Millions of people are disabled on account of chronic pain. The prevalence of this syndrome is anywhere from 20% to 35% in the general population. Some consider 3 months and some 6 months as the cut off criteria to label the presence of pain as chronic pain syndrome.
In general, any pain lasting for over and above the time necessary for healing of tissues can be considered as chronic pain syndrome. It is more common in women. It is difficult to manage and can lead to several complications. However, with appropriate multimodal support and treatment it can be managed to a great extent.
Chronic Pain Syndrome Causes
The causes are often multifactorial. Some have even suggested that it might be psychologically learned behavioural response that has its origins in a painful stimulus. If the patient finds that the pain behaviour has some rewards like avoidance of work, sex and responsibilities, or increased attention paid by family and friends, then chronic pain is more likely to occur.
It needs to be emphasized that the learned behavioural response operates largely at an unconscious level and is devoid of a conscious or deliberate attempt on the part of the patient. Patients with mental disorders like depression, hypochondriasis, somatization disorder and conversion disorder are more prone to the development of this syndrome.
There are a variety of musculoskeletal, neurologic, urinary, gastrointestinal and reproductive disorders that can contribute to or cause chronic pain.
Chronic Pain Syndrome Symptoms
The main symptom is pain. The location, type, radiation and relieving or aggravating factors of the pain vary from patient to patient and also depend on the associated systemic disorder. Typically the pain will be proportionately more compared to the underlying impairment and objective findings.
There may be dramatization of the complaints, alcohol and/or drug abuse and some disability. Sometimes there may be history of a psychosocial nature like anxiety disorder, depression, sexual or physical abuse, and family or marital problems.
Chronic pain syndrome can affect the patient in a variety of ways. Major effects are fatigue, anxiety, depressed mood, and reduced libido. If depression is associated, there could even be suicidal ideation or attempt, particularly in adolescents. Other complications are prolonged physical ailment, sleep disturbances, family or marital problems, disability, loss of job and adverse reactions or side effects of long-term drug therapy.
Chronic Pain Syndrome Management
Treatment varies depending on the needs of individual patients. Treatment should aim at restoring function (minimization of disability), reducing need for medications, and preventing relapse. Often, psychological therapy needs to be combined with medical therapy. Family members need to be involved in the whole process of the treatment and rehabilitation of the patient. Most of the cases can be managed on an outpatient basis.
In some cases, simple analgesics like paracetamol, aspirin, ibuprofen or naproxen may suffice. Some may require opioid or narcotic analgesics like oxycodone or fentanyl to manage their pain. Certain anticonvulsants like pregabalin and gabapentin are helpful if there is neuropathic pain.
Tizanidine can provide relief from the pain by facilitating the pain inhibitory function of the nervous system. Antidepressants have also been tried with success in some cases of chronic pain syndrome, particularly in those with associated mental symptoms like anxiety and depression.
Physical and Occupational Therapy
Physical therapy needs to be given along with occupational therapy so that the patient can be functionally restored. The physical therapy involves stretching exercises, positioning, application of heat or cold, manipulations, and transcutaneous electrical nerve stimulation (TENS).
Occupational therapy involves desensitization techniques and counseling.
Nerve Blocks and Spinal Interventions
Nerve blocks include epidural injections and sympathetic blocks. Stimulation of the spinal cord and use of intrathecal pumps delivering morphine are also helpful.
Relaxation methods (progressive muscle relaxation) and biofeedback in combination with medications are also helpful. Stress management techniques can also help. Other therapies known to work are acceptance and commitment therapy and cognitive-behavioural therapy.