Chronic Pain – A Specific Healthcare Problem (Consequences and Causes)

“Chronic and recurrent pain is a specific healthcare problem, a disease in its own right” J L Henry

The official definition of pain is as follows:
“an unpleasant sensory and emotional experience associated with actual or potential tissue damage”
And that includes any abnormal feeling from aching, burning, shooting, numbness, cramping etc.

Chronic pain can manifest anywhere in the body but the more common types include:
Shoulder and neck * Arms, wrists and elbow * Low back * Pelvic * Hip and Knee * Headache * Muscular, Neuropathic pain *Neuralgia * Bowel conditions * Osteoarthritis * Rheumatoid arthritis * Muscle *Chronic and degenerative diseases.
And I am sure we all know someone who has suffered with some form of chronic pain. It is estimated that 1 in 4 people suffer with chronic pain, i.e. pain which continues for a long time, medically defined as longer than 3 months.

What is common to all of these conditions is inflammation (from the Latin inflammatio, to set on fire). Inflammation is a complex biological response by the body to injury or assault, as it attempts to remove the stimulus and initiate tissue healing. Inflammation manifests as symptoms such as swelling, heat and redness with attendant pain as blood flow increases to the affected area and immune cells accumulate to eliminate the cause of injury and initiate the healing process. Although inflammation is a normal part of the healing process, when it becomes prolonged and if left untreated, it can cause numerous problems. Chronic inflammation can result when the body’s immune system is “tricked” into attacking its own soft tissue as though it was an invader, resulting in tissue destruction and the development of a number of chronic conditions.

Pain is caused by the stimulation of special sensory nerve endings that respond to bodily irritation, pressure, heat, cold, injury, stress and disease. Each person will perceive pain differently, and that perception will be influenced by a number of factors including, other health conditions, beliefs, mood and ability to cope, previous pain experiences, social, cultural and ethnic differences.

Chronic pain can have a serious effect on both physical and mental wellbeing.

The consequences of chronic pain can include;
+Immobility and subsequent wasting of muscles and joints
+Depression of the immune system and increased susceptibility to disease
+Disturbed sleep
+Poor appetite and nutrition
+Dependence on medication
+Over dependence on family and caregivers
+Poor performance at work or inability to work
+Isolation from family and society
+Anxiety, fear, bitterness, frustration and depression

Chronic pain is often poorly treated. The usual answer is to mask the pain with drugs rather than addressing the underlying cause. However this can cause more problems than it solves. Non steroidal anti-inflammatory drugs have been shown to be linked with an increased risk of stroke, even with short term use. A Danish study found that this increased risk ranged from about 30% with Ibuprofen to about 85% with Diclofenac. In theUKapproximately 2,500 people die every year from the gastro-intestinal effects of Non steroidal anti-inflammatory drugs such as aspirin, ibuprofen, diclofenac, celecoxib etc.

Chronic pain – Causes and Treatments

An individual’s pain may be relieved by understanding and addressing the specific causes and mediators relating to that pain. Pain can come from several sources but one of more of the following factors will be involved:

+Mood and Emotions
+Nutritional status
+Inflammation of body tissues
+Gut Health
+Hormonal balance

Mood and Emotions
A person’s perception of pain is strongly linked to their emotional state. It is the brain which is responsible for an individual’s experience of pain. In the brain pain and emotion share the same neural pathways and are therefore closely linked. Pain states can cause an increase in frustration, worry, anxiety and depression. Likewise frustration, worry, anxiety and depression can cause an increase in pain related conditions. Anger and sadness amplify pain. Love and similar emotions tend to decrease pain. Stress increases the inflammatory load because it stimulates the pro-inflammatory mechanisms due to defects of the stress response systems.

Nutritional status
Medication and / or manipulation may reduce pain and inflammation but they cannot influence a diet induced pro-inflammatory state. Dietary modification and supplementation are the only interventions that will address underlying causes. The Average British Diet, with its high dependence upon meat, dairy products, manufactured foods and sugar laden foods, is pro-inflammatory.

Inflammation of body tissues
The pain of inflammation and injury is usually limited and resolves as the injury heals. However inflammation and injury are always accompanied by changes in the peripheral and central nervous systems and in some cases inflammation can sensitise the nervous system. If further inflammatory agents such as poor diet, smoking, toxic toiletries, stress etc are then added this can lead to chronic inflammatory states and hence the experience of painful conditions.

Acidification of body tissues causes localised pain and the degree of local tissue acidosis correlates with the severity of the pain. High acidity of body tissues increase the loss of minerals such as magnesium and potassium which are necessary for muscle relaxation. The Average British Diet, with its high dependence upon meat, dairy products, manufactured foods, cereals and sugar laden foods, is very acidic

Gut Health
A high fat diet can affect the composition of the friendly bacteria in the gut. A high proportion of bad bacteria can increase gut permeability leading to leaky gut syndrome. Leaky gut can lead to over-stimulation of the immune system and the development of auto-immune diseases. Toxins produced in the gut due to poor dietary choices can lead to inflammation in muscle, fat stores and the liver.

Hormonal balance
Women have a higher prevalence than men of several pain related conditions such as migraine and tension headaches, fibromyalgia, IBS, Osteo and Rheumatoid arthritis. When both sexes suffer from the same pain condition, women often report more severe, frequent, widespread and longer lasting pain. Women tend to have an heightened inflammatory response due to the role of hormones in inflammation.

The incidence and intensity of pain varies with a woman’s menstrual cycle and with pregnancy. As oestrogen levels decrease near to menstruation then pain related conditions tend to increase. Contraceptives and HRT which interfere with natural hormonal balance have been linked to pain syndromes. The menopause is often associated with an increase in musculo-skeletal pain.