Is Chronic Pain Manageable?


What is Chronic Pain?

Chronic pain is the physical discomfort that survives for a tenure of greater than 6 months; however, this definition lacks generalization across the scientific community. The chronicity of pain progresses for a longer-term despite the resolution of acute pain following tissue healing (Cleveland Clinic, 2020). The psychological and social attributes predominantly impact the chronic pain pattern and its maladaptive behaviors (Tompkins, Hobelmann, & Compton, 2017). Chronic pain proves to be a most difficult situation for patients affected with chronic and/or life-threatening disease complications. The psychosocial and emotional manifestations of chronic pain appear insurmountable. The acute pain usually emanates due to nociceptor activation after non-neural tissue damage. The acute pain signals develop under the impact of peripheral tissue injury and transmitted to the brain through dorsal horn pain transmission neurons. The somatosensory nervous system disease or lesion triggers neuropathic pain in the affected patients. The centrally amplified pain pattern under the impact of shingles, diabetes, vasculitis, and/or stroke deteriorates the pain perceptions of the affected patients. They eventually experience high-intensity pain that usually lasts for a shorter-tenure or acquires chronicity due to clinical complications. Chronic pain, however, is a complex emotional and sensory experience that variably impacts the individuals based on their psychological states. The emotional and cognitive factors potentially influence the pain perceptions of people to a considerable extent. The environmental stimuli, negative/positive emotions, and attentional states of people substantially influence their descending and afferent pain pathways. The chronicity of pain also modulates the emotional and cognitive responses of individuals. The prolonged or chronic pain, including its recurrent acute onset, triggers the development of mental health complications including depression and anxiety. This eventually increases the psychological stress that further amplifies and deteriorates the chronic pain pattern to an unprecedented level. The waxing and waning of chronic pain drastically impact the health-related quality of life and wellness outcomes. The chronic pain syndromes emanate under the impact of the following conditions (Crofford, 2015). 

  1. Fibromyalgia 
  2. Sleep disturbance, including unrefreshing sleep
  3. Mood disturbances 
  4. Dyscognition 
  5. Fatigue 
  6. Pelvic pain 
  7. Irritable bladder/interstitial cystitis 
  8. Irritable bowel syndrome 
  9. Temporomandibular disorder 
  10. Chronic headaches 
  11. Psychogenic rheumatism 

What are the Risk Factors/Causes of Chronic Pain Syndrome?

Chronic pain syndrome usually develops under the influence of the following factors (Yasaei & Saadabadi, 2020) (Mills, Nicolson, & Smith, 2019). 

  1. Trauma-based on heavy lifting, back strain, and/or other accidental causes 
  2. Underlying conditions including autoimmune diseases, arthritis, spine disease, and pancreatitis 
  3. Persistent migraines 
  4. Tension-type headaches 
  5. Psychological, sociological, and biological factors 
  6. Environmental factors 
  7. Disability 
  8. Substance abuse 
  9. Socioeconomic deprivation 
  10. Reduced job satisfaction 
  11. Prolonged distress 

What is the Pathophysiology of Chronic Pain?

The pathophysiology of chronic pain relies on the following mechanisms (Scholz, 2014). 

