Pain is an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage. The purpose of pain is to alert us that something may be wrong. For sufferers of chronic pain, the condition can be debilitating and affect many aspects of life.

Neuraxpharm provides medication alternatives for chronic pain and once your doctor has determined your specific needs, they can prescribe the product that best adapts to your needs and condition.

Read on to find out more about the condition, including symptoms and treatment options.

What is chronic pain?

The International Association for the Study of Pain describes chronic pain as ‘pain which has persisted beyond normal tissue healing time’(1). Chronic pain is defined as pain that lasts or recurs for more than three months. It can involve complex psychological and social factors.

What are the main types of chronic pain?

Chronic pain is a long-term condition, with examples including arthritis, fibromyalgia, migraine, and back pain. There are three broad categories of chronic pain:

  • Neuropathic pain: This relates to nerve damage.
  • Nociceptive pain: Nociceptors are the nerve receptors that get activated when there’s an injury; in chronic pain the receptors may still send pain messages, even after the injury heals.
  • Idiopathic pain: This is pain that has no apparent underlying cause.

How many people have chronic pain?

At least 10% of the global population suffers with chronic pain, while estimates of prevalence in some countries and regions are around 20–25%. A further one in 10 people develop chronic pain every year worldwide(2). In Europe, almost 20% of the adult population report having moderate or severe chronic pain(3), which equates to 150 million people.

Symptoms

The exact symptoms vary between individuals, but chronic pain is recognised as pain that persists past normal healing time. Usually, pain is regarded as chronic when it lasts or recurs for more than three to six months(4).

What are the symptoms of chronic pain?

If a pain persists for longer than 12 weeks, it is chronic pain. The pain could be related to a previous trauma or injury, or it could be caused by damage to the nervous system (such as sciatica). In older individuals it could develop because of a degenerative condition such as arthrosis. Chronic pain can interfere with the ability to perform daily activities and may have an impact on sleeping and mental health. Sufferers can find they are doing less activity in an effort to minimise the pain, and could put on weight and grow lethargic as a result. The impact on daily life linked to long-term pain can include:

  • Reduced involvement in family or social activities
  • Difficulty concentrating
  • Missing work
  • Changes to sex life

What are the stages of chronic pain?

Chronic pain is a long-term condition that sufferers learn to live with through pain management techniques, under the supervision of a doctor. The pain can be constant or intermittent and some days the severity can be debilitating. But it is the longevity of chronic pain that makes it difficult to deal with. It’s common to experience emotional upset alongside the physical symptoms.


Some specific conditions – for example, back pain – may start as acute pain following a sprain or strain but could continue for much longer than expected. The treatment plan for this would be a stepped approach starting with self-management, and moving up to physical therapy, pharmacological treatment or even surgery. The journey of every patient with chronic pain is an individual one.

What are the early signs of chronic pain?

Chronic pain is defined as pain that lasts or recurs for more than three months. The exact pain is very different for each individual. Chronic pain can occur in any part of the body. It could be steady or intermittent and come and go without any obvious reason; it may feel sharp or dull. If any pain persists for an extended period of time, it could become classed as chronic pain.

Causes, risk factors and life expectancy

What causes chronic pain?

Chronic pain is common and has many different causes. While the pain can be related to other medical conditions, trauma or injury, it can also be caused by problems with the nervous system, which can send pain signals to the brain despite a lack of obvious tissue damage.

Potential causes of chronic pain include:

  • Cancer: Chronic pain can occur as a result of either the disease or its treatment.
  • Trauma: Surgical or accidental trauma to tissue can lead to chronic pain.
  • Disease of the somatosensory nervous system: This can result in peripheral and central neuropathic pain.
  • Secondary musculoskeletal pain: An underlying disease elsewhere can cause chronic pain in bones, joints, and tendons.

Is chronic pain hereditary?

Chronic pain itself is not hereditary, but there is evidence to suggest that some conditions which can lead to chronic pain may be.

A team of UK researchers carried out a study involving 8,000 sets of twins(5), looking at four conditions that can manifest as chronic pain: irritable bowel syndrome, musculoskeletal pain, pelvic pain, and dry eye disease. The study showed that if one identical twin suffered from one of these ailments, then it was likely the other twin did as well. As identical twins share virtually the same genetic code, this suggests a heritable element to these conditions.

Who gets chronic pain?

