What is Chronic Pain?

Chronic pain is pain that lasts more than 6 months.  It can involve exacerbations and remissions, increases and diminutions in intensity but pretty much lingers as a constant nagging ache, burn or stiffness.  It affects the way one is able to live his or her life and is one of the top reasons a person off work or unable to return at all.

Causes of chronic pain can be lumped into a few different categories: acute injuries that fail to heal properly, repetitive strain injuries, neurological conditions, problems with hormonal regulation and/or other systemic diseases.  As a manual therapist, I primarily work with the first three; acute become chronic injuries, repetitive strains and neurological conditions.

 Acute-become-chronic injuries can be further subcategorized as really severe injuries including some surgical procedures, repetitions of the same injury or repeated injuries to the same area.  A really severe injury could include near complete to complete rupture of ligaments and muscles, badly broken bones, impact traumas that damage internal structures, or a joint replacement surgery.  In these instances the body likely experienced a period of shock as it scrambled to deal with the moment of injury and the convalescent period.  These injuries can involve many structures, or a single structure and typically call for a longer period of healing and potential immobilization.  In the event of less severe but repeated injury, we can see a lingering of inflammation and syndromes in other, closely related areas.  For instance, a mildly sprained ankle, once, isn’t a terribly injury and one is likely up and doing their thing right away.  Repeated sprains though decrease the stability of the joints, leading to the potential for a more severe sprain, stiffness and a constant swelling in the ankle.  This can set the stage for shin splints to develop as the Tibialis Anterior muscle on the front of the shin sees a lot more activity in stabilizing the joint than it ought.

Repetitive strain injuries (RSIs) involve constantly working a part in the same fashion, frequently/daily, without adequate rest and care in between bouts of effort.  Some of the most common include Golfer’s and Tennis elbow, where the knobby bits on either side of the elbow get really sore and inflamed.  Presently, tendonopathies like these are understood as being repeated periods of inflammation leading to adhering of the various layers of tissue.  With these tissues getting bogged down and stuck together by the inflammatory fluids, glide ceases to happen between the tissues and restrictions begin.  Eventually the tissues get thicker as a means of protection from the constant friction and we see a decrease in available, pain-free range of motion.  This sort of tendonitis can happen just about anywhere there is a tendon. 

Neurological syndromes can be a bit trickier to pin down.  Nerves are like tubes that split off of main channels to carry their messages all across the body.  Because of this, what appears to be a Carpal Tunnel syndrome may actually be associated with a dysfunction higher up the chain at the elbow, shoulder or neck.  Even issues like the above mention RSIs can be associated with poor neurological functioning.  Causes of neurological dysfunction can be either mechanical or chemical.  It becomes very important to work closely with the diagnosing physicians to ensure that what may appear to be a simple mechanical neuropathy isn’t in fact a more complex problem involving even higher branches of the nervous system or hormonal dysfunctions.

The thing to really take home about chronic pain is how dramatically it can alter one’s lifestyle.  To go from being an active participant to restricted in simple things like standing at the counter long enough to make a sandwich, put on one’s socks or brush the teeth is very frustrating at best.  The emotional toll can be high as quality of life diminishes and the ability to experience pleasure is challenged.  Relationships with self and others suffer and even personal identity can be affected.

For those who are close with person’s living in chronic pain it is important to remember that this pain is a daily experience and is truly exhausting.  It is up to us to remain sensitive to their emotional and physical needs, and to be as compassionate as we can.

ABOUT THE AUTHOR

Jen Fleming, RMT

www.jenflemingrmt.com