Chronic pain is characterized by its prolonged duration, extending for weeks, months, or even years, and is identified as pain that endures beyond the typical recovery timeframe. It may manifest as sensations such as burning, aching, tingling, pricking, or stinging. This type of pain can be persistent or may occur intermittently. Various factors can contribute to the onset of chronic pain, including injuries, infections, arthritis, cancer, physical and environmental influences.

Types of Chronic Pain

 It manifests in various forms and can affect multiple areas of the body. It serves as a primary indicator for numerous injuries, infections, and medical conditions. Among the prevalent types of chronic pain are:

• Arthritis or joint pain
• Back pain (lower back)
• Cancer pain
• Fibromyalgia
• Headaches, including migraines
• Neck pain
• Neuropathic (nerve) pain
• Psychogenic pain (pain that isn’t caused by disease, injury, or nerve damage)

Symptoms

It persists for an extended duration, often spanning months or even years, and can impact any region of the body. It disrupts everyday activities and may contribute to development of depression and anxiety. According to Dr. Subrata Chakravartry the pain is not always severe it can be a dull headache that occur regularly or sometimes it comes with  alarming like sharp pains and burning sensations. The other symptoms  also may include:

• Squeezing
• Stiffness
• Stinging
• Throbbing

Causes

 It often originates from an initial injury, such as a back sprain or a strained muscle. It is believed that this type of pain arises when nerves sustain damage, leading to heightened and prolonged sensations of pain. In such instances, addressing the original injury may not alleviate the chronic pain.

Conversely, some individuals experience chronic pain without any preceding injury. The precise reasons for this in the absence of injury remain poorly  understood. In certain situations, this pain may stem from an underlying medical condition. In such conditions that don’t seem to have an underlying issue such as fibromyalgia, for example, there will be no signs from medical imaging that the condition exists (although there is a blood test that may be used in coming years for a diagnosis.) That may lead a physician – or even the patient – to believe the pain is imagined or to not take proper treatment action to address the problem. Yet the patient will still suffer the symptoms, in some cases for years.

– Chronic fatigue syndrome: characterized by profound fatigue, sleep abnormalities followed by pain and worsen by exertion.

Treatment

The treatment is based on specific type of pain disease and condition. A multidisciplinary approach is required to treat it which includes many skilled professionals like  Anesthesiologist and Dr. Subrata Chakravarty has the experience of more than 15 years in this field.

• Physical and occupational therapies, including massage and whirlpool treatments, are employed to enhance mobility and comfort.
• Exercise is recommended to diminish spasticity, prevent joint contractures, reduce joint inflammation, address spinal alignment issues, and counteract muscle weakening and atrophy, thereby averting additional complications.
• Local electrical stimulation involves the application of short bursts of electrical impulses to nerve endings beneath the skin to achieve pain relief.
• In addition treatment may include surgery and acupuncture.

Identification of Chronic pain patients

1. Understanding Pain as a Symptom

• Pain usually has a clear cause. For instance, knee pain following an injury is expected and tends to lessen as healing occurs.

2. Acute Pain vs. Chronic Pain

• Acute Pain: Generally, this type of pain is linked directly to an injury and diminishes as the injury heals.
• Chronic Pain: Defined as pain that persists beyond three to six months. This pain can initially start from an injury, but in some cases, it appears without any obvious health issue.

3. Ongoing Pain Signals

• With chronic pain, the nervous system continues to send pain signals to the brain even after the initial injury has healed.
• Individuals may not show physical signs, like limping, but still experience pain, often due to possible nerve damage.

4. Characteristics

• Localized Pain: Typically limited to one area, such as pain from a specific injury.
• Diffuse Pain: Many people with its report widespread discomfort across their body without a specific focus.

5. Increased Sensitivity in Patients

• Allodynia: Heightened sensitivity to stimuli that wouldn’t usually cause pain, like light touches or mild temperature changes.
• Hyperalgesia: An amplified response to minor injuries, making the pain feel much more intense.
• Sensitivity to Other Stimuli: Some patients may also be more sensitive to sounds and light, compounding their discomfort.

These factors together create a unique and complex pain experience for chronic pain patients, requiring a careful, individualized approach to diagnosis and treatment.

Imaging Techniques May Not Identify Chronic Pain

Dr. Subrata Chakravarty points out that standard imaging techniques often miss the root cause of it, making it hard to diagnose and treat. While imaging like X-rays or MRIs can rule out issues like fractures or herniated discs, they usually fail to show chronic pain since it doesn’t appear the same way as acute injuries.

Key Points:

• Chronic Pain and Imaging: Its conditions usually involve chemical changes in the brain, not physical changes that imaging can detect. For example, while injuries show clear signs on scans, chronic pain often remains “invisible.”
• Advancements in Fibromyalgia Imaging: For fibromyalgia, a common chronic pain condition affecting about 12 million people in the U.S., recent MRI studies show unique brain patterns. These findings offer proof that fibromyalgia has a physical basis, countering beliefs that it’s purely psychological.
• Alternative Diagnostic Methods: Some doctors are using ultrasounds to locate muscle trigger points and electrodes to detect nerve issues, offering alternative ways to identify sources of pain.
• Relying on Patient Descriptions: Since measuring pain objectively is difficult, Dr. Chakravarty often relies on patients’ own descriptions—whether the pain feels sharp, dull, burning, or itching.
• Pain Rating Scales: Medical professionals may also ask patients to rate their pain on a scale, helping to gauge its intensity and underlying causes.

 

Additional Indicators of Chronic Pain

In addition to pain itself, healthcare providers can look for other signs that may indicate chronic pain in patients. For example, many people with chronic pain also show psychological symptoms like depression or anxiety, affecting nearly half of those with persistent pain.

Depression may develop as patients struggle to cope with pain, especially when they feel it’s misunderstood or overlooked by their healthcare providers. This mental stress can interfere with their social life and limit physical activities, which are both crucial for mental well-being. Because of this, antidepressants sometimes help relieve some chronic pain symptoms by boosting neurotransmitters in the brain that improve mood.

Other signs include fatigue, which often results from poor sleep due to pain. Poor sleep is also linked to a lower pain tolerance, making discomfort even harder to manage. Cognitive issues, like memory problems and trouble focusing, can also be key indicators.

About a quarter of those with chronic pain may develop Chronic Pain Syndrome, which brings additional symptoms. This syndrome can start with an initial injury, but as Dr. Subrata Chakravarty points out, it can also stem from other conditions like Lyme disease or inflammatory bowel disease.

Assessing a patient’s lifestyle and diet can give healthcare providers important clues. For example, chronic stress from an unhealthy work environment can reduce the body’s ability to handle pain.

 

Managing Chronic Pain

Regardless of whether medical interventions identify the underlying cause of pain, the patient’s experience of pain is genuine and should not be dismissed. Therefore, it is essential to establish an effective treatment plan for individuals reporting persistent pain, as emphasized by anesthesiologist Dr. Subrata Chakravarty.

Dr. Subrata’s Conclusion

A variety of approaches can help improve the quality of life for its patient, ranging from medications, to lifestyle changes, to learning meditation and relaxation techniques. Accepting the pain and becoming involved in managing symptoms can help patients regain a sense of control that’s often lost in these situations, says Dr. Subrata Chakravarty.