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Chronic Pain: The Invisible Disability

Isolated times of pain are part of a normal, healthy body's way of signaling injury, disease or distress, helping us take good care of ourselves. Everyone has these experiences and, though they can be difficult, we can understand the natural processes at work in these limited times of pain.

What is chronic pain?

Chronic pain, sometimes also called persistent pain, is different from the pain all people experience occasionally because it does not go away. Simply put, it is not serving a good purpose and is not part of a healing process. Chronic pain is not normal, not healthy, and may be a serious disability affecting the quality of one's life.

What people with this disability have in common is the chronic nature of their pain, whatever sort of pain it is, however it began. For some, the pain begins with an initial injury or infection but never goes away. For others, it is unclear how and why the pain began and persists. According to the National Institutes of Health, while chronic pain may begin with a medical condition, "some people suffer chronic pain in the absence of any past injury or evidence of body damage."[1]

Who suffers from chronic pain?

Unfortunately, millions of Americans of all ages and all walks of life know how difficult it is to live with persistent pain. The chart below, taken from the website of the American Academy of Pain Medicine, makes it clear that "pain affects more Americans than diabetes, heart disease and cancer combined."[2]

Condition

Number of Sufferers

Pain

76.2 million people, National Centers for Health Statistics

Diabetes

20.8 million people (diagnosed and estimated undiagnosed) American Diabetes Association

Coronary Heart Disease (heart attack and chest pain) and Stroke

18.7 million people, American Heart Association

Cancer

1.4 million people, American Cancer Society

A report issued by Partners for Understanding Pain, a consortium of over 50 groups, states that 80% of those suffering from chronic pain are between the ages of 24 and 64.[3] It also states that "chronic pain is the number-one cause of adult disability in the United States."[4]

Common Causes of Chronic Pain

While each person's experience is unique, many common conditions are associated with chronic pain. According to the American Academy of Pain Medicine, "Back pain is the leading cause of disability in Americans under 45 years old. More than 26 million Americans between the ages of 20-64 experience frequent back pain."[5] "Chronic back pain is measured by duration - pain that persists for more than 3 months is considered chronic. It is often progressive and the cause can be difficult to determine."[6]

The National Institutes of Health reports that "common chronic pain complaints include headache, low back pain, cancer pain, arthritis pain, neurogenic pain (pain resulting from damage to the peripheral nerves or to the central nervous system itself), [and] psychogenic pain (pain not due to past disease or injury or any visible sign of damage inside or outside the nervous system)."[7] In addition, The National Foundation for the Treatment of Pain also lists severe burns, myocardial ischemia, renal colic and gout as conditions often involving intractable pain.[8]

The American Pain Foundation lists common pain conditions as including Central Pain Syndrome, which can be caused by a variety of medical conditions, muscle and joint problems, and neuropathic pain, or pain caused by damage to the nerve fibers, which can result from a number of different conditions.[9] Other conditions associated with chronic pain include depression, fibromyalgia, myofascial pain syndrome, sickle cell, osteoarthritis, and shingles.

When people experience pain that cannot be linked to an organic problem (that is, a bodily organ), a diagnosis of psychogenic pain is made. Most commonly, muscle, stomach, and back pain are associated with this type of chronic pain, as well as headaches.[10]

As is clear from this brief sampling, there are many possible causes of chronic pain and diagnosing its cause is often a complex matter. All forms of pain are real and require careful attention and treatment. Living with pain is difficult, but many types of help are available.

Treatments for Chronic Pain

Just as there are many different causes for chronic pain, there are also many possible treatments which may help a person manage his or her discomfort, and a combination of strategies may be necessary. The Cleveland Clinic lists the following:

  • Non-steroidal anti-inflammatory drugs (NSAIDs) [over the counter]
  • Narcotics (such as morphine or codeine)
  • Localized anesthetic (a shot of a pain killer medicine into the area of the pain)
  • Nerve blocks (the blocking of a group of nerves with local anesthetics)
  • Acupuncture
  • Electrical stimulation
  • Physical therapy
  • Surgery
  • Psychotherapy (talk therapy)
  • Relaxation techniques such as deep breathing
  • Biofeedback (treatment technique in which people are trained to improve their health by using signals from their own bodies)
  • Behavior modification[11]

Controversial Issues: Disparities in Pain Treatment

According to the American Pain Foundation, there are disturbing minority and gender issues involved in pain treatment. Minorities are less likely than non-Hispanic whites to "have access to pain management services and treatments, have their pain documented by healthcare providers, and receive pain medications."[12] The same report states that "women's pain complaints tend to be poorly assessed and undertreated."[13]

All people in pain deserve help and support for managing their situation as best as possible. Accurate diagnosis and careful assessment of the best treatment possibilities can help those living with chronic pain to improve the quality of their lives.

Suggested Resources for Further Information:

American Chronic Pain Association: www.theacpa.org

American Pain Foundation: www.painfoundation.org

National Institute of Health Chronic Pain Information Page:

http://www.ninds.nih.gov/disorders/chronic_pain/chronic_pain.htm

Medical information on chronic pain gathered from National Institutes of Health and published for the public: http://vsearch.nlm.nih.gov/

Department of Pain Medicine and Palliative Care at Beth Israel Medical Center: http://www.stoppain.org/pain_medicine/content/chronicpain/myofascial.asp

Partners Against Pain http://www.partnersagainstpain.com/

Cleveland Clinic Website

Mayo Clinic www.mayoclinic.com



[3] This report is available in pdf format at a link on The American Chronic Pain Association website: http://www.theacpa.org/partners/media.asp

[4] Ibid.

[5] http://www.painmed.org/patient/facts.html Accessed January 22, 2009.

[8] http://www.paincare.org/ Accessed February 8, 2009.

[9] http://www.painfoundation.org/page.asp?file=Library/Index.htm Accessed January 22, 2009.

[10] http://my.clevelandclinic.org/services/Pain_Management/hic_Psychogenic_Pain.aspx Accessed February 8, 2009.

[11] http://my.clevelandclinic.org/ Accessed February 8, 2009.

[12] http://www.painfoundation.org/page.asp?file=Publications/Index.htm Issue Briefs. Pain Management and Disparities. November 2008. Accessed February 8, 2009.

[13] http://www.painfoundation.org/page.asp?file=Publications/Index.htm Issue Briefs. Pain Management and Disparities. November 2008. Accessed February 8, 2009.

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