What Is Chronic Pain And How Is It Diagnosed?

What is chronic pain?

Those living with chronic pain will find the sensation all too familiar. It chips away at your confidence, always lurking in the back of your mind. Picking up the grandkids, going shopping, even simple household chores become a battle between mind, body, and your inner determination. One in five adults living in Europe will suffer from either nociceptive or neuropathic pain, with a third of those individuals experiencing constant pain.

Pain can come in waves, initially sharp before subsiding. It can also be more severe, ranging from a constant tingling or numbness to a burning sensation. Statistically, the likelihood of chronic pain does increase as you get older. However, chronic pain should not be considered a natural part of the ageing process.

Chronic pain is classified via two categories, nociceptive and neuropathic. The former is the kind of pain all of us will have experienced. Think back to the last time you broke a bone, cut your arm, or got burned by the kettle; these are all examples of nociceptive pain.

The latter, neuropathic pain, comes from within and is caused by damage to our nervous system. Some patients have reported the pain to feel like they are being shocked by electricity. It is typically resistant to traditional medication and becomes incredibly debilitating. Both types of pain can prevent sufferers from being able to sleep, work, or live healthy, active lives.

What causes chronic pain?

With more than 50% of chronic pain sufferers waiting up to two years before their pain is under control, understanding what causes it is paramount. Both categories of pain typically occur after some type of trauma. That being said, identifying the exact trigger for chronic pain is, in some cases, impossible.

Headaches, back pain, and arthritis; these conditions fall under the umbrella of nociceptive pain. Now, imagine that the pain is constant, or occurs regularly for six months or more. That is precisely what those living with chronic pain have to go through. Because the exact cause varies so much, every case has to be considered on its own merit. The pain could be the result of illness, disease, injury to the skin, a broken bone—the catalyst for chronic pain can come in many forms.

For chronic neuropathic pain, symptoms can present themselves in any part of the body. This only adds to the immense frustration felt by sufferers. Nerves and nerve pathways can become obstructed or impaired, leading to the onset of acute periods of pain. Our nervous system’s ability to process pain correctly can also become distorted.

For most individuals, a cut to the arm or being grabbed by the hand may hurt initially, but the pain soon fades. Those living with neuropathic pain can feel the pain in whole parts of their body like an arm or leg. They can even feel excruciating pain just by being lightly poked or prodded.

It’s difficult to diagnose chronic pain

Given the complexity of chronic pain’s onset, diagnosis and any treatment that follows are hard to tailor to the individual. The reason for the reduced rate of prognosis is because of the way our brain processes the experience of pain. What may hurt you significantly may not have the same on your partner. The same source of pain could also be more severe in children or the elderly.

Everyone's pain threshold differs. If you asked twenty people what it felt like when they broke their arm, the answer would vary every time. The same rules apply if you then asked the same twenty individuals to rate their pain on a scale of 1–10. Because there is currently no means of scientifically testing the severity of pain, we end up relying on the patient for diagnosis. Not only do they have to tell doctors how severe the pain is, but they also have to try and describe the source of the pain. With neuropathic conditions, this is almost impossible and entirely fruitless.

Some methods test for pain emanating from bones or deep tissue. X-rays, MRI, and CT scans can all help in this respect. For checking the integrity of nerves, patients can also undergo an electrophysiological study. Even a combination of these tests can fail to isolate the exact cause of chronic pain.

Prevalence of chronic pain in Europe

Although the exact number of people living with chronic pain differs from country to country, the figure is always in the millions—eight million in the UK, ten million in France, and sixteen million in Italy. In Spain, of the five million people suffering from chronic pain, 500,000 have been diagnosed with a neuropathic condition.

The statistics don’t get any better when looking at the effectiveness of treatment. 38% of all Europeans with chronic pain say that their pain is not adequately managed, and most have been living with the condition for upwards of seven years.

Chronic pain is undertreated

Chronic pain is both difficult to diagnose and incredibly debilitating. For those living with it, it can feel like it is the only thing that exists in life. Not all is lost, though. Some treatments can support effective management of pain. In mild cases, over the counter pain medication is sufficient. For severe pain, codeine or morphine can be prescribed. The risk with opioids is they carry many side effects, and most patients have concerns about the impact of their long-term use. Nerve blockers or muscle relaxants are also useful; however, their efficacy will depend on the type of pain being treated.

The primary goal of any form of treatment will always be to try and return that individual to participating in everyday activities. Whether that be returning to work, taking the dogs for a walk, or just being able to sleep through the night.

Despite the steps taken by health professionals, the vast spectrum of variables means chronic pain remains mostly undertreated. The unrelenting nature of chronic pain often causes the development of mental disorders. Anxiety and depression are common, especially when sufferers feel isolated by their physical inability.

A better understanding of chronic pain is absolutely vital, both for patients suffering now and for those diagnosed in the future. In worst case scenarios, chronic pain may never go away. However, in most cases, it can be managed through changes to lifestyle, diet, and support from medical professionals.