Acute pain can be a useful alarm signal – "Better see the doctor about this ache." Chronic pain is now understood to be different. This type of pain goes on and on without stopping. Although the pain often stems from some type of illness or injury, its role changes when it becomes chronic.
Traditionally, pain was defined as chronic once it had lasted a certain length of time.
It is now considered to be pain that goes on after one expects to feel better or be healed. Chronic pain is much more common than we might think. Surveys around the world show that up to a third of the population suffers from some kind of chronic pain. About three per cent of people suffer from severe chronic pain – pain that interferes with every aspect of life.
In the 1950s, chronic pain clinics began to assess and treat patients. At first, these clinics provided treatment for cancer pain. By the late 1960s, patients with other kinds of pain were also treated. Many therapies of the time first found the cause of pain, and then used injection treatments to interrupt pain signals. These techniques worked well for cancer pain.
However, there were often significant side effects like numbness, weakness and even paralysis. The cost was thought to be worth the benefit of helping dying patients live more comfortably.
These side effects made the techniques less useful with pain that did not come with cancer. As well, there was less benefit, as pain usually came back after weeks or months. Repeated injections did not usually solve the problem. Second and later injections often gave less relief or none at all. This was puzzling and frustrating. It was not understood why interrupting the 'wires' to the brain did not work permanently, and sometimes made things much worse.
During the 1960s, scientists began to discover that pain was not simply an alarm system as originally thought. Cutting the wires to the brain was not likely to stop the pain. In fact, results varied from at best having pain continue as before, and at worst having it become much worse.
People who have had a limb amputated experience phantom limb pain – feeling in a limb that no longer exists. Despite the fact that the wires are cut, the pain continues. This type of pain resists treatment. Research has shown that the alarm system in the nervous system has changed and can cause pain.
Further research reveals that the alarm system is incredibly complicated. It is not a simple one-way telegraph system, but a constantly adapting system with varying input and output signals. Once this was discovered, 'wire cutting' techniques were used much less. We have a better understanding of why they were not effective.
At this point, we began to use more medications. This included even strong painkillers like opioids or morphine-like drugs. While these drugs help, they do not seem to stop pain. Instead, they just take the edge off so people still must live with pain. Over time, people often must increase the amount of medication, paying more and getting less results.
In spite of years of research, the tools are still not perfect. The body is very good at putting pain back where it was before medications were added.
It seemed cruel to tell people to learn to live with chronic pain. Surely if this was possible they would already be doing so, and would not ask for help. Next, the idea of pain management emerged. This idea focused on learning techniques to successfully cope with chronic pain. By the early 1980s, a number of larger pain clinics had begun to offer specific pain management programs. This was an entirely new idea and was greeted with much skepticism. Many doctors wanted to continue the search for better injections to stop the pain signals or better medications to control them.
However, the pain management programs proved both successful and helpful. People who tried them seemed to have a better quality of life. Many also had less pain.
Over many years, health care providers working in the field of chronic pain saw that pain management techniques improved quality of life more than injections or medication used alone. This has been supported by further research. It is now accepted that using more than one method to treat chronic pain is much more successful than single-mode treatments.
This is not surprising, as chronic pain has such a devastating effect on every part of a person's life. Modern treatment plans include medication and sometimes injections as a kick-start that allows resumed activity. People learn psychological and physical skills to help manage pain. They can improve their level of physical and social functioning without having pain go beyond tolerance. This is not just 'mind over matter' or pushing through pain. People learn the skills needed to actually reduce pain.
Chronic pain is a disease that requires pain self-management. Just as with living with diabetes, lifestyle changes are necessary. Briefly, the skills for managing chronic pain include:
These skills can be taken anywhere, there are no side effects, and the body does not become tolerant to them.
We now better understand the three types of pain:
Each requires a slightly different plan of management. Using self-management skills helps people to better understand their own pain and apply the most effective therapies. Most chronic pain sufferers have a combination of pain types.
Research in the area of chronic pain continues. Our understanding of the nature of pain is expanding. It is now known that pain is not an accurate indication of the health of the body. It is not a simple alarm system. It is better thought of as a measure of the brain's evaluation of the need to protect the body. As this is very complex, so are the methods of controlling pain. However, quality of life can improve for those living with chronic pain.