with mild sedation.||No polyps, growths, bleeding, or irregularities seen in the small bowel|
|Looks for growths
Strictures of the large intestine
| A colon prep is advised for 1-2 days prior to the exam to clean out the bowels involving dietary restrictions that cause frequent stools.
You will change into a gown after removing all clothes. Sedation is administered (usually intravenously) while you lie on your side on the examination table in a fetal position with knees drawn to your chest.
The doctor inserts a long, flexible, lighted tube into the rectum and guides it slowly to the colon, which is filled with air for proper viewing.
A video image is obtained from a camera attached to the scope, which is also transmitted to a computer.
Any polyps or abnormal tissue can be biopsied through the colonoscope.
After satisfactory viewing, the scope is withdrawn slowly. The procedure typically takes 20-60 minutes, but an additional hour is needed for recovery from the anesthetic.
|Clean, pink bowel mucosa seen with no growths, ulcers, or irregularities|
Common Medications and Treatments for Chronic Pain
Usually a combination of both drug and complementary therapies are tried in unison until a suitable result is obtained.
Psychotherapy is often recommended simultaneously as depression, anxiety and mood changes commonly accompany chronic pain and having this state makes the pain linger for a longer time. Conversely, stress exaggerates the sensation of pain and thus learning relaxation techniques helps to diminish the discomfort.
Complementary and Alternative Therapies
How it’s Done
|Cognitive-Behavioral Therapy (counseling)||Uses counseling or group therapy to alleviate depression and stress||Depression, anxiety, stress and mood changes are associated with chronic pain and decreasing one, helps alleviate both|
|Physical Therapy||Hot and cold therapy is applied to alleviate painful body parts. Stretching exercises are also done||Mobility, strength and flexibility is attained|
|Transcutaneous electrical nerve stimulation (TENS)||Short electrical pulses are applied to nerve endings in the skin||This therapy decreases pain signals to diminish the sensation of pain|
|Biofeedback||Control of body functions through meditation and focus||Consciously controls body areas where pain emanates to decrease the sensation|
|Acupuncture||Thin needles are inserted into the skin along specific energy zones||Achieves inner balance to the energy fields to command a healthier state of being.|
|Hypnosis||State of concentration where the patient is placed in touch with one’s subconscious state and less aware of current surroundings||Method of managing pain by individual directly|
|Massage||Rubbing the soft tissues and muscles||Reduces tension and pain while increasing relaxation and improving circulation|
|Meditation||Focusing attention away from pain||Enhances relaxation and calm|
|Naturopathy||Promotes healthy lifestyle through use of organic foods and exercise||Improving health helps the body heal itself and decrease painful cause|
|Hydrotherapy||Water massage or soaks to treat illness and maintain health||Promotes relaxation|
|Yoga||Breathing and physical Exercise and meditation||Decreases stress and promotes health|
How it works
|NonsteroidalAnti-Inflammatory drugs (NSAIDs)
and Oral Analgesics
|Diminish inflammation to relieve pain|
|Antidepressants||Modifies brain chemical levels to control pain|
|Anticonvulsants||Diminish the effects of nerve-related pain|
|Transdermal patches||Analgesics absorbed through the skin to decrease pain sensation|
|Analgesic Creams||Topically applied analgesics through creams decrease transmission of pain-relaying chemicals to the brain.|
|Narcotics||For severe painAct on pain receptors to control severe chronic pain|
|Nerve Blocks||Injection of local anesthetic to body region or nerves to specific area|
|TENS- Transcutaneous electrical nerve stimulation||small device delivers low dose electrical current to block pain as needed (often used with trigger point injections)|
|Radiofrequency Ablation||Nerve tissue sites are heated to diminish pain signals in a specific area. Under CT imaging guidance, a needle is inserted at the nerve site and an electrical current is used to heat and destroy (giving relief for up to 6 months)|
|Trigger Point Injections||Local anesthetic is injected into specific trigger point to relieve pain.|
|Pain pacemaker||pacemaker device is implanted which delivers electrical pulses to the spinal cord or specific nerves to help block pain signals from reaching the brain.|
|Spinal drug pump(intrathecal pump)||implanted pump that delivers local anesthetic, narcotic and other analgesics to block the nerve from sending a signal to the spinal cord|