What Is Chronic Pain?
Pain is your body’s way of telling you that something is wrong and that it needs to be fixed. If you cut a finger or break a leg, your body’s warning system is alerted and you will feel pain. But pain that persists beyond the normal healing period could develop into chronic pain. It’s important not to ignore it.
Acute pain versus chronic pain
Acute pain is referred to as a useful pain and is defined as lasting less than 3 months. It is short-term and resolves with healing of the underlying injury.
Chronic pain is different – it persists, often disrupting normal living and sleep patterns. It serves no protective function. In fact, it degrades health and functional capability. It is classified as a disease. The longer you ignore it, the more it can progress.
Persistent pain can be caused by a number of factors, including;
- a condition (e.g. arthritis, fibromyalgia)
- an isolated event (e.g. injury, infection) or
- a non-traceable occurrence
We have a comprehensive list of 140 conditions where chronic pin may be a factor. It demonstrates the disease’s true impact and health burden on society.
Neuropathic pain or nerve pain is a very specific subtype of chronic pain that is caused by damage to or dysfunction of the nerves, spinal cord, or brain. Typical effects are felt as a burning, crawling, stabbing, shocking or numbness type of pain.
Dr Paul Murphy outlines the differences between acute pain and chronic pain.
Chronic pain is a complex, multifaceted, often life-altering condition. But it can be treated and sometimes resolved. Very early and accurate diagnosis is critical.
A person with chronic pain may feel a range of emotions for the reduction or loss of many aspects in their quality of life. It also impacts family members, loved ones and society as a whole.
1 in 3 people in Ireland have chronic pain, with 1 in 5 people living with pain for 10 years or more. These research findings were part of the PRIME study, conducted by the Centre of Pain Research at NUI Galway.
A holistic approach to chronic pain management
The biomedical model of pain is the typical model of acute pain and a standard belief within society. For instance, if a person has pain sensations they presume they have tissue damage but with medical intervention the pain will eventually go away.
Chronic pain is much more complex. People with chronic pain get central sensitisation. This means that they become hypersensitive to pain sensations. In other words, the systems that a person has to dampen down pain transmission are no longer working as effectively as they normally would.
Comprehensive multidisciplinary care is essential for the treatment of chronic pain. This patient-centered approach, utilizing a range of strategies and specialist treatments, is based on the biopsychosocial model of pain. Not only is it clinically effective, but it is also cost-effective.
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The biopsychosocial model of pain
The biopsychosocial model gives people with chronic pain an understanding that there are other ways of dealing with their pain. These can include self-management interventions such as relaxation, mindfulness, becoming more aware of thinking patterns etc.
People with chronic pain often deal with their pain for years while seeking the correct diagnosis. These experiences often coincide with and reinforce feelings of helplessness due to ongoing treatment failures.
Chronic pain affects many aspects of a person’s quality of life, with serious impacts on lifestyle, daily activities, work and mental wellbeing. Issues such as depression, anxiety, stress, sleep problems and more can also become factors, adding to even more distress. Mental wellbeing is very important when dealing with and living with chronic pain.
“There are a number of changes I’d like to see to improve the quality of life of Irish chronic pain sufferers. Primarily amongst these is a recognition within society as a whole that chronic pain is a disease and that sufferers of chronic pain, like sufferers of other disorders such as diabetes, asthma and epilepsy, have a right to access a range of multidisciplinary services to help treat their pain and improve their quality of life.”
– Dr Paul Murphy, My Pain Feels Like campaign video
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The definition of pain
In 2020, the International Association for the Study of Pain (IASP) announced a new definition of pain to better convey the nuances and the complexity of pain. It is hoped that the revised definition would lead to improved assessment and management of those with pain.
The latest definition of pain is:
“An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage,” and is expanded upon by the addition of six key Notes and the etymology of the word pain for further valuable context.
- Pain is always a personal experience that is influenced to varying degrees by biological, psychological, and social factors.
- Pain and nociception are different phenomena. Pain cannot be inferred solely from activity in sensory neurons.
- Through their life experiences, individuals learn the concept of pain.
- A person’s report of an experience as pain should be respected.
- Although pain usually serves an adaptive role, it may have adverse effects on function and social and psychological well-being.
- Verbal description is only one of several behaviors to express pain; inability to communicate does not negate the possibility that a human or a nonhuman animal experiences pain.
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Why chronic pain classification is important
Early and accurate diagnosis of pain is a vital step for any patient. That diagnosis or classification determines medical treatment, as well as other public services a patient might be assessed for and entitled to.
ICD is the foundation for the identification of health trends and statistics globally. It is a medical classification system and the global standard for recording health information, developed and updated by the World Health Organization annually. ICD-11 is the latest revision. It is the diagnostic classification standard for all clinical and research purposes. ICD defines the universe of diseases, disorders, injuries and other related health conditions.
Under ICD-11, pain was – for the first time – assigned a single diagnostic code (MG30.0 Chronic primary pain). Furthermore, pain is now recognised as a health condition and as a symptom that can be secondary to other underlying health issues.
Chronic primary pain (in which no underlying condition adequately accounts for the pain or its impact) and chronic secondary pain (in which an underlying condition adequately accounts for the pain or its impact). Chronic primary pain and chronic secondary pain can coexist.
The IASP has a complete list of chronic pain definitions and classifications
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Chronic primary pain
Chronic primary pain represents chronic pain as a disease in itself. Chronic primary pain is characterized by significant functional disability, or emotional distress and is not better accounted for by another diagnosis of chronic pain. Here you find chronic widespread pain, chronic primary musculoskeletal pain previously termed “non specific” as well as the primary headaches and conditions such as chronic pelvic pain and irritable bowel syndrome. They are recognised as a group of chronic pain syndromes for the first time in ICD-11.
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Chronic secondary pain
Chronic cancer-related pain is chronic pain that is due to cancer or its treatment, such as chemotherapy.
Chronic postsurgical or post-traumatic pain is chronic pain that develops or increases in intensity after a tissue trauma (surgical or accidental) and persists beyond three months.
Chronic secondary musculoskeletal pain is chronic pain in bones, joints and tendons arising from an underlying disease classified elsewhere. It can be due to persistent inflammation, associated with structural changes or caused by altered biomechanical function due to diseases of the nervous system.
Chronic secondary visceral pain is chronic pain secondary to an underlying condition originating from internal organs of the head or neck region or of the thoracic, abdominal or pelvic regions. It can be caused by persistent inflammation, vascular mechanisms or mechanical factors.
Chronic neuropathic pain is chronic pain caused by a lesion or disease of the somatosensory nervous system. Peripheral and central neuropathic pain are classified here.
Chronic secondary headache or orofacial pain contains the chronic forms of symptomatic headaches (those termed primary headaches in the ICHD-3 are part of chronic primary pain) and follows closely the ICHD-3 classification. Chronic secondary orofacial pain, such as chronic dental pain, supplements this section.
Chronic Pain Ireland can help you through education and self-management support as you explore treatment options for you and your pain. What works for one person may not necessarily work for you and it may take some time to find a treatment option that reduces your pain.
“Pain is a major healthcare problem in Europe. Although acute pain may reasonably be considered a symptom of disease or injury, chronic and recurrent pain is a specific healthcare problem, a disease in its own right.”