CHRONIC PAIN

Chronic Pain is described as pain that persists past normal healing time. Usually, pain is regarded as chronic when it lasts or recurs for more than 3 to 6 months. Chronic pain is a frequent condition, affecting an estimated 20% of people worldwide and accounting for 15% to 20% of physician visits.[1]

Conditions Associated with Chronic Pain:

  • Chronic Headaches: Headaches that occur on at least 50% of the days during at least 3 months.1
  • Chronic Back Pain: Back pain that lasts more than three to six months, or even after tissue has healed.1
  • Repetitive Strain Injury: Caused by repetitive, forceful, or awkward movements that can result in injury to muscles, nerves, tendons, and ligaments, and can include carpal tunnel syndrome, tendonitis, lower back pain, and tension neck syndrome.[2]
  • Fibromyalgia: Though the exact cause of fibromyalgia is unknown, it causes widespread muscle fatigue and pain and is often accompanied by chronic fatigue, sleep disorders, and irritable bowel syndrome.[3]
  • Depression: While depression is commonly thought of as a mental health disorder, it is often accompanied by chronic pain.[4]
  • Phantom Limb Pain: Pain that is perceived in a part of the body which is no longer present.[5]
  • Chronic Primary Pain: Pain in 1 or more anatomic regions that persists or recurs for longer than 3 months and is associated with significant emotional distress or significant functional disability (interference with activities of daily life and participation in social roles) and that cannot be explained by another Chronic Pain condition.1
  • Chronic Cancer Pain: Pain caused by the cancer itself (the primary tumor or metastases) and pain that is caused by the cancer treatment (surgical, chemotherapy, radiotherapy, and others).1
  • Chronic Postsurgical and Posttraumatic Pain: Pain that develops after a surgical procedure or a tissue injury (involving any trauma, including burns) and persists at least 3 months after surgery or tissue trauma.1
  • Chronic Neuropathic Pain: Caused by a lesion or disease of the somatosensory nervous system. Pain may be spontaneous or evoked, as an increased response to a painful stimulus (hyperalgesia) or a painful response to a normally nonpainful stimulus (allodynia). Diagnosis requires a history of nervous system injury, for example, by a stroke, nerve trauma, or diabetic neuropathy, and a neuroanatomically plausible distribution of the pain.1
  • Chronic Visceral Pain: Pain is persistent or recurrent pain that originates from the internal organs of the head and neck region and the thoracic, abdominal, and pelvic cavities. The pain is usually perceived in the somatic tissues of the body wall (skin, subcutis, muscle) in areas that receive the same sensory innervation as the internal organ at the origin of the symptom (referred visceral pain).1
  • Chronic Musculoskeletal Pain: Persistent or recurrent pain that arises as part of a disease process directly affecting bone(s), joint(s), muscle(s), or related soft tissue(s).1

Canadian Statistics:[6]

  • In 2007 to 2008, more than 1.5 million Canadians aged 12 to 44 reported experiencing Chronic Pain. An estimated 669 males and 867 females reported experiencing Chronic Pain; this shows that females were more likely to have this condition compared to males.
  • The occurrence of Chronic Pain increases with age.
  • About a third of people who reported experiencing Chronic Pain (14% of males and 17% of females) also reported having back problems.
  • Migraines or headaches were also common especially among females (17%).
  • About half of males and females (less than 5%) with Arthritis also reported Chronic Pain.
  • More than 60% of those with Chronic Pain reported experiencing activity limitations when driving and also while at home, school, work, and during times of leisure. Compared to men, women were also more likely to need help moving around inside the house, doing housework, running errands, and preparing meals.
  • Nineteen percent (19%) of males and 18% of females with Chronic Pain had consulted a physiotherapist in the past 12 months.

Behaviours associated with Chronic Pain:2,[7]

  • Sleep disturbance
  • Inability to carry out mundane tasks
  • Permanent disability
  • Avoids others
  • Loses concentration or focus
  • Isolates self or refuses to get out of bed

Feelings associated with Chronic Pain:2,[8]

  • Pain-related fear
  • Depression
  • Hypervigilance
  • Stress
  • Hopelessness
  • Failure

Thoughts associated with Chronic Pain:

  • “I cannot do anything without taking note of my level of pain.”
  • “I cannot take any more of this pain. I would rather end my life than continue living this way.”
  • “I am in so much pain. I cannot sleep and I feel like I am going to throw up. Why is this happening to me?”
  • “I want my life back. I do not want to be sick anymore.”

