Chronic Pain: Causes, Symptoms & Treatment

Chronic pain is not perceived as such by many patients, which is why often no doctor is consulted. In principle, all pain that lasts longer than two weeks should be taken seriously. Self-therapy with painkillers should be avoided, because behind chronic pain can be serious causes.

What is chronic pain?

Infogram on pain regions, progression and development of pain, and intensity levels in pain sensation. Click image to enlarge. Pain is normally a protective function of the body to perceive physical disturbances. If chronic pain occurs, it sometimes exists without a physical cause. In its chronic form, the pain has then detached itself from the physical and continues to exist. Pain can be categorized based on different characteristics, such as how it originates or how it is experienced. Chronic pain may always be present or it may cease from time to time and recur later. According to the place of origin, a distinction is made between somatic pain of the muscles, joints or skin, neuropathic pain, synonymous with nerve pain, pain in the head region and pain of the internal organs. One speaks of chronic pain if it lasts at least three months and the person is impaired in his daily life.

Causes

Chronic pain is caused by nerve impulses becoming independent. In severe injuries, nerve cells send impulses to the brain over a long period of time, and their metabolism can change as a result. This is referred to as pain memory of the nerve cells. This incorrect polarity occurs in the spinal cord. As a result, many stimuli, such as normal touch, cold or heat, are perceived as painful. The same applies to psychological stimuli such as stress, grief, fear or the memory of pain. Other causes can be diseases such as rheumatism, herniated discs or severe inflammation.

Symptoms, complaints and signs

Chronic pain does not differ in its point of origin from pain that occurs acutely. Rather, in chronic pain, the duration of its existence defines that the symptoms accompanying it are considered chronic. A distinction must be made between pain that recurs with attacks and pain that is permanent. A typical feature of chronic pain is that it persists over a long period of time. The severity of the pain can vary as much as the location of the pain. The symptoms of chronic pain can be varied. They depend on the underlying problem. This may have arisen due to surgery or for other reasons. As a precursor of chronic pain, acute burning, stabbing or dull pain may occur first. These do not respond (sufficiently) to symptomatic treatment or recur repeatedly. The symptoms of chronic pain become independent after a while. They are stored in the pain memory and form an independent disease after chronification. Depending on the extent of the chronic pain, a pain syndrome can develop. Often in chronic pain, individual symptoms are no longer perceived as such. In chronic back pain, only a complex pain sensation is perceived instead of individual strained muscle strands. If the pain can be assigned to a nerve, it is a neuralgia. Severe chronic pain may be accompanied by accompanying symptoms such as edema, circulatory disturbances, sweating, depression, or withdrawal from the usual life.

Diagnosis and course

Diagnosis is complex because the forms of chronic pain are very diverse. An exceptionally differentiated diagnosis is essential to find the right therapy. The diagnosis includes the obligation on the part of the patient to keep a pain diary. In it, all situations in which the pain occurs are recorded, all symptoms that accompany the pain are noted. In some cases, it may make sense to check the patient’s medical records for previous findings and to take a closer look at the patient’s life situation. Often, emotions and relationships influence how pain is felt. In addition, the patient fills out a scale on the intensity of the pain.This is accompanied by a thorough physical examination, a neurological and orthopedic examination, ultrasound, CT or magnetic resonance imaging, and possible neurophysiological diagnosis.

Complications

Complications can arise with chronic pain primarily if the patient self-medicates it with pain medications over a long period of time. Usually, painkillers damage the stomach in the long run and should not be taken for a long period of time. However, the further complications depend greatly on the cause of the pain and can never be universally predicted. In general, however, pain reduces the quality of life. The affected person can no longer actively participate in social life and often suffers from psychological discomfort. Likewise, pain leads to stress and an aggressive attitude. It is not uncommon for pain to spread from one point to different regions and can cause discomfort and pain even in unaffected locations. Often, due to the pain, there are restrictions in movement or other limitations in everyday life. Treatment of pain is always causal, but may be primarily aimed at relieving the pain. In many cases, therapies are necessary to treat the pain. It is not uncommon for physical treatment to be supported by psychotherapy. Whether life expectancy is reduced by chronic pain cannot generally be predicted.

When should you see a doctor?

Chronic pain, which can originate in different structures or organs of the body, is not always a reason to see a doctor regularly. Whether it makes sense to consult a medical professional depends largely on the individual case. An initial visit to the doctor is primarily important in order to determine the cause of permanent pain conditions and to find out about suitable forms of therapy. This serves, on the one hand, to ensure an exact diagnosis and, on the other hand, to enable the patient to act when the pain occurs. If a cause is found or the patient is well adjusted to the treatment of the pain, a further visit to the doctor is often not necessary. This is often the case, for example, if a helpful medication has been found for migraine or the chronic pain is not too severe and can even be alleviated with home remedies that have no side effects. A visit to the doctor is always advisable if the pain changes in quality or if the treatment options currently available to the patient do not help or no longer help. Here, the type has several options. Often, the visit to the doctor begins with an extensive examination to determine whether anything has changed organically. This can be followed by a change in therapy or the inclusion of alternative healing methods. In severe cases, another visit to the doctor for chronic pain leads to a referral to a specialized pain therapist.

