Chronic Pain

Chronic pain is frequent or constant pain that does not respond to the usual treatments. Unlike acute pain, which gets better and goes away in a short time, chronic pain persists for at least several months. It often causes depression. You may lose your desire to eat. You may have trouble sleeping. You may be taking several pain medications and may be functioning poorly at home and on the job.

Chronic pain is not a normal result of getting older. However, many conditions that cause chronic pain (such as arthritis and cancer) are common among older adults.

How does it occur?

Pain usually starts as the result of some injury to the body. The pain you feel, however, depends on a combination of responses by your body and your brain. Each person experiences pain differently.

Acute pain lasts only a short time. It has a distinct beginning and a clear cause. In contrast, chronic pain usually lasts more than three months and often produces a greater reaction than is usual for the cause. It leaves you distressed and unable to function normally.

How is it evaluated?

Your chronic pain will need to be evaluated thoroughly. Several types of health care providers may take part: doctor, nurse, psychologist, social worker, physical therapist, and/or occupational therapist.

Our trained staff will take a complete medical history. You will have a thorough physical exam. How you feel, physically and emotionally, and what you can and cannot do will be taken into account. New and chronic illnesses will be reviewed, as will any medications you are taking. Your body language (grimacing, limping, restlessness) may also provide clues.

You may be asked to keep a personal diary charting how often you hurt and for how long. The diary may help find the cause of your pain. You should include the following:

• what you were doing when you had the pain
  
• the time the pain started and how long it lasted
  
• how the pain felt (for example, stabbing, crushing, aching, throbbing, burning)
  
• how bad the pain was (for example, you might rate it with a number from 1 to 10)
  
• the medicines you took for the pain, noting whether or not they worked anything that made the pain better or worse, such as heat, cold, exercise, baths, massage, rest.

How is it treated?

Treatment of chronic pain usually requires several approaches combined into a pain management program designed just for you. Both drug treatment and nondrug treatment are usually included.

The right medication for your pain may be one medicine or a combination of medicines. Drugs other than narcotics are used to treat mild to moderate pain. These medications are not really addicting. However, they may have side effects such as upset stomach, bleeding in the stomach, kidney damage, or confusion. The side effects vary from one drug to another and from person to person.

Stronger drugs may be needed to relieve moderate to severe pain. These drugs are sometimes used to manage chronic pain, usually after trying other medicines and nondrug treatments or when there is suspicion that those medications won?t make a major improvement. These stronger medications can be addicting. However, people using these drugs for pain usually do not become dependent on them if they use the drugs as prescribed. These medications may be given in several different forms, including by shot, pill, liquid, suppository, or skin patch.

These drugs have a range of side effects including nausea, drowsiness, confusion, breathing problems, and hallucinations. The side effects depend on the drug and the dose. You and your health care provider must decide which side effects you can live with. Medications in the same class can have different side effects for each individual. Thus, occasionally switching medications to alternate but similar medications in the same drug class can lessen side effects while maintaining the effect.

There are also some drugs that are moderate in strength but have less addictive potential and side effects, and other medications that have other primary clinical applications but can improve pain in some people. Although none of these drugs work like the usual kind of "painkillers," they can be useful in managing certain types of chronic pain.

Pain often cannot be managed by medication alone. Other treatments may include:

• heat
  
• cold
  
• an exercise program, which might include walking, swimming, aerobics physical or occupational therapy
  
• devices called TENS, which electrically stimulate nerves
  
• water therapy (hydrotherapy), using swimming pools, hot tubs, or whirlpools
  
• hypnosis
  
• acupuncture or acupressure
  
• massage therapy
  
• counseling
  
• biofeedback, especially for headache pain
  
• programs to change behavior, including use of relaxation methods, imagery, music, and meditation
  
• healthy diet
  
• hobbies and social activities
  
• in severe cases, cutting the nerves causing the pain.
  

Treatment of chronic pain can be difficult for both you and our team. Keep your follow-up appointments so we can find out what is helping and what is not. Together we can continue to seek a solution.

Developed by Harriet Berliner, MSN, ANP, and Daniel L. Swagerty, MD, MPH, for iMcKesson Clinical Reference Products.
Published by iMcKesson Clinical Reference Products.
Copyright © 1995-2000 iMcKesson LLC. All rights reserved.

Adapted from content provided by iMcKesson, LLC
Review Date: 6/9/2001