Chronic Pain and the Body:2

People who experience Chronic Pain usually experience at least one of the following physical symptoms:

  • Joint stiffness
  • Muscle tightness
  • “Pins and needles”
  • Redness
  • Swelling
  • Fatigue

Chronic Pain and the Brain:

Several brain regions (insula, anterior cingulate cortex, thalamus, and basal ganglia) show reduction in gray matter volume among people suffering from Chronic Pain. This reduction in gray matter is associated with alterations in pain processing and sensitivity. On the other hand, the only regions with increased gray matter volume are the hippocampus and the parahippocampal gyrus. The parahippocampal gyrus is involved in pain modulation and sensitivity. The hippocampus is also activated during pain while the person experiences anxiety, leading to greater pain perception.[9]

Pain serves as an inciting even and also establishes specific functional connectivity strength between the medial prefrontal cortex and nucleus accumbens. If this functional connectivity strength is high, then the limbic brain learning circuitry will continue to reorganize the gray matter profile of the cortex, which produces the properties of the Chronic Pain state.[10]

Does Psychology work?

  • Cognitive-Behavioural Therapy (CBT): CBT focuses on the connections between your thoughts, emotional reactions, behaviours, and the physical pain you experience. The goal of therapy is to improve your mood by teaching you skills to change your thoughts and behaviours. Research supports the efficacy of CBT with Chronic Pain and evidence shows that CBT was able to have significant effects in terms of managing the pain intensity, working with catastrophic thinking, helping with mood regulation, and managing life and leisure activities.[11]
  • Mindfulness Therapy (MT): Mindfulness is defined as the intentional awareness and gentle acceptance of the body. Research shows that Mindfulness-based Interventions for Chronic Pain are able to result in long-term valuable outcomes. Positive effects of MT were found for pain intensity, depression, disability, quality of life, anxiety and pain interference in activities.[12]
  • Eye Movement Desensitization and Reprocessing Therapy (EMDR): Research shows that EMDR is capable of directly improving pain intensity and to some extent reduce anxiety and depression among people who suffer from Chronic Pain (such as with issues such as phantom limb pain, headache, fibromyalgia, musculoskeletal pain, and neuropathic pain). EMDR targets the affective distress and associated distressing events that are related to the pain experience and thus alleviates it.[13]

Tips to Manage Chronic Pain![14]

Chronic Pain makes it difficult for people to function in their everyday activities but here are five ways that people can manage their pain:

  • Increase understanding of pain and reasons for it. Know where the pain comes from and why. Identify own beliefs about the pain, negative thoughts and behaviours. For example, when is pain okay or manageable and how this can relate to mood.
  • Identify opportunities to change and understand when change is possible and when it is not. Break down issues into manageable groups and set simple, measurable, achievable, realistic goals. Identify negative behaviours and irrational thoughts.
  • Utilize health care services and improve communication skills. Moderate expectations and communicate effectively what you are feeling.

People who experience Chronic Pain often find their lives disrupted or damaged by their illness. They are no longer able to do the things that they were able to do before. A simple activity, such as sleeping, becomes difficult. Along with the constant pain, this condition also takes a toll on the person’s emotional and mental health. The good news is that pain can be reduced or managed through the use of pain medication, physical treatments (such as physiotherapy, massage therapy, and chiropractic care), and through a variety of psychological interventions such as Cognitive Behavioral Therapy, Mindfulness Therapy, Somatic Therapy, and Eye Movement Desensitization and Reprocessing Therapy. Hopewell Psychological clinicians can help you manage and/or resolve Chronic Pain, while offering you a supportive, trusting, non-judgmental, and collaborative setting. Our day and evening availability and multiple locations are designed to accommodate your schedule.

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*Psychologists are covered under Insurance Companies in Canada. You will need to check with your insurance company about the specific details regarding your coverage.

References

[1] Treede, R-D., Rief, W., Barke, A., Aziz, Q., Bennett, M. I., Benoliel, R., Cohen, M., Evers, S., Finnerup, N. B., First, M. B., Giamberardino, M. A., Kaasa, S., Kosek, E., Lavand’homme, P., Nicholas, M., Perrot, S., Scholz, J., Schug, S., Smith, B. H., Svensson, P., Vlaeyen, J. W. S., & Wang, S-J. “A Classification of Chronic Pain for ICD-11.” Pain. 156. 6. (2015). Pp. 1003-1007. DOI: 10.1097/j.pain.0000000000000160.

