Understanding Your Chronic Pain

In recognition of the need for more education related to chronic pain, Congress declared 2002 - 2011 as the Bone & Joint Decade, and this September is National Pain Awareness Month. Events like these include a series of initiatives focused on creating the awareness of chronic pain and information about diagnosis and treatment options.

Consequently, this newsletter is focused on chronic pain--how it is experienced, perceived and managed. More information— including top-rated, peer-reviewed articles and other patient-oriented resources -- is available on our new Chronic Pain Health Hub. Our goal is to provide context, comfort and direction, so that you can obtain pain relief.

All pain is real

Saying that “pain is real” may seem like a painfully obvious statement (pardon the pun), but people with chronic back pain or neck pain are often treated as if their pain is actually made up or greatly exaggerated. In truth, chronic pain often is caused by misfires in the nerve pathways or other anatomical problems that are difficult or impossible to diagnose using standard medical testing.

Fortunately, the medical community is now starting to establish and accept that pain cannot be diagnosed like other medical problems (such as a broken bone that can be diagnosed by an X-ray) and needs to be treated and managed differently. See also Chronic pain as a disease: why does it still hurt? and Modern theories on chronic pain.

Pain is a unique, personal experience that needs to be treated

Everyone experiences and expresses pain differently. Two people with the exact same back problem will often feel and show their pain in unique ways depending on a number of factors. The newest theories of pain can now explain, on a physiological level, how and why people experience pain differently.

This is especially true for spinal problems, where it is not uncommon that no objective evidence or physical findings explain the patient’s painful symptoms. Fortunately, the medical community is now starting to understand that even if pain is not traceable to an underlying problem, the pain is still experienced and therefore needs to be treated as the primary pathology. See Pain management for back and neck pain.

Chronic pain is different from acute pain

Chronic pain does not serve a biologic or protective function like acute pain does.

• With acute pain, the severity of pain directly correlates to the amount of damage, thus providing you with a protective reflex (e.g. to immediately remove your hand if you touch a hot iron). Acute pain is a symptom of injured or diseased tissue, and your pain goes away when the injury heals.
• With chronic pain, the pain does not serve a protective or other biological function. Instead, even though there is no tissue damage, the nerves just continue to send pain signals to your brain.

If back pain moves from acute to chronic, factors other than tissue damage and injury come more into play. These include ongoing “pain” signals in the nervous system even though there is no tissue damage, as well as thoughts and emotions. See also When acute pain becomes chronic pain.

Additional health conditions can develop as a result of unmanaged chronic pain

At times chronic pain has a snowball effect, with additional symptoms piling on as the pain wears on. Two frequent co-existing symptoms are depression and insomnia.

• Depression often goes hand-in-hand with chronic pain
  Depending on how your life is affected by chronic pain, you may also experience stress and depression. Depression is a serious, but treatable, disease. Talking with your physician is critical, as untreated depression can worsen the pain and slow the healing rate. Read more in 4 tips to help cope with chronic pain and depression.
• Pain can lead to sleep problems, which lead to more pain
  Patients with chronic back pain may also sleep poorly, which exacerbates the pain problem. Sleep disorders should be treated in conjunction with the underlying cause of the back pain—not in isolation from it. Read about effective treatment techniques in Breaking the cycle of chronic pain and insomnia.

Connect with others in a similar situation

Many people feel better when they can talk with others who are experiencing similar challenges. If you don't have a friend who can adequately relate to your situation, you can connect online through message boards.Spine-health.com has very active SpineForum Message Boards.

Final thoughts

Chronic pain can severely impact your quality of life, including dimensions like sleep and mental health. All aspects of the chronic pain problem need to be treated to effectively reduce the pain experienced. We encourage you to work with your physician(s) and other healthcare professionals to ensure your chronic pain is treated comprehensively and with the most appropriate techniques available. If you're unsure whether your pain is technically "chronic pain", please read Types of back pain: acute pain, chronic pain, and neuropathic pain.

Best wishes,
Peter F. Ullrich, Jr., MD, Medical Director
Stephanie Burke, President

About the Spine-health.com Newsletter: Each issue of the Spine-health.com newsletter, SpineNews Update, is written by the founders of Spine-health.com - Peter F. Ullrich, Jr., M.D., Medical Director for Spine-health.com and Stephanie Burke, President of Spine-health.com.The content in the newsletters is not peer reviewed by Spine-health.com’s Medical Advisory Board.The articles to which the Spine-health.com newsletters link have been peer reviewed by members of the Medical Advisory Board.