  1. Chronic pain is categorized into neuropathic and nociceptive pain patterns based on their underlying disease and associated somatosensory complications. 
  2. Nociceptive pain develops due to noxious stimuli and their impact on nociceptors.  
  3. The noxious stimuli induce chemical mediators while causing inflammation of body tissues. 
  4. The elevated action of nociceptive nerve fibers triggers peripheral sensitization that increases the threshold of voltage-gated sodium channels and nociceptors. 
  5. The peripheral sensitization triggers the processing of pain-related neurotransmitters and action potential across the spinal cord’s dorsal horn. 
  6. The central sensitization is based on the elevated excitation of dorsal horn neurons under the impact of noxious stimuli. 
  7. The deployment of (NMDA) N-methyl-D-aspartate-type glutamate receptors reciprocates with elevated depolarization. 
  8. The nociceptive circuits dramatically shift their activity under the sustained impact of gene expression changes, signaling pathways activation, and intracellular calcium elevation due to the induction of neuropeptide receptors and NMDA. 
  9. The excitatory transmission inside the hippocampus and its prolonged potentiation is based on central sensitization. 
  10. The painful stimuli induce central sensitization that further contributes to the pain-related responses arising from non-painful factors. These outcomes potentially elevate the development of allodynia and hyperalgesia. 
  11. The hypersensitivity of pain induces structural alterations in the brain.  
  12. The neuropathic pain emanates from the ectopic or stimulus-dependent activity of the peripheral nerve lesion and its corresponding fibers. 
  13. The induction of the peripheral nerve fibers due to pain stimulus triggers the immune responses across the spinal cord’s dorsal horn and peripheral somatosensory neurons of the dorsal root ganglion. 
  14. The release of chemical mediators from the active microglia potentiates the neuronic activity. 
  15. The neurotrophic factor is a brain-derived mediator that combats the inhibitory effect of glycine and GABA (gamma-aminobutyric acid). 
  16. The lesioned nerve produces abnormal input under the impact of the dorsal horn’s polysynaptic connections based on disinhibition. 
  17. The transmitter uptake deficit induces glutamatergic transmission that not only decreases inhibitory neurons but also leads to the death of excitotoxic cells. 
  18. The reduction of disinhibitory neurons across the brainstem’s descending modulatory pathways disturbs the equilibrium between excitation and inhibition. 
  19. The treatment of chronic pain patterns proves highly challenging due to the intricacies of complex pain processes. 
  20. The selection of the appropriate biomarkers is highly necessary to configure targeted chronic pain management strategies for the patient populations.   

What are the Best Possible Methods of Chronic Pain Management?

Pharmacological management of chronic pain often does not provide a complete remedy to the psychosocial and emotional complications of treated patients. The blend of pharmacological and non-pharmacological interventions, however, prove highly efficacious to the patients affected with chronic pain pattern. Some of these interventions are discussed below (Jamison & Edwards, 2012) (Reid, Eccleston, & Pillemer, 2015) (Brain et al., 2019) (De-Gregori et al., 2016) (Bjørklund et al., 2019). 

  1. Chronic pain patients receive various therapies based on their disease complications. They continue receiving antidepressants, inhalers, blood pressure management drugs, or blood thinners to control their chronic manifestations. However, these interventions do not provide complete relief to chronic pain patterns in a variety of patient scenarios. 
  2. The disease conditions including cancers, liver complications, bladder/kidney diseases, hypertension, coronary artery disease, diabetes mellitus, pulmonary disease, COPD, and/or asthma potentially deteriorate the health and wellness of patients while elevating their chronic pain. The systematic management of these conditions is, therefore, highly necessary to reduce the intensity of the reported pain. 
  3. Cognitive behavior therapy proves to be the robust pain management intervention that helps to combat the passive or negative thoughts of the treated patients. This therapy also improves the pain perceptions of the patients while enhancing their realistic thoughts. 
  4. Cognitive restructuring relies on the administration of adaptive management interventions to improve the pain tolerance level of treated patients.   
  5. Psychological counseling of substance abuse-addicted patients is highly needed to reduce the extent/quality of their chronic pain. Furthermore, psychological counseling of the patients on opioid therapy assists to control their breathing issues, urinary retention, itching, dizziness, nausea, tiredness, and constipation. 
  6. Enhancement of sleep pattern, elevated socialization, and improvement in daily living activities potentially assist in reducing the intensity of chronic pain. 
  7. The setting up of rational pain management goals while improving the pain-related attitudes and beliefs of the patients helps in enhancing their overall pain perceptions. 
  8. The administration of family-centered interventions through the engagement of relatives, caretakers, or family members not only improves the mental health of patients but also enhances their pain perceptions to a considerable extent. 
  9. The provision of instrumental and emotional support for the chronically ill patients enhances their treatment compliance and pain tolerance level. 
  10. The rational treatment of comorbidities and reduction in stressors also helps in combatting the intensity of chronic pain patterns. 
  11. Engagement in exercises not only improves the coping skills of patients but also elevates their potential to overcome their negative pain-related attitudes. 
  12. The selective use of NSAIDs’ (based on medical supervision) along with appropriate dietary measures improves the immunity and pain tolerance of chronically ill patients.  
  13. The consumption of diets based on vegetables and fruits rather than ultra-processed food assist in reducing the inflammatory state of the human body. 
  14. The consumption of Citrus bergamia juice helps in reducing the oxidative stress and free radical accumulation that eventually improves the pain perceptions of chronically ill patients. 
  15. The regular consumption of the Mediterranean diet along with olive oil also maintains the energy levels while reducing the overall oxidative stress. 
  16. The improvement in living conditions and health-related quality of life potentially enhances the pain-related coping skills of individuals. 
  17. The elevated consumption of analgesic and antinociceptive natural products rich in taurine, ω-3 polyunsaturated fatty acids, curcuminoids, terumbone, and flavonoids helps to reduce the pattern patterns of the chronically ill patients.    

