Ultimate Guide: Understanding Chronic Pain | Part 1

Chronic pain blogger details her own chronic pain, myofascial pain syndrome, pelvic girdle dysfunction (SIJ, sacroiliac dysfunction), neuropathic pain & depression journey on the strivetoheal.com blog. Find information on mainstream and alternative chronic pain treatments, understanding chronic pain as well as motivation & inspiration.

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.

Chronic Pain or Chronic Pain Syndrome is complex and difficult to treat. Part 1 of this guide will help you to understand what is chronic pain, the different types of chronic pain (somatic, inflammatory, nociceptive, neuropathic, visceral) & the differences between acute pain and chronic pain. Knowledge is power.

(c) 2018 STRIVETOHEAL.COM

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
    • Testing
    • Arriving At A Diagnosis
    • Specialists
    • 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.

The Ultimate Guide To Understanding Chronic Pain - Part 1 will help you to understanding what is chronic pain, chronic pain syndrome, chronic pain illness or non cancer chronic pain. It also goes into details about the different types of chronic pain as well as gives a comparison of chronic pain vs acute pain.

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.

Understanding your chronic pain is half the battle. Find out all there is to know about chronic pain/chronic pain syndrome, the different types of pain/chronic pain & chronic versus acute pain. Understanding your chronic pain experience will help to guide you towards the right treatments and therapies.

(C) 2018, STRIVETOHEAL.COM

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).

 

What is somatic pain? If you are experiencing chronic somatic pain, find out all there is to know in this Ultimate Guide To Understanding Chronic Pain. Part 1 goes into details of what is somatic chronic pain, what does somatic pain feel like, and how nociceptive receptors and inflammation play a part in chronic pain. It also discusses deep and superficial somatic pain, and gives a list of body areas that are involved in somatic pain (joints, skin, muscles, ligaments, tendons, bones, connective tissue, body wall).

(C) 2018, STRIVETOHEAL.COM

 SOMATIC PAIN

  • 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

 

Visceral chronic pain involves the internal organs. It has a nociceptive and inflammatory component. Learn what visceral pain feels like. Examples of visceral pain are endometriosis and irritable bowel syndrome.

VISCERAL PAIN

  • 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

 

What is neuropathic pain or nerve pain? Also find out what neuropathic pain feels like & what is allodynia, hyperalgesia and paresthysia. In Part 1 of the Ultimate Guide To Understanding Chronic Pain you will also find out that neuropathic pain is caused by irritation, injury or dysfunction of the peripheral (PNS) or central nervous system (CNS).

(C) 2018, STRIVETOHEAL.COM

  NEUROPATHIC 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
Do you have a new fibromyalgia diagnosis and are looking to understand your diagnosis? Find out all there is to know about your fibro chronic pain in this Ultimate Guide To Understanding Chronic Pain.

(c) 2018, STRIVETOHEAL.COM

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.

 

This section compares acute pain vs chronic pain. Learn what the similarities and differences are of chronic pain and acute pain, including recovery, treatments, medications, pain maps and impact on daily living,

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.

Find out the differences between chronic pain vs acute pain including information on recovery time, survival value, medications & other treatments as well as brain pain maps.

(c) 2018, STRIVETOHEAL.COM

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.

The chronic pain, chronic illness and invisible disability blog, Strive To Heal (strivetoheal.com) has written The Ultimate Guide To Understanding Chronic Pain - Part 1. This sections deals with the ups and downs of chronic pain when you have good days, flare days and everything in between.

 

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.

Do you suffer from chronic pain or chronic pain syndrome? Find out everything you need to know about the pain your fibromyalgia, arthritis, lyme disease, myofascial pain syndrome, sacroiliac dysfunction or any other pain condition causes.

(c) 2018, STRIVETOHEAL.COM

Sources:

