The International Association for the Study of Pain (IASP) defines pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage".
When thinking about chronic pain, it is important to realize the difference between chronic pain and acute pain. Acute pain is a normal reaction to an injury that provides an early warning system that an injury has occurred. Acute pain does not last very long, as the majority of injuries will normally heal within three months.
Chronic pain is pain that doesn’t go away after three months. Chronic pain can be intermittent – occurring on and off, the pain may vary with intensity during the day or can be persistent pain. Chronic pain can result from a known cause, such as surgery or inflamed joints, or a consequence of a disease process, such as, rheumatoid arthritis. Many times the cause is unknown.
Chronic pain can be an abnormal processing of pain where the original injury or cause of acute pain has resolved, but the “warning system” has failed to shut off. When this occurs the “warning bells” are still going off, however it is no longer signaling “danger” or “harm” but rather indicating a problem of pain processing.
There are different types of chronic pain. Two of the major, non-cancer chronic pains are:
- Musculoskeletal Pain - Pain that affects the bones, muscles, ligaments and tendons. Musculoskeletal pain can result from various causes including sports or occupational injuries, motor vehicle collisions, repetitive strain injuries and disease processes, such as, arthritis.
- Neuropathic Pain - A complex, multi-faceted state of chronic pain that may have no obvious cause. It can involve damaged tissue, injury or malfunctioning nerve fibers or changes in brain processing. An example of neuropathic pain is phantom limb syndrome. The brain still receives signals from nerves that originally carried impulses from the now missing limb. Other types of neuropathic pain include numbness, burning, ‘pins and needles’ sensations and shooting pain.
If you are suffering from chronic pain, there are many effective treatments and self-management techniques that you can use to increase your functionality.
Experiences of Chronic Pain
Pain is a very complex experience and many factors contribute to how an individual perceives, responds to and manages their chronic pain. In other words, everyone brings a unique mix of cultural, family and social adaptations to their pain experience. Some people appear to be better able to manage their chronic pain than others. There are social and psychological benefits to maintaining relationships and usual activities as much as possible at home and at work. People who take an “active role” in learning and practicing active coping behaviors tend to experience less of the following issues:
Social Isolation - Some people with chronic pain may lose their friends, strain their family relationships and wear down social supports. With this loss of community comes a loss of interaction and engagement with people or activities that previously helped them cope with their pain.
Psychological Shifts - A person’s mental health and overall attitude toward life can greatly affect their pain experience. For example, research has shown that for people with low back pain, feelings of helplessness, fear and a ‘glass-half-empty’ perspective are linked to poorer health outcomes. Conversely, those with a strong sense of psychological wellbeing and a more positive outlook on life tend to cope better with chronic pain.
Work/Career Shifts - Some people with chronic pain struggle to keep their jobs. Sometimes the challenge is convincing employers to let employees with chronic pain modify their jobs or their workloads to allow them to manage their pain while continuing to work. Research has shown that workers who return to work earlier have better health outcomes. Being engaged in ones work reduces focus and attention on pain. The reduction of focus on pain actually changes how the brain processes pain experiences.
Self-redefinition – Chronic pain can lead to fundamental changes in how people see themselves and their lives. And how people think about themselves affects how they feel. Fortunately, there are several new ways of thinking, feeling and “being” or acting that can help people recognize and control what’s going on with their bodies.
If you are feeling the effects of any of the above issues, it's important that you talk with your doctor. You may also consider joining a local support group of others who live with chronic pain.
Chronic Pain Services in Canada
The Canadian health system does not adequately support most people with chronic pain. Effective chronic pain management programs, services, and drugs are not always available or accessible to all Canadians. And while guidelines about how best to manage chronic pain has been developed, they are not fully supported by the current health system.
Chronic pain is a serious health problem in Canada. Overall, between 10 and 12 per cent of Canadians live with chronic pain. Those numbers more than double among seniors. In a 2005 survey, close to one in three Canadians aged 65 and over (27%) reported living with chronic pain. This number rose to 37% among those living with two or more chronic conditions.
Canadians with chronic pain also face:
- An inequitable geographical access to appropriate treatment
- No monitoring of programs, services, and drugs to determine which are over-used and which are under-used
- Inequitable financing of treatments that result in the encouragement of some forms of care (e.g., injections) but not others (e.g. counseling)
- No credentialing of chronic pain providers and clinics.
Finally, there is little to no information about how people in specific groups, such as those living with a mental illness and/or addiction problems and those in rural and remote communities manage chronic pain.
Chronic pain can impact many parts of life. It can prevent people from fully participating in employment, leisure activities and hobbies. It may affect people’s sense of self worth, emotional well-being and overall quality of life. For about half of chronic pain suffers, it worsens their economic situation (costs of medication, treatment, etc.).
Addressing the Problem
The McMaster Evidence Brief: Supporting Chronic Pain Management across Provincial and Territorial Health Systems in Canada recommended the following options to better support people living with chronic pain:
- Create a model patient registry/ treatment-monitoring system in a single jurisdiction.
- Create a national network of centres with a co-ordinating “hub” to provide chronic pain-related decision support.
- Broker and support a cross-payer, cross-discipline model of patient-centred primary healthcare-based chronic pain management.
Note: These three options are not mutually exclusive. They could all be pursued or elements from each could be targeted to create a fourth option.
Physiology of Pain
- James Henry. This article was written in 2008. http://fhs.mcmaster.ca/paininstitute/documents/pathophysiology_of_chronic_pain.pdf
- Reference: Can Psychol_Soc Comm Mod.pdf
- Chapter 10 Psych Assessment_10-01-04.doc
Chronic Pain & Canada
- Supporting Chronic Pain_2009-12-09.pdf (McMaster Evidence Brief)
- Chronic Pain Report (Oct 28, 2010(?)