In a 2019 study published in the British Journal of Anaesthesia, researchers reviewed studies that looked at the association between myriad risk factors – including biological, psychological, and socio-economic – and the development, persistence, or severity of chronic pain(6). They found that the most important clinical risk factor (or ‘tell-tale sign’) for chronic pain to develop is the presence of another site of acute pain within the body. In other words, people who experience short-term severe pain (for example, as a result of an injury) are more likely than people without any pain to develop chronic pain.


The study also found that patients with depression or cardiovascular disease were more likely to suffer with chronic pain than those without.


While age isn’t a determining factor for suffering from chronic pain, as a person ages it becomes more likely they will experience conditions that could lead to chronic pain.

How long can you live with chronic pain?

Chronic pain does not reduce life expectancy, and most patients can find ways to manage their pain in order to live a full life. However, while chronic pain can’t kill anyone, it can have a profound effect on quality of life and mental health; people with severe chronic pain are twice as likely as others to have suicidal thoughts(7).

Diagnosis

If someone thinks they are suffering with chronic pain, it is important to visit a doctor so that they can make a diagnosis.

How is chronic pain diagnosed?

As pain measurement is subjective and very personal to each individual, the healthcare provider will need to carry out a systematic and comprehensive assessment to characterise the pain – for example, to determine whether it is burning, stabbing, or throbbing – and clarify its impact on the individual’s life. They will take into consideration any other medical and psychological problems. A physical examination may be required as part of the assessment, and it is important to discuss and evaluate all the pain treatments that have been tried. This helps them gain a clearer understanding of the pain and the potential benefits of treatment.


A detailed pain assessment will allow the healthcare professional to determine whether the pain being experienced matches a well-known pain syndrome, or whether there is a structural disease that may help explain the pain. This can then help to form an understanding of what it is that maintains the pain and whether the cause is physical or psychological. The assessment will also highlight any negative effects the pain has on physical and social functioning, and explore any co-existing problems that may need treatment at the same time.

Test to diagnose chronic pain

Although there is no specific diagnostic test for chronic pain, there are tools that healthcare providers can use to help determine the severity of pain and the impact it has on daily life. A pain assessment chart can be used to help gather a clear history of the pain while assessing its nature and severity. The chart can be used over time to establish which treatments are working. The three types of assessment chart that are usually used rate pain on a numerical scale, a verbal scale, or a visual scale.


In addition to pain charts, there are other methods healthcare professionals can use to diagnose chronic pain. These depend on the type of pain being experienced but, for example, in the case of peripheral neuropathy a nerve function test called electromyography (EMG) could be used. This involves an electrode being inserted into a muscle to record electrical activity and detect nerve damage. At the same time, the doctor may perform a nerve conduction study to record the nerves’ responses to an electric current by attaching a flat electrode to the skin that emits a low electric current.

Treatment and medication

How is chronic pain treated?

Treatment plans are tailored to the individual and usually consist of a combination of medication, exercise, and physical therapy. No single technique is guaranteed to provide complete pain relief, but most patients are able to find a combination of treatment options that helps them manage their condition. Patients are usually advised to continue working if possible, even if sometimes a reduced workload is necessary, as this can provide a distraction from the pain. Carrying on with life as normally as possible can help reduce the chance of feeling low and developing depression. Any treatment plan will take into account the patient’s preferences and situation with a package of care that addresses the pain symptoms and any other associated problems, which could include low mood, anxiety, or sleep disruption.

Medication

Over-the-counter painkillers such as non-steroidal anti-inflammatory drugs, analgesics and simple opioid drugs can help reduce pain but are not a long-term solution. Because the condition is so personal to each patient, any medication plan will be tailored to the individual and should be overseen by a healthcare professional. In some cases, pain relief or steroid injections can be given. Anti-convulsants (anti-epileptic drugs) may be used to treat various neuropathic pain conditions, while sedatives or anti-anxiety agents could be prescribed for short-term treatment of sleep problems resulting from chronic pain. Anti-depressant medication may also be given as some anti-depressants have specific indication for the treatment of certain forms of chronic pain, and some people with chronic pain may also suffer from depression. Types of anti-depressants that could be prescribed include tricylic anti-depressants and selective serotonin reuptake inhibitors.

Therapy

It’s likely a doctor will refer someone with chronic pain to services that can provide self-help techniques to manage the pain. Physical therapy is a common treatment for chronic pain and can involve manipulation, stretching, and pain relief exercises. The physiotherapist will want to understand the pain and how it affects daily life in order to help the individual live well again. They are likely to provide exercises that can be done at home to help relieve the symptoms. Many patients find these types of pain management techniques an effective way of coping with daily life.