Treatment and therapy

Treatment of chronic pain targets the cause and factors that exacerbate pain. It can be achieved through medication, physiological, psychological, and social methods. Medication interrupts the faulty transmission of pain impulses. At the same time, the patient’s perception of pain is altered. Non-steroidal anti-inflammatory drugs are used for mild pain, and opioids are used for moderate, severe and very severe pain. Some pain patients are dependent on pain medications. In these cases, drug-induced pain may have occurred and withdrawal occurs. Depending on the type of pain, anticonvulsants or antidepressants may relieve pain in some cases. Anti-epileptic drugs are often prescribed for nerve pain. Forms of treatment that may complement drug therapy include:

  • Psychotherapy
  • Transcutaneous electrical nerve stimulation
  • Acupuncture
  • Autogenic training and exercise therapy
  • Physiotherapy
  • Local anesthetics
  • Operations
  • Change of lifestyle

Outlook and prognosis

Chronic pain is a permanent or recurrent condition and thus its prognosis is dependent on pain management. In addition, the course of chronic pain depends on the underlying disease.In the case of degenerative diseases that can no longer expect to be cured, chronic pain usually worsens at the same time as the disease progresses. If, on the other hand, the chronic pain is due to a disease that can still be influenced in its course, then it may well get better again. If, on the other hand, it is due to a permanent physical change such as the loss of a body part, the pain can also become permanent and require pain therapy. Modern medicine now has many effective chemical painkillers that are suitable for combating pain, at least for a short period of time. In the long term, however, pain therapy provides for methods that do not rely on drugs, because many highly effective painkillers become addictive over time. Thus, if a patient with chronic pain is dependent on medication for a longer period of time, medication dependence may develop in addition to pain, creating another problem that requires treatment. In the long term, chronic pain management is mainly about finding methods for patients to learn to tolerate pain or eliminate it without causing unnecessary harm to the body or becoming dependent on medications.

Prevention

To prevent chronic pain, exercise generally can’t hurt. Furthermore, it is important to take prolonged pain seriously and see a specialist instead of fighting it in self-therapy. Being aware of your own needs can also be important. Know what is generally good in life and what should rather be avoided, where social or personal problems are present.

Aftercare

Depending on the type and intensity, the doctor chooses a treatment. It should stop possible complications and support the patient in his or her daily life. However, it usually does not eliminate the causes of chronic pain. Therefore, follow-up care cannot aim to prevent a recurrence. After an initial diagnosis, the patient presents at an agreed-upon interval. The main topic of discussion is the experience with the measures taken. The improvement of the symptoms plays a decisive role for further progress. Depending on the clinical picture, certain examinations are able to document the progress. Suitable tests include blood tests, imaging procedures (X-ray, ultrasound, CT) and neurological or internal medicine methods. Medication may also be indicated. If necessary, a rehabilitation program can be ordered. In this program, patients learn techniques for dealing with chronic pain in everyday life. Relaxation exercises such as yoga, autogenic training or meditation help them cope with the problem. In some cases, rehabilitation also introduces patients to acupuncture or psychological support, which they can then continue at home. A rehabilitation measure does not have to be a one-time event. It may even prove useful several times.

What you can do yourself

The perception of pain is strongly influenced by the psyche, in particular by the importance attached to pain and how much attention it is given. Especially in the case of mild to moderate chronic pain, it can therefore already be helpful to focus on something else in everyday life. Relaxation techniques such as yoga or autogenic training can help. Those who are no longer employed should look for a fulfilling hobby or get involved in charitable work. The distraction generated in this way means that chronic pain is no longer the focus of the patient’s own perception. Many patients also find it helpful to talk to other sufferers. Self-help groups are available locally or on the Internet. Depending on the cause of the chronic condition, simple home remedies can also help. Heat is often very effective for nerve pain. Nerve pain is therefore treated with a red light lamp or, quite traditionally, by placing a hot potato wrapped in a towel. For rheumatic complaints, baths in warm brine help many patients. Brine baths are offered in many health resorts. At home, Dead Sea salt can be used for bathing and is available in pharmacies, health food stores and drugstores. In naturopathy, a number of mild herbal remedies are also used. For rheumatic diseases and gout, preparations with devil’s claw are prescribed.Tea from willow bark is used as a mild painkiller. Chronic pain in the mouth and jaw area is treated with clove oil.