The Ultimate Guide To Understanding Chronic Pain | PART 1
I want to start this guide off with an important statement. It took me quite a while to piece it together, so if this idea is new to you, I want you to hear it now and let it sink in before you continue reading.
once chronic pain sets in, there are changes that happen in our bodies, & chronic pain itself becomes an illness
Chronic pain, no matter how it started off, ends up having more similarities than differences. So that no matter what your diagnosis is, if you experience chronic pain, then this guide is for you.
It doesn’t matter that I suffer from pelvic girdle dysfunction, myofascial pain syndrome & neuropathic pain and that you suffer from fibromyalgia or osteoarthritis or migraines or endometriosis. Once chronic pain sets in, similar changes are happening in our bodies, and chronic pain becomes an illness on its own.
I am not saying that all medical conditions that result in pain are the same, but that the actual pain experience is similar. So you and I may need different treatments for our underlying medical issues, but when it comes to the chronic pain “illness” itself, this is where our differences start to blur.
One of the main reasons why it is difficult to treat or manage chronic pain is because chronic pain is very complex. In order to get as much pain relief as you can on your healing journey, you need to be an informed patient.
Unless you are one of the lucky ones who got proper medical care right off the bat, chances are that you will need to become an advocate for your health.
If you suffer from chronic pain, you need to understand how and why chronic pain develops, as well as how the chronic pain cycle operates. To be able to find significant pain relief, you need to put as many speed bumps and stop signs into the chronic pain cycle as you can.
too many of us fall through the cracks
Too many chronic pain patients fall through the cracks.
Our concerns are not always taken seriously until the pain &/or fatigue is so severe that we can’t function in our daily lives. Our bodies are not examined thoroughly enough. Our medical histories and our long list of symptoms seem to often fall on deaf ears. Diagnoses are given out as a default option, so many of us end up misdiagnosed. Or we end up being told, “I can’t tell what’s wrong with you”.
We go from physician to physician praying that this next doctor will be the one who will be able to unravel the mess that our bodies have turned into. We pray for a glimmer of hope, that this nightmare that our life has turned into, actually has a chance of coming to an end.
This guide is meant to help you understand what may be happening with your health. To give you a glimmer of hope when you so desperately need it.
Heck, once you get a hang of this information you will know more than some of the doctors and other medical professionals that you have or will encounter on your healing journey.
I am including references to scientific literature and published books as well as insights from my own experiences.
The medical and scientific mumbo jumbo is mostly left out except when required, such as disease names and the proper names of other science “things” but definitions and explanations are provided.
I want anyone to be able to read through this guide and feel that they have a better understanding of what is happening with their chronic pain.
I want you to feel empowered by this knowledge. Because I know what it feels like to feel utterly helpless & hopeless, and like you have lost all control of your life and future.
PART 1 of the guide covers:
- What Is Chronic Pain?
- What Are The Different Types of Chronic Pain?
- Acute Pain vs. Chronic Pain
PART 2 of the guide covers:
- Chronic Pain Assessment
- Which Doctor Should I See First For My Chronic Pain?
- Determine The Pain Type(s)
- Your Medical & Family History
- Physical Examination
- Arriving At A Diagnosis
- A Word On Pain Clinics
- We Are Not “Doctor Shopping”
- It includes a FREE 7-page printable Medical History & Symptoms form and checklist that is especially useful for your initial appointments with specialists.
What Is Chronic Pain?
Chronic pain by definition is an on-going pain that lasts for at least 3-6 months or pain that lasts longer than it would take for an acute injury to heal (1, 2.) Sometimes it is defined as pain without biological value (3). A unified definition of chronic pain does not yet exist, and you will find that experts usually use anywhere from a six week all the way to a 12-month timeframe (1, 2, 3).
You also need to keep in mind that there are some acute pains that could last long enough for some to consider them chronic. For example, acute pain from surgery, burns or broken bones.
long-lasting acute pain is not the same as chronic pain
But, it is very important to remember that acute pain that lasts for months is NOT the same as chronic pain.
There is tons of research indicating that there are many similar changes that happen to how the body functions, how the chronification of pain happens, and how this affects the psychology of patients who suffer from chronic pain. These changes don’t seem to take place in the presence of prolonged acute pain.
The changes which take place happen in the peripheral (outside the brain and spinal cord) and central nervous systems (within the brain & spinal cord ) (4, 2, 5). I will describe these and other changes in another, yet to be released, part of this guide.
