Chronic pain — its causes and treatments

chronic pain fentanyl photo

For centuries, there was nothing you could do about chronic pain but wince and bear it. Today we have medications ranging from the simple aspirin all the way up to opioids to relieve pain. This has proven to be both a blessing and a curse; while relief from pain is welcome, misuse of opioid pain medications has reached epidemic proportions, leading to a crackdown that is likely to harm many innocent chronic pain victims.

Let’s look at what pain is and how it is treated. Pain is a physical and emotional interchange between your nerves, brain, and spinal cord. It incorporates both learning and memory, and many factors influence how you react to it, including the pain itself. There are two different types of pain – acute and chronic.

Acute pain lasts for a short period of time and is severe or very sudden. Usually you know the exact cause for the pain; most likely it’s due to an injury. Chronic pain lasts for many months and the specific reason may be unknown.

Besides the pain, chronic pain sufferers may develop symptoms of other health issues, such as:

  • Fatigue;
  • Sleep disturbance;
  • Decreased appetite; and
  • Mood changes.

The pain may interfere with a patient’s mobility, leading to reduced flexibility, strength, and stamina. Inability to lead a full and active life can sometimes cause disability and despair.

Causes of chronic pain

The simplest explanation for when pain occurs is from one of four reasons:

  • When specific nerve endings are stimulated;
  • When damage or disruption happens to the nerves;
  • From an unknown cause; and
  • After a healed injury.

Pain can be categorized into two main categories of damage – tissue and nerve.

Tissue damage occurs when special nerve endings (called nociceptors) at the site of the damage relay pain impulses back to your spinal cord. Called nociceptive pain, it can be described as:

  • Sharp;
  • Stabbing;
  • Throbbing;
  • Burning;
  • Stinging;
  • Tingling;
  • Nagging;
  • Dull; or
  • Aching.

Nerve damage happens when pain signals are sent spontaneously instead of in response to an actual injury. It’s called neuropathic pain and commonly described as “pins and needles,” as well as:

  • Burning;
  • Freezing;
  • Numbing; or
  • Tingling.

There are certain factors that influence how one person might be more sensitive to the same pain than another. These include:

  • Genetics: your genetics affect how sensitive you are to pain perception, as well as your response to medications to treat the pain.
  • Gender: women are more prone to report more frequent, severe, and longer-lasting pain than men.
  • Long-term health problems: other chronic health conditions, like fibromyalgia and migraines, are associated with pain.
  • Psychological factors: people with depression and anxiety are more likely to have pain.
  • Social factors: according to research, having lower education and income, and being unemployed may be linked to a higher frequency of pain.
  • Past experiences: prior memories of painful experiences can influence current ones.
  • Other individual factors: your coping strategies, general attitude, and upbringing all influence how you tolerate pain.

Treating chronic pain

ibuprofen bottle photoTreatment for chronic pain involves a variety of nonpharmacological and pharmacological treatments. The medications commonly used are:

Antidepressants

Anticonvulsants

Analgesics

  • Oxycodone (Oxycontin)
  • Fentanyl (Duragesic, Fentora, Onsolis, Actiq)
  • Acetaminophen (Tylenol)

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

  • Ibuprofen (Motrin, Advil)
  • Naproxen (Anaprox, Naprosyn)
  • Diclofenac (Voltaren, Cataflam XR, Zipsor, Cambia)
  • Indomethacin (Indocin)
  • Ketoprofen

Opioids for cancer pain

Opana ER photoWhile pharmacologic treatment depends on the type of injury and its severity, the Centers for Disease Control and Prevention (CDC) Guideline for Prescribing Opioids for Chronic Pain recommends limiting opioid medications (i.e. Oxycodone, Fentanyl, etc.) to acute and chronic, cancer pain. Nonpharmacologic (i.e. physical therapy, occupational therapy, etc.) and non-opioid (i.e. NSAIDs, anticonvulsants, etc.) treatments are preferred for chronic, non-cancer pain.

The main concern in restricting opioid usage is the ongoing opioid epidemic. According to the CDC over 50,000 deaths in 2015 were due to drug overdoses and about 63% of those involved an opioid. About half of opioid-related deaths involved a prescription one. The economic burden from healthcare costs, lost productivity, treatment for addiction, and the criminal justice system in the United States is estimated to be $78.5 billion per year.

According to the National Institute on Drug Abuse, the opioid crisis began with the manufacturing of prescription opioid medications and pharmaceutical companies’ reassurance to healthcare providers that they were not habit-forming. Unfortunately, these assurances — which many lawsuits now argue were incorrect — led to overprescribing of the medications, which in turn led to misuse, addiction, and ultimately overdosing. The FDA has implemented an action plan to try to get control of the problem.

In July 2017, Endo Pharmaceuticals pulled its Opana ER at the FDA’s request after the agency said the opioid drug’s potential for abuse and misuse far outweighed its benefit. It was the first time the agency had taken steps to remove a currently marketed opioid pain medication from sale due to the public health consequences of abuse but is not likely to be the last.

The epidemic has had other consequences, as well. There has been an increase in neonatal abstinence syndrome (or drug withdrawal in a newborn infant) from opioid use during pregnancy. The spread of HIV and Hepatitis C are also on the rise from injecting the drugs.

Avoiding opioid addiction

There is no sure-fire way to avoid becoming addicted to an opioid medication if you are prescribed one. However, it is important to take your medication exactly as prescribed, and if you are still in pain to discuss any dosage changes with your healthcare provider first.

Equally as important is to determine whether you need to take the opioid medication in the first place or if you can manage the pain with nonpharmacologic and/or non-opioid treatments. Lastly, try to minimize the duration you’re on the opioid drug.

According to a recent CDC report, patients are at risk for continuing their opioid medication long-term if they take it for more than 5 days and aren’t likely to stop taking it if they take it for 90 days. No one wants to go back to biting bullets, but there are many effective ways to control pain without resorting to opioids.

About the Author

Julie Kaplan, Pharm. D.
Julie Kaplan is a licensed pharmacist in Virginia and the District of Columbia. She received a Bachelor’s of Arts in English from The College of William and Mary and a Doctor of Pharmacy from Virginia Commonwealth University. She has experience in patient communication from working as a retail pharmacist.