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Chronic pain was originally defined as pain that has lasted 6 months or longer. It is now defined as pain that persists longer than the normal course of time associated with a particular type of injury. This constant or intermittent pain has often outlived its purpose, as it does not help the body to prevent injury. It is often more difficult to treat than acute pain. Expert physician care is generally necessary to treat any pain that has become chronic. When opioids are used for prolonged periods drug tolerance, chemical dependency and even psychological addiction may occur. Chemical dependency is common among opioid users; however, psychological addiction is less frequent. Apparent drug tolerance to the pain-relieving effects of opioids may occur. This may be confused with progression of the underlying disease in cancer patients rather than an actual decrease in efficacy of the drug.

Causes

Chronic pain is essentially caused by the bombardment of the central nervous system (CNS) with nociceptive impulses, which causes changes in the neural response. The pain subsequently provokes changes in the behavior of the patient, and the development of fear-avoidance strategies. As a result, the patient may also become physically atrophied and deconditioned. However, it is important to remember that chronic pain is multifactorial, with the underlying biological changes affecting physical and psychosocial factors.

In 2005, University of Toronto researcher Min Zhuo established a connection between chronic pain and the NR2B protein.

Types

There are various types of chronic pain: malignant and non-malignant. Cancer-associated pain can be caused by the cancer itself or by treatment. Causes of non-malignant pain include arthritis, neuropathy/neuralgia, back pain from injury or disorders (cervical stenosis, degenerative disc disease, other disc disorders, etc), migraines and other types of headaches, abdominal pain from chronic pancreatitis, bowel disorders, etc; pelvic pain from various conditions (endometriosis, interstitial cystitis, etc); and also diffuse conditions such as fibromyalgia, reflex sympathetic dystrophy, lupus and other systemic autoimmune/connective tissue conditions, multiple sclerosis and some other neuromuscular conditions. Chronic pain can occur anywhere in the body; this list includes only a few examples of conditions that can cause chronic pain.

Trigger Point Injections / Core Blocks

(Excerpt from Chronic Pain written by patient undergoing this treatment) Only recently has research been undertaken to try and find more permanent solutions for these debilitating conditions. One method that has been formulated is Trigger Point Injections which are also somtimes reffered to . This involves the injection of a mixture of steroid and anaesthetic into the specific pressure points in the body where the pain is located in an attempt to disburse contracted tissue that could be causing the disturbance.

There has been some success treating cases of migraines, back pain, and other muscular associated situations with this procedure. If they are able to isolate the centres that are the focal points of the pain then a series of treatments are started. In theory as the treatment progresses the nerves are released from the pressure that is causing the continual transmission of the pain signal to the memory centre of the brain. This in turn should allow the brain to forget the pain.

At this time these procedures are starting to become readily available in North America. In the United States the procedure is showing very promising results with patients according to the Chronic Pain Association of America. Insurance companies are gradually starting to cover the costs of the procedure because the government has recognized it’s validity, based from the outcome of many completed studies and regimens of injections. This also means that the procedures are now regulated so you do have a guarantee that the standards of the Core Block are being maintained.

Although the procedure is covered by provincial health programs in Canada it can only be done by anaesthesiologists in a hospital situation. Since not all doctors in that field even perform this procedure, the wait time to get into a pain clinic can be as high as sixteen months.

External links

• Lower Back Pain Answers
• American Chronic Pain Association
• Chronic Pain as a Disease: Why does it still hurt?
• American Pain Foundation

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