A Breakdown Of Chronic Pain

This post was originally posted on Blogger July 29, 2024.

Over the past week, I've been experiencing a significant increase in pain intensity, making it difficult to maintain my usual routines. The colder, wetter weather, combined with the pressure to achieve my summer goals before school starts, has triggered this flare-up. My body and mind are offering a preview of what this fall and winter might be like. When my pain reaches this level, it overwhelms my entire system, forcing me to shut down and lay in silence due to the sheer exhaustion.

In cooler, damp weather, my legs experience a deep, throbbing ache that seems to penetrate to the bone. This is accompanied by more intense symptoms, including a burning sensation from the inside out, stabbing pains that feel like hundreds of sharp objects piercing my legs, and electrical jolts that shoot up from my ankles. While my back and neck are less affected by the weather, they are more sensitive to physical activity and movement.

A bulging disc in C3, resulting from a bus accident, and torn neck muscles that failed to heal have contributed to ongoing neck and back issues. For years, I've struggled to stand for extended periods due to the pain in my legs and back. Currently, I can only stand for about five minutes before needing to rest by sitting or lying down. This limitation makes it challenging to perform household tasks, attend social events, and overall restricts my activities and their duration.

Unfortunately, I am not alone in this. An estimated 7.63 million Canadians aged 15 or older, or one in four, live with chronic pain. This is not a uniquely Canadian issue, as chronic pain is a global concern. The World Health Organization now recognizes chronic pain as a disease, not merely a symptom of another condition.

There are two primary types of chronic pain:

1. Chronic Primary Pain: This occurs when pain persists long after the body has healed or when there is no identifiable cause. Examples include fibromyalgia, pelvic pain, muusculoskeletal pain, and lower back pain. My diagnosis of Complex Regional Pain Syndrome (CRPS) and neck and back pain fall under this category.

2. Chronic Secondary Pain: This occurs alonside underlying diseases or issues, such as cancer treatment, post surgical pain and rheumatoid arthritis.

When treating chronic pain, many healthcare professionals employ the "5 A's" framework to address and manage pain more effectively. These A's stand for Analgesia, Activity, Adverse effects, Aberrant behaviors, and Affect. Each represents a crucial aspect of chronic pain management. Recently, a sixth A, Adequate Documentation, has been added for review.

• Analgesia: Refers to pain relief and involves finding the most appropriate and effective ways to alleviate pain, such as medications, physical therapy, alternative treatments or a combination of approaches.

• Activity: Encompasses daily tasks like bathing, dressing, eating and mobility. Assessing how pain affects a person's ability to perform these activities is essential for adapting and optimizing daily routines.

• Adverse Effects: Involves carefully weighing the benefits of pain relief against potential side effects of medications or treatments. It requires constant monitoring and adjustment to minimize negative consequences while ensuring effective pain management.

• Aberrant Behaviors: Refers to unexpected or problematic behaviors related to the use of pain medications, such as misuse, non-compliance, or signs of addiction. Identifying and addressing these behaviors is crucial for safe and responsible medication use. 

• Affect: Refers to the emotional and psychological aspecdts of pain, including mood, stress, anxiety and depression. Addressing these emotional factors is integral to a holistic approach to chronic pain management.

There are also four P's that medical professionals use for the assessment of chronic pain:

• Pain: The nature of the pain, its possible mechanisms, and underlying pathologies.

• Pathologies/Past Medical History: Knowledge of the patient's comorbidities can improve their quality of life and enable better physical and emotional management of pain. It can also influence treatment options.

• Performance and Function: Understanding the patient's activities, level of deconditioning, and any fear or avoidance behaviors can help assess their physical and social function.

• Psychological/Psychiatric Assessment Status: Assessing for depression and anxiety is important for understanding the overall impact of chronic pain.

While many medical professionals use these four P's, another set of four P's can also be employed:

• Physical Reactivation: An exercise program can benefit chronic pain patients.

• Psychological Strategies: Pain education, anagement of poor pacing, fear avoidance, and anxiety and stress management can be helpful.

• Pharmacological Medications: Appropriate medication selection and optimization are crucial.

• Procedure and Intervention: Considering potential procedures or interventions that may benefit the patient.

Everyone experiences pain differently, so keeping a pain scale can help measure pain levels and guide treatment planning. Most pain scales range from 0 to 10, with 0 being no pain and 10 being the worst possible pain.

It’s broken down as follows:

• 0 = No pain. 
• 1 = Pain is very mild, barely noticeable. Most of the time you don't think about it. 
• 2 = Minor pain. It's annoying. You may have sharp pain now and then. 
• 3 = Noticeable pain. It may distract you, but you can get used to it. 
• 4 = Moderate pain. If you are involved in an activity, you're able to ignore the pain for a while. But it is still distracting. 
• 5 = Moderately strong pain. You can't ignore it for more than a few minutes. But, with effort, you can still work or do some social activities. 
• 6 = Moderately stronger pain. You avoid some of your normal daily activities. You have trouble concentrating. 
• 7 = Strong pain. It keeps you from doing normal activities. 
• 8 = Very strong pain. It's hard to do anything at all. 
• 9 = Pain that is very hard to tolerate. You can't carry on a conversation. 
• 10 = Worst pain possible.

Pain is a complex disease, and its treatment is equally complex. Living with chronic pain is a challenging journey. The physical and emotional toll it takes can significantly impact daily life. While there are various approaches to managing chronic pain, finding the right combination of treatments and coping strategies is essential for improving quality of life. It's important to seek professional guidance and support to navigate this complex condition effectively.