So we have this “chronic pain” wording that can be used in different contexts, as well as a lack of agreement within the medical community as to a standard chronic pain definition. And in addition, the medical community is still deciding on how to name this chronic pain “illness” although some experts do call it Chronic Pain Syndrome (CPS) or Chronic Noncancer Pain (CNCP), while others simply call it Chronic Pain.
No wonder I was confused for such a long time as to what the doctors I was seeing were exactly talking about! You can read some of my chronic pain & chronic illness story here.
But the bottom line is, no matter what it is called, getting a “chronic pain syndrome” diagnosis is life-changing. I know what a crushing feeling it is.
chronic pain is complex & challenging to treat
Even though there is lots of research happening to gain a better understanding of how and why chronic pain sets in, as well as how to best treat it, the fact is that all these mechanisms are very complex and there is still a lot of missing pieces to the chronic pain syndrome puzzle (4, 2, 5).
But do not lose HOPE! There are many things that you CAN do to start regaining your health and life.
What Are The Different Types of Chronic Pain?
Chronic pain can be broadly classified into somatic, visceral & neuropathic pain (6, 2, 7, 3, 8). Sometimes chronic pain is classified only into nociceptive & neuropathic pain and other times the inflammatory pain component is classified on its own (3, 7).
- pain involves the skin, muscles, joints, tendons, ligaments, bones or body wall
- causes musculoskeletal pain
- this pain can be intense as there are many nerves that supply these tissues
- there is a nociceptive pain component
- responds to stimuli such as temperature extremes (e.g. burn), mechanical force (e.g. a cut, pinch, pressure, stretch) or chemical (e.g. chilli powder, molecules from tissue injury)
nociceptors are types of sensory neurons in the peripheral nervous system that respond to damaging or potentially damaging stimuli by sending “possible threat” signals to the spinal cord and the brain
- you can also have an inflammatory pain component that also results in heat, redness & swelling
inflammation results in additional pain because the inflammatory process causes additional nociceptor stimulation
- there is a mechanical/compressive component & you can experience pain that is made worse by activity and that is temporarily improved with rest
- you can have muscle dysfunction, loss of range of motion, tenderness and muscle spasm
- sometimes it can be due to an underlying structural problem that throws off your musculoskeletal system
- somatic pain can be local or widespread
- superficial somatic pain can feel sharp, throbbing, pricking or burning; It occurs in the skin and mucous membranes
- deep somatic pain can feel sharp or dull, like a deep ache, cramping or gnawing
- this is the type of pain you feel when you, for example, get a burn, a cut, a sprain or strain, break a bone, suffer from arthritis, tension headaches or joint instability
- pain that involves the internal organs
- these tissues are not supplied by as many sensory nerves as somatic tissues
- the pain can be difficult to pinpoint and it is often referred to other areas
- there is a nociceptive component
- there can also be an inflammatory component
- visceral pain can be localized or widespread
- it often feels like a deep squeeze, ache or pressure; it can be diffuse
- this is the type of pain you feel when you, for example, suffer from endometriosis, menstrual cramps or irritable bowel syndrome
- visceral pain has been less researched than somatic pain
- pain produced by damage, irritation or dysfunction of the nervous system
- also known as nerve pain
- the pain can feel electrical, burning, radiating, shooting, stabbing, knife-like or toothache-like
- it can follow a nerve distribution
- it can cause allodynia which is pain that is caused by a stimulus that normally should be painless (6, 3, 5)
allodynia – gentle touch or gentle rubbing, hot or cold temperature or pressure from clothing causes pain
- it can cause hyperalgesia which is an increased sensitivity to pain
hyperalgesia – a minor injury causes you to feel severe pain
- it can cause paresthesia which is a non-painful sensation such as tingling or pins & needles, pricking, burning, tickling, numbness, itching, skin crawling, weakness or coolness
paresthesia – abnormal painless sensation without an apparent physical cause
- nerve pain or abnormal sensations can be local or widespread
- can be produced by the peripheral or central nervous system:
- Peripheral – involves damage, irritation or dysfunction of the nerves outside of the brain & spinal cord
- Central – involves damage, irritation or dysfunction of the brain & spinal cord nerves
- this is the type of pain you experience when you suffer, for example, from fibromyalgia, sciatica, carpal tunnel syndrome, diabetic neuropathy or phantom limb pain
remember that you are most likely experiencing multiple different pain types in your chronic pain journey (3, 5).
