What Causes Chronic Pain?

Chronic pain can be caused by many different factors. Often conditions that accompany normal aging may affect bones and joints in ways that cause chronic pain. Other common causes are nerve damage and injuries that fail to heal properly.

Some kinds of chronic pain have numerous causes. Back pain, for example, may be caused by a single factor, or any combination of these factors:

" Years of poor posture
" Improper lifting and carrying of heavy objects
" Being overweight, which puts excess strain on the back and knees
" A congenital condition such as curvature of the spine
" Traumatic injury
" Wearing high heels
" Sleeping on a poor mattress
" No obvious physical cause
" Ordinary aging of the spine (degenerative changes)

Disease can also be the underlying cause of chronic pain. Rheumatoid arthritis and osteoarthritis are well-known culprits, but persistent pain may also be due to such ailments as cancer, multiple sclerosis, stomach ulcers, AIDS, and gallbladder disease.

In many cases, however, the source of chronic pain can be a very complex and even mysterious issue to untangle. Although it may begin with an injury or illness, ongoing pain can develop a psychological dimension after the physical problem has healed. This fact alone makes pinning down a single course of treatment tricky, and it is why health care providers often find they have to try a number of different types of curative steps.

What Are the Treatments for Chronic Pain?

The treatments for chronic pain are as diverse as the causes. From over-the-counter and prescription drugs to mind/body techniques to acupuncture, if one approach doesn't work, another one might. But when it comes to treating chronic pain, no single technique is guaranteed to produce complete pain relief. Relief may be found by using a combination of treatment options.

Drug Therapy: Nonprescription and Prescription

Milder forms of pain may be relieved by over-the-counter medications such as Tylenol (acetaminophen) or nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and Aleve. Both acetaminophen and NSAIDs relieve pain caused by muscle aches and stiffness, but only NSAIDs can also reduce inflammation (swelling and irritation). Topical pain relievers are also available, such as creams, lotions, or sprays that are applied to the skin in order to relieve pain from sore muscles and arthritis.

If over-the-counter drugs do not provide relief, your doctor may prescribe stronger medications, such as muscle relaxants, anti-anxiety drugs (such as Valium), antidepressants, prescription NSAIDs such as Celebrex, or a short course of stronger painkillers (such as Codeine, Fentanyl, Percocet or Vicodin). A limited number of steroid injections at the site of a joint problem can reduce swelling and inflammation.

Trigger Point Injections

Trigger point injection is a procedure used to treat painful areas of muscle that contain trigger points, or knots of muscle that form when muscles do not relax. During this procedure, a health care professional, using a small needle, injects a local anesthetic that sometimes includes a steroid into a trigger point. With the injection, the trigger point is made inactive and the pain is alleviated. Usually, a brief course of treatment will result in sustained relief.
Trigger point injection is used to treat muscle pain in the arms, legs, lower back, and neck. In addition, this approach has been used to treat fibromyalgia, tension headaches, and myofascial pain syndrome (chronic pain involving tissue that surrounds muscle) that does not respond to other treatment

TENS

Transcutaneous electrical nerve stimulation therapy, more commonly referred to as TENS, uses electrical stimulation to diminish pain. During the procedure, low-voltage electrical current is delivered through electrodes that are placed on the skin near the source of pain. The electricity from the electrodes stimulates the nerves in an affected area and sends signals to the brain that "scramble" normal pain signals, offering short-term pain relief. While effective in the short-term, long-term effectiveness of TENS remains questionable

Physical Therapy

Physical therapy helps to relieve pain by using special techniques that improve movement and function impaired by an injury or disability. Along with employing stretching and pain-relieving techniques, a physical therapist may use, among other things, TENS to aid treatment.

Exercise

Although resting for short periods can alleviate pain, too much rest may actually increase pain and put you at greater risk of injury when you again attempt movement. Research has shown that regular exercise can diminish pain in the long term by improving muscle tone, strength, and flexibility. Exercise may also cause a release of endorphins, the body's natural painkillers. Some exercises are easier for certain chronic pain sufferers to perform than others; try swimming, biking, walking, rowing, and yoga.

Psychological Treatment

When you are in pain, you may have feelings of anger, sadness, hopelessness, and/or despair. Pain can alter your personality, disrupt your sleep, and interfere with your work and relationships. In turn, depression and anxiety, lack of sleep, and feelings of stress can all make pain worse.

Psychological treatment provides safe, nondrug methods that can treat your pain directly by reducing high levels of physiological stress that often aggravate pain. Psychological treatment also helps improve the indirect consequences of pain by helping you learn how to cope with the many problems associated with pain.

A large part of psychological treatment for pain is education, helping patients acquire skills to manage a very difficult problem.

Alternative Therapies

In the past decade, strong evidence has accumulated regarding the benefits of mind-body therapies, acupuncture, and some nutritional supplements for treating pain. Other alternative therapies such as massage, chiropractic therapies, therapeutic touch, certain herbal therapies, and dietary approaches have the potential to alleviate pain in some people. However, the evidence supporting these therapies is less concrete.

Mind-Body Therapies

Mind-body therapies are treatments that are meant to help the mind's ability to affect the functions and symptoms of the body. Mind-body therapies use various approaches including relaxation techniques, meditation, guided imagery, biofeedback, and hypnosis. Relaxation techniques can help alleviate discomfort related to chronic pain.

Visualization may be another worthwhile pain-controlling technique. Try the following exercise: Close your eyes and try to call up a visual image of the pain, giving it shape, color, size, motion. Now try slowly altering this image, replacing it with a more harmonious, pleasing -- and smaller -- image.

Another approach is to keep a diary of your pain episodes and the causative and corrective factors surrounding them. Review your diary regularly to explore avenues of possible change. Strive to view pain as part of life, not all of it.

Electromyographic (EMG) biofeedback may alert you to the ways in which muscle tension is contributing to your pain and help you learn to control it. Hypnotherapy and self-hypnosis may help you block or transform pain through refocusing techniques. One self-hypnosis strategy, known as glove anesthesia, involves putting yourself in a trance, placing a hand over the painful area, imagining that the hand is relaxed, heavy, and numb, and envisioning these sensations as replacing other, painful feelings in the affected area.

Relaxation techniques such as meditation or yoga have been shown to reduce stress-related pain when they are practiced regularly. The gentle stretching of yoga is particularly good for strengthening muscles without putting additional strain on the body.