References

Bjørklund, G., Aaseth, J., Dosa, M. D., Pivina , L., Dadar, M., Pen, J. J., & Chirumbolo, S. (2019). Does diet play a role in reducing nociception related to inflammation and chronic pain? Nutrition, 153-165. doi:10.1016/j.nut.2019.04.007

Brain, K., Burrows, T. L., Rollo, M. E., Hayes , C., Hodson, F. J., & Collins, C. E. (2019). The Effect of a Pilot Dietary Intervention on Pain Outcomes in Patients Attending a Tertiary Pain Service. Nutrients, 11(1). doi:10.3390/nu11010181

Cleveland Clinic. (2020). Acute vs. Chronic Pain. Retrieved from https://my.clevelandclinic.org/health/articles/12051-acute-vs-chronic-pain

Crofford, L. J. (2015). Chronic Pain: Where the Body Meets the Brain. Transaction of the American Clinical and Climatological Association, 167-183. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4530716/

De-Gregori, M., Muscoli , C., Schatman, M. E., Stallone, T., Intelligente, F., Rondanelli, M., . . . Allegri, M. (2016). Combining pain therapy with lifestyle: the role of personalized nutrition and nutritional supplements according to the SIMPAR Feed Your Destiny approach. Journal of Pain Research, 1179-1189. doi:10.2147/JPR.S115068

Jamison, R. N., & Edwards, R. R. (2012). Integrating Pain Management in Clinical Practice. J Clin Psychol Med Settings, 19(1), 49-64. doi:10.1007/s10880-012-9295-2

Mills, S. E., Nicolson, K. P., & Smith, B. H. (2019). Chronic pain: a review of its epidemiology and associated factors in population-based studies. British Journal of Anaesthesia, 123(2), e273-e283. doi:10.1016/j.bja.2019.03.023

Reid, M. C., Eccleston, C., & Pillemer, K. (2015). Management of chronic pain in older adults. BMJ. doi:10.1136/bmj.h532

Scholz, J. (2014). Mechanisms of chronic pain. Molecular Pain, 10(1). doi:10.1186/1744-8069-10-S1-O15

Tompkins, D. A., Hobelmann, J. G., & Compton, P. (2017). Providing chronic pain management in the “Fifth Vital Sign” Era: Historical and treatment perspectives on a modern-day medical dilemma. Drug Alcohol Dependency, 173(1), S11-S21. doi:10.1016/j.drugalcdep.2016.12.002

Yasaei, R., & Saadabadi, A. (2020). Chronic Pain Syndrome. In StatPearls. Treasure Island (Florida): StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK470523/

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