A significant proportion of chronic pain patients suffer from more than 1 pain type & more than 1 pain condition (5).
When pain is persistently severe it can be difficult for you to tease out the different pain types that you may be experiencing. Or, as was my case for the longest time, you may think that all the pain is being generated in the same way, when in fact you are experiencing different pain mechanisms all at once.
I was able to identify some of my different pain types, and some of their triggers, only once my pain levels came under better control. This is one of the reasons why properly diagnosing and treating chronic pain can be so challenging.
Acute Pain versus Chronic Pain
Acute pain can be mild or severe and it can last for hours, days, weeks or months until the disease or injury heals. It is essential for survival because you need to recognize and prevent further injury. It differs from chronic pain in that it has a predictable beginning, middle, and end (3). Acute pain generally responds well to current medications and other current treatments (2).
Chronic pain, on the other hand, has very limited, if any, survival value. There is no predictable end, and the beginning and middle continue to leave both patients as well as doctors and researchers with a lot of unanswered questions.
The goal of chronic pain treatment is to improve your functionality & to develop long-term self-management skills that will help you to live a healthy and meaningful lifestyle despite persistent pain (3).
Medications are not the sole focus of chronic pain treatment since the effectiveness of currently available medications is limited.
Chronic pain will often end up disrupting your ability to participate in normal life activities, create a sense of uncertainty and decrease your quality of life (2, 3).
Let me now re-iterate something that I already mentioned at the beginning of this guide. Once chronic pain evolves into chronic pain syndrome, the body responds differently to pain – it even responds differently to acute pain if the patient suffers from chronic pain (4). So that if a chronic pain patient suffers acute pain, the body responds to it in a similar way that it responds to the chronic pain.
acute pain & chronic pain light the brain up differently (9)
There are known areas of the brain that respond to pain – these are known as pain maps. Research shows that in people who suffer from chronic pain, these pain maps get bigger, and as a result, we start to feel pain over a larger area of our body.
With time the pain maps also start spilling over into adjacent areas of the brain, and we start to develop referred pain. So that now we not only feel pain over a larger area but also in different areas of the body.
Our brain maps also become very sensitive, so that we may feel severe pain from a light touch (allodynia) or something that would otherwise cause only minor pain (hyperalgesia) (9).
Don’t despair as you read this information. There is life beyond & amidst chronic pain but I can’t lie – the path isn’t an easy one to take and it does come with its own challenges.
I want you to look at your recovery as a journey with peaks and valleys. There are things that YOU can do to assist your recovery. And with help from the right medications, the right medical treatments, alternative treatments & lifestyle changes, you can reach higher peaks and end up in valleys that are not as deep.
There will be times when you will hit rough patches in your recovery & take 1 step forward only to take 2 steps back.
But what is incredibly important is that you continue striving to heal.
This is why we are WARRIORS.
We have all these obstacles to overcome…uphill battles left, right & center. But, we choose to keep fighting for our health and wellbeing so that we can once again live our lives fully and meaningfully.
I don’t want you to be alone in your fight. Join me so that we can continue to warrior on together. Chronic pain is already lonely and isolating enough (you can read some of my story here). So let’s strive to heal together as a community!
There is so much I have learned on my journey & I want to make your path to healing a bit easier to get through 🙂
Now that you have a good understanding of what chronic pain is, check out The Ultimate Guide To Understanding Chronic Pain | Part 2 – Chronic Pain Assessment.
PART 2 of the guide includes a FREE 7-page printable Medical History & Symptoms form and checklist that is especially useful for your initial appointments with specialists.
Did you learn something new about your chronic pain from this post?
Does this information help you to understand your pain better?
I would love to hear from you in the comments section below!
P.S. In PART 3 of the Ultimate Guide To Understanding Chronic Pain, I will go into details about the current theories of pain. Remember that knowledge is power. The better you understand your enemy (i.e. chronic pain), the better you can fight it.
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- TINKLE B, CASTORI M, BERGLUND B, COHEN H, GRAHAME R, KAZKAZ H, LEVY H: Hypermobile Ehlers-Danlos Syndrome (aka Ehlers-Danlos Syndrome Type III and Ehlers-Danlos Syndrome Hypermobility Type): clinical description and natural history. Am J Med Genet C Semin Med Genet 2017; 175 (1); 48-69.
- Doidge, Norman. The Brain That Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science. New York: Viking, 2007.