Intervention

Many techniques are recommended that can help people manage chronic pain. These include:

  • Deep breathing: Controlling breathing and concentrating on each breath helps the body to relax, which can reduce the pain.
  • Mind-body therapies: These are techniques that aim to use the mind to affect the symptoms of the body. Examples include hypnosis, cognitive behavioural therapy, and meditation.
  • Hot or cold compresses: These can be used singly, or in combination. Physical supports can also be helpful, depending on where the pain is.
  • Complementary or alternative therapies: Some patients find that acupuncture and other therapies provide some relief from their symptoms.
  • TENS (transcutaneous electrical nerve stimulation) machine: This is a method of pain relief that uses a mild electrical current. A device is attached to the body with electrodes that deliver an electrical signal, which can reduce the pain signals going to the spinal cord and brain. These can be purchased for home use and in some instances can be hired. It’s best to speak with a healthcare provider before looking into this.

Diet

Although there is no solid scientific evidence that a particular diet can treat chronic pain, eating a variety of foods, including fruits and vegetables, is recommended for a healthy lifestyle. A healthy diet optimises energy and balances hormones, which can help with the symptoms.

There is, however, a suggestion that some dietary modification by supplementing the diet with specific nutrients may be useful in people with chronic pain(8).

Exercices

Although resting for short periods of time can alleviate pain, too much rest could increase the risk of injury when the person attempts to move again. Exercise is recommended as part of a daily routine for those with chronic pain as it improves muscle tone, strength, and flexibility. For many people, doing exercise each day can reduce the number of bad pain days, or at least lead to the pain becoming more manageable; this is because exercise releases the body’s natural painkiller, endorphins. Helpful gentle exercises to try include walking, swimming, using an exercise bike, and yoga.

Prevention

Chronic pain is a serious condition that often has a huge impact on the sufferer’s life and puts a burden on health services. Unfortunately, there is no proven preventative measure for the condition, but chronic pain that develops as a result of a severe or sudden injury can sometimes be prevented through proper management of the initial injury.

Scientific studies

As chronic pain is a condition affecting so many patients worldwide, it is unsurprising that there are a wealth of scientific studies on the topic, ranging from the efficacy of treatment options to how widespread the condition is. Research institutions around the world have entire departments dedicated to exploring pain management.


The European Commission is currently funding an international collaborative research project called QSPainRelief, which brings together 10 partner institutions from five European countries and the USA to develop and implement new personalised treatments for chronic pain patients. The five-year project started in January 2020 and aims to use computer and mathematical models to support drug discovery and guide research in order to identify different combinations of existing medication that may provide relief for these patients.

Referenced sources

  1. International Association for the Study of Pain, Subcommittee on Taxonomy. Classification of chronic pain: descriptions of chronic pain syndromes and definitions of pain terms. Pain Suppl. 1986;3:S1-S226. PMID: 3461421
  2. Jackson TP, Sutton Stabile V, McQueen KAK. The global burden of chronic pain. ASA Newsletter. 2014;78(6):24-27. 
  3. Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2006;10:287-333. doi: 10.1016/j.ejpain.2005.06.009
  4. Treede RD, Rief W, Barke A et al. A classification of chronic pain for ICD-11. Pain. 2015;156(6):1003-1007. doi: 10.1097/j.pain.0000000000000160 
  5. Vehof J, Zavos H, Lachance G, Hammond C, Williams F. Shared genetic factors underlie chronic pain syndromes. Pain. 2014;155(8):1562-1568. doi: 10.1016/j.pain.2014.05.002
  6. Mills SEE, Nicolson KP, Smith BH. Chronic pain: a review of its epidemiology and associated factors in population-based studies. Br J Anaesth. 2019;123(2):e273-e283. doi: 10.1016/j.bja.2019.03.023
  7. Racine M. Chronic pain and suicide risk: a comprehensive review. Prog Neuropsychopharmacol Biol Psychiatry. 2018;87(Pt B):269-280. doi: 10.1016/j.pnpbp.2017.08.020
  8. Philpot U, Johnson M. Diet therapy in the management of chronic pain: better diet less pain? Pain Manag. 2019;9(4):335-338. doi: 10.2217/pmt-2019-0014
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