  1. ELMAN I, BORSOOK D: Threat response system: parallel brain processes in pain viss-a-vis fear and anxiety. Front Psychiatry 2018; 9; 29.
  2. LIGON CA, MOLONEY RD, GREENWOOD-VAN MEERVELD G: Targeting epigenetic mechanisms for chronic pain: a valid approach for the development of novel therapeutics. J Pharmacol Exp Ther; 357; 84-93.
  3. HOOTEN WM, TIMMING R, BELGRADE M, GAUL J, GOERTZ M, HAAKE B, MYERS C, NOONAN MP, OWENS J, SAEGER I, SCHWEIM K, SHTEYMAN G, WALKER N: Assessment and management of chronic pain. Institute for Clinical Systems Improvement, 2013.
  4. ARENDT-NIELSEN L: Pain sensitisation in osteoarthritis. Clin Exp Rheumatol 2017; 35 (Suppl. 107); S68-S74.
  5. ELLER-SMITH OC, NICOL, AL, CHRISTIANSON JA: Potential mechanisms underlying centralized pain and emerging therapeutic interventions. Front Cell Neurosci 2018; 12; 35.
  6. HAWKER GA: The assessment of musculoskeletal pain. Clin Exp Rheumatol 2017; 35 (Suppl. 107); S8-S12.
  7. SHENG J, LIU S, WANG Y, CUI R, ZHANG Z: The link between depression and chronic pain: neural mechanisms in the brain. Neural Plast 2017; 2017: 9724371.
  8. 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 historyAm J Med Genet C Semin Med Genet 2017; 175 (1); 48-69.
  9. Doidge, Norman. The Brain That Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science. New York: Viking, 2007.
What is chronic pain? If you suffer from fibromyalgia or one of the many other chronic pain conditions then you NEED to read The Ultimate Guide To Understanding Chronic Pain written by the blogger behind the chronic pain blog StriveToHeal.com.

(c) 2018, STRIVETOHEAL.COM

 

 

If you have a new, or even an old, fibro diagnosis, you NEED to read this ultimate chronic pain guide. To get the most out of your treatments and therapies, you HAVE to have a good understanding of your chronic pain illness.

(c) 2018, STRIVETOHEAL.COM

If you have a new, or even an old, chronic pain or chronic pain syndrome diagnosis, then learn all about it here. Find out why chronic pain is an illness in itself, how and why acute pain turns into chronic pain and what the latest research is saying.

(c) 2018, STRIVETOHEAL.COM

Do you suffer from Chronic Pain Syndrome? Find out what the latest research is saying & all there is to know about this chronic pain condition in this Ultimate Guide To Understanding Chronic Pain.

(c) 2018, STRIVETOHEAL.COM

Looking to understand your chronic pain diagnosis? Find out all there is to know about chronic pain the illness, including what the latest research is saying. If you suffer from one of the many chronic pain conditions, such as fibromyalgia, EDS, osteoarthritis, rheumatoid arthritis, endometriosis, SI dysfunction, then this Ultimate Guide To Understanding Chronic Pain is for you!

(c) 2018, STRIVETOHEAL.COM

Find out what the different types of chronic pain are. Learn all about somatic or musculoskeletal, viscerdal or inner organ, neuropathic or nerve, nociceptive & inflammatory pain. Learn about the different types of causes of chronic pain & what they feel like.

(c) 2018, STRIVETOHEAL.COM

Chronic pain types can be classified into somatic or musculoskeletal pain, visceral or inner organ pain, neuropathic or nerve pain as well as nociceptive or inflammatory pain. These pain types have different causes and sensations.

(c) 2018, STRIVETOHEAL.COM

Do you know that chronic pain itself is an illness? This guide will help you to understand your chronic pain condition, so that you can be an informed and empowered patient. In Part 1, find out what the medical community considers to be chronic pain, what the differences are between chronic pain vs acute pain, the different types of chronic pain and why chronic pain or chronic pain syndrome is now considered an illness all of its own.

(c) 2018, STRIVETOHEAL.COM

What are the different types of chronic pain? What body parts are affected? What does musculoskeletal or somatic, inner organ or visceral, nerve or neuropathic pain feel like?

(c) 2018, STRIVETOHEAL.COM

Do you want to understand your chronic pain syndrome better? This guide is packed full of information, including the latest research and personal insight. from the blogger behind StriveToHeal.com.

(c) 2018, STRIVETOHEAL.COM

This ultimate guide will give you a great understanding of your fibromyalgia, arthritis, myofascial pain, sacroiliac joint dysfunction, pelvic girdle etc. chronic pain. Learn how the nervous system maladapts when you suffer from ANY chronic pain condition.

(c) 2018, STRIVETOHEAL.COM

What is chronic pain and what does it mean for you as a patient suffering with a chronic pain condition such as fibromyalgia or osteoarthritis? If you want a good understanding of what is happening with your body when you experience chronic pain then this Ultimate Guide To Understanding Chronic Pain will provide many answers.

(C) 2018, STRIVETOHEAL.COM

What is chronic pain or chronic pain syndrome? Find out what the latest research is saying about the experience of prolonged chronic pain and how your body changes because of it.

(c) 2018, STRIVETOHEAL.COM

Chronic pain vs acute pain has very significant differences that result in chronic pain being much more complex and as a result, more difficult to treat. Understanding the changes that happen when you experience long term pain, can help you find more effective treatments.

(c) 2018, STRIVETOHEAL.COM

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