Chronic pain

Chronic pain is the pain present for a longer period of time (> 3 months), and often continues after the cessation of the triggering factor or without a definite cause. It is a multidimensional issue and a disease in its own right. It’s a functionless pain, as it only reduces quality of life (whereas acute pain saves us from injury and teaches us).

Biological, psychological and social aspects of pain all influence perception of pain, and in turn are influenced by pain. Patients typically present with several issues besides pain, like exhaustion, depression issues, stress/anxiety, sleep issues, weak muscles, inactivity, loss of personal and social functioning, overuse of medicine, relationship issues, etc.

It’s a common problem, as it affects 10 – 30% of the EU.

Evaluation

Extensive pain interview, pain scales. It’s important to evaluate:

• The severity
• The impact on the patient
• The quality
• The time period
• Aggravating or alleviating factors

Treatment

The treatment is always multimodal, chronic pain treatment is not mainly pharmacological. Physical therapy is very important in reducing and treating chronic pain, as is psychotherapy. Opioids should not be used for chronic pain as a tolerance is built and opioid use disorder often occurs. Nonopioids, including NSAIDs, COX-2 inhibitors, and paracetamol, are useful, as are gabapentin, pregabalin, amitriptyline, etc. Gabapentin and pregabalin are especially useful for neuropathic pain, but like opioids they carry risk of dependency.

Management of chronic pain is very difficult because there is no good treatment and these patients often have high expectations for the physician to cure them of the pain. This is usually impossible, and so strategies to live with the pain should be sought.