[2] Borrelli, C. D. “Repetitive Strain Injury – RSI.” Digital Mammography: A Holistic Approach. (2015). Pp. 195-202. DOI: 10.1007/978-3-319-04831-4_23.

[3] Zemel, L., & Blier, P. R. “Juvenile Fibromyalgia: A Primary Pain, or Pain Processing, Disorder.” Seminars in Pediatric Neurology. 23. 3. (2016). Pp. 231-241. DOI: https://doi.org/10.1016/j.spen.2016.10.007.

[4] Holmes, Alex, Christelis, Nicholas, & Arnold, Carolyn. “Depression and Chronic Pain.” The Medical Journal of Australia 199.6 (2013): S17-S20. doi: 10.5694/mja12.10589

[5] Stockburger, S., Mandakini, S., & Omar, H. A. “Phantom Limb Pain.” Journal of Pain Management. 9. 2. (2016). Pp. 161-164. DOI: http://search.proquest.com/openview/12b3a5c9b61aa31c26b4869f3755bca7/1?pq-origsite=gscholar&cbl=2034829.

[6] Ramage-Morin, Pamela L., & Gilmour, Heather. “Chronic Pain at Ages 12 to 44.” Statistics Canada. 2015. Web. April 2017.

[7] Jacobson, C. J. Jr., Kashikar-Zuck, S., Farrell, J., Barnett, K., Goldschneider, K., Dampier, C., Cunningham, N., Crosby, L., & DeWitt, E. M. “Qualitative Evaluation of Pediatric Pain Behavior, Quality, and Intensity Item Candidates and the PROMIS Pain Domain Framework in Children with Chronic Pain.” The Journal of Pain. 16. 12. (2015). Pp. 1243-1255. DOI:  https://doi.org/10.1016/j.jpain.2015.08.007.

[8] McCracken, L. M., & Morley, S. “The Psychological Flexibility Model: A basis for integration and progress in psychological approaches to chronic pain management.” The Journal of Pain. 15. 3. (2014). Pp. 221-234. DOI: https://doi.org/10.1016/j.jpain.2013.10.014.

[9] Smallwood, R. F., Laird, A. R., Ramage, A. E., Parkinson, A. L., Lewis, J., Clauw, D. J., Williams, D. A., Schmidt-Wilcke, T., & Farrell, M. J. “Structural Brain Anomalies and Chronic Pain: A quantitative meta-analysis of gray matter volume.” The Journal of Pain. 14. 7. (2013). Pp. 663-675. DOI: https://doi.org/10.1016/j.jpain.2013.03.001.

[10] Mansour, A. R., Baliki, M. N., Huang, L., Torbey, S., Herrmann, K. M., Schnitzer, T. J., & Apkarian, A. V. “Brain white matter structural properties predict transition to chronic pain.” Pain. 154. 10. (2013). Pp. 2160-2168. DOI: https://doi.org/10.1016/j.pain.2013.06.044.

[11] Ehde, Dawn M., Dillworth, Tiara M., & Turner, Judith A. “Cognitive-Behavioural Therapy for Individuals with Chronic Pain: Efficacy, innovations, and directions for research.” American Psychologist 69.2 (2014): 153-166. http://dx.doi.org/10.1037/a0035747.

[12] Veehof, M. M., Trompetter, H. R., Bohlmeijer, E. T., & Schreurs, K. M. G. “Acceptance- and Mindfulness-based Interventions for the Treatment of Chronic Pain: A Meta-Analytic Review.” Cognitive Behaviour Therapy 45.1 (2016): 5-31. http://dx.doi.org/10.1080/16506073.2015.1098724

[13] Tesarz, Jonas, Leisner, Sabine, Gerhardt, Andreas, Janke, Susanne, Seidler, Gunter H., Eich, Wolfgang, & Hartmann, Mechthild. “Effects of Eye Movement Desensitization and Reprocessing (EMDR) Treatment in Chronic Pain Patients: A systematic review.” Pain Medicine 15.2 (2014): 247-263. DOI: 10.1111/pme.12303

[14] Taylor, S. JC., Carnes, D., Homer, K., Pincus, T., Kahan, B. C., Hounsome, N., Eldridge, S., Spencer, A., Diaz-Ordaz, K., Rahman, A., Mars, T. S., Foell, J., Griffiths, C. J., & Underwood, M. R. “Improving the self-management of chronic pain: Coping with persistent pain, effectiveness research in self-management (COPERS).” Programme Grants for Applied Research. 4. 14. (2016). DOI: http://europepmc.org/abstract/med/27656730.

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