Pain is an undesirable feeling which occurs in response to tissue injury or damage in the body and comes as a warning. It is due to nervous system's action and remains until the cause is there. Once the tissue is healed, it usually stops hurting. But if the pain lasts for months or even years, even after the cause is cured or the pain comes without any trigger, it is considered to be chronic pain. If chronic pain continues for long in some patients, it can develop into chronic pain syndrome. Initially, it starts as a result of disease, but then it becomes a condition on its own. Chronic pain syndrome comes with mental and physical health problems such as depression, trouble sleeping, and anxiety.
Chronic pain syndrome emerges from various causes and may have multiple roots, like people having abnormalities with the nerves, which then cause them to feel the pain more. Studies have revealed that in chronic pain syndrome, the brain and spinal cord may undergo changes that reduce the pain threshold. An imbalance is created in the pain receptors, manifested as chronic pain syndrome. It can also be a learned behavior, i.e., even after your pain is gone, you continue to feel it. Chronic pain syndrome can arise after psychological trauma or conditions like sickle cell anemia.
Several other conditions which may be the initial cause of chronic pain syndrome are;
● Osteoarthritis – is a condition in which the protective part of the bone wears away.
● Fibromyalgia – is a condition that causes pain in the muscles of the whole body.
● Rheumatoid arthritis – is an autoimmune disease in which the joints are inflamed.
● Backaches – may result from nerve compression in the spine.
● Inflammatory bowel disease – chronic inflammation in the gut produces cramping.
● Endometriosis – causes tissue to grow outside of the uterus.
● Nerve damage – causes neurogenic pain.
● Lyme disease
● Testicular pain
The frequency of chronic pain syndrome is higher in old age patients. Moreover, according to the national health interview survey (NHIS), the percentage of women affected with chronic pain syndrome was more than men. Approximately 25% of United States residents experience chronic pain.
According to research, some people are at higher risk of chronic pain syndrome than others. The reasons are;
● Psychological distress.
● Sleeping disorders – improper sleep schedule increases the intensity of chronic pain.
● Multimorbidity – having more than two diseases at the same time.
● Disabilities related to pain
● Neurological distress
Chronic pain syndrome comes with the usual pain that can be constant or episodic and can become intense during an activity. In addition to the pain, some more symptoms involve your physical and mental health. Such symptoms include;
● Muscular pain
● Joint pain
● Tiredness and fatigue
● Insomnia or poor quality sleep
● Loss of energy
● Decreased flexibility
● Mental health problems like depression, mood swings, irritability, and anxiety.
Your doctor will take your medical history as the first step in the diagnosis. The history-taking includes questions like when the pain started, its location, its severity, what increases, or decreases it, etc. The doctor will also ask about any primary disease or injury causing the pain. Chronic pain is diagnosed if the pain has lasted for more than three months.
Apart from that, physical examinations and tests are done to determine the cause of the pain. They are;
● CT scan (computed tomography).
● MRI (magnetic resonance imaging).
● Nerve conduction tests.
● CSF test (cerebrospinal fluid).
In the differential diagnosis of chronic pain syndrome, the conditions which are confused are the episodes of acute pain or diseases which include;
● Neoplasia of nerves
● Bipolar disorder
● Cervical stenosis
● Pelvic floor syndrome
● Peritoneal cysts
● Myofascial pain
● Rotator cuff disease, etc
Chronic pain is easy to treat if its cause is known and treated properly. But, if the source of pain isn't clear, doctors treat and manage the pain. The treatment process varies depending on the type and cause of pain and the patient's overall health. It may include;
● Various lifestyle changes
● Physical therapies
If your chronic pain comes along with mental health issues, you must seek medical attention for that as well.
Medications that your healthcare provider can prescribe include;
● NSAIDs (non-steroidal anti-inflammatory drugs)
● Anti-convulsants (anti-seizure drugs)
● Opioids (these are narcotics that are addictive. Doctors consider them after using all other treatment options).
● Muscle relaxants
If the options mentioned earlier fail to treat the pain, then certain specialized procedures are done that help relieve the pain.
● Nerve Blocks: An anesthetic is injected near the pain area, reducing the sensation there, and helping decrease the pain.
● TENS (transcutaneous electrical nerve stimulation): Electrical impulses are used on the pain site in the form of small shocks which relieve pain.
● Spinal drug delivery: It is also known as intrathecal drug delivery. The doctor places a pump under the skin, which pumps the medicine directly to the intrathecal space near the spinal cord, so the pain is significantly reduced.
● Epidural steroidal injections: Steroid or corticosteroid medications are injected into the epidural space, which is the spinal cord's outermost layer, which decreases the spinal nerves' inflammation.
Chronic pain syndrome cannot be treated completely. However, its medications and other treatments can reduce pain by up to 30%. It usually disturbs a person's mental health, significantly decreases the quality of life, and reduces productivity. Chronic pain patients can also become suicidal.
The condition can be modified by implementing certain lifestyle changes like taking a rest, eating a healthy diet, quitting smoking, exercising, and having a positive mindset. Physical and behavioral therapies, including cognitive-behavioral therapy, are recommended. They can manage stress, relax and reassure the patient, and reduce the frequency and severity of the pain.
Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on May 15, 2023.
Chronic Pain Syndrome - StatPearls - NCBI Bookshelf (nih.gov)
Chronic pain syndromes: overlapping phenotypes with common mechanisms - PMC (nih.gov)