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Chronic Pain Management: The Quality of Life


What is chronic pain, and how can one manage it to ensure greater quality of life?


Chronic pain is defined as “pain that can persist past normal healing time and hence lacks the acute warning function of physiological nociception,” and it lasts more than 3 to 6 months [1]. “Stress and stress response systems” are considered a factor for chronic pain [2]. Chronic pain has been a pathway for devastating effects such as “restrictions in mobility and daily activities, dependence on opioids, anxiety and depression, and poor perceived health or reduced quality of life,” [3]. Additionally, it has caused sleep problems and social isolation [4]. Professor of Health Economics Ceri J. Philips in her 2009 review finds that “there are enormous costs which society has to bear as a result of the burden of chronic pain and its suffering,” so much so that there is a range of estimates regarding prevalence of chronic pain from “8% to 60% and over,” [5]. Some suggested ways to relieve chronic pain include “physical therapy, hot and cold therapy, massage, and acupuncture," [4]. A collaboration between the International Association for the Study of Pain (IASP) and the World Health Organization (WHO) developed a task force to create a new classification of chronic pain for the ICD-11 framework [1]. Regardless of difficulty creating a classification, they were able to create seven groups under chronic pain for “(1) chronic primary pain, (2) chronic cancer pain, (3) chronic posttraumatic and postsurgical pain, (4) chronic neuropathic pain, (5) chronic headache and orofacial pain, (6) chronic visceral pain, and (7) chronic musculoskeletal pain,” [1].


People experience pain in many ways, and it can be “influenced by emotional states and attentional direction,” [6]. Different brain regions are “involved in the cognitive and emotional control of pain,” [6]. A fronto–periaqueductal grey–brainstem circuit can “increase or decrease pain experience depending on the emotion being experienced,” [6]. Insula–parietal–somatosensory corticocortical pathways are involved in attention that “can reduce pain via distraction,” [6]. People have been using “cognitive behavioral therapy, yoga, meditation, hypnosis and relaxation procedures” to cope with pain [6].


Bushnell et al. (2013) found that “when pain becomes chronic, structural changes are seen in multiple brain regions involved in emotional and attentional aspects of pain modulation, possibly leading to a diminished ability in pain regulation,” [6]. The effects of chronic pain can also lead to “impairments in performance on decision-making and learning tasks,” [6]. However, there are successful treatments of chronic pain that have helped people get back to themselves including hip replacement and back surgery [6]. There are also psychology-based treatments that can “prevent or reverse these pain-related changes in brain structure and function,” [6].


The multidimensional negative impact of chronic pain leads to poorer quality of life among patients with chronic pain compared to the general population and patients with other long-term conditions. Patients are trying to find ways to deal with chronic pain and acknowledge how it affects their lives.


References:

1. Treede, R. D., Rief, W., Barke, A., Aziz, Q., Bennett, M. I., Benoliel, R., Cohen, M., Evers, S., Finnerup, N. B., First, M. B., Giamberardino, M. A., Kaasa, S., Kosek, E., Lavand'homme, P., Nicholas, M., Perrot, S., Scholz, J., Schug, S., Smith, B. H., Svensson, P., … Wang, S. J. (2015). A classification of chronic pain for ICD-11. Pain, 156(6), 1003–1007. https://doi.org/10.1097/j.pain.0000000000000160


2. Crofford L. J. (2015). Chronic Pain: Where the Body Meets the Brain. Transactions of the American Clinical and Climatological Association, 126, 167–183.


3. Dahlhamer, J., Lucas, J., Zelaya, C., Nahin, R., Mackey, S., DeBar, L., Kerns, R., Von Korff, M., Porter, L., & Helmick, C. (2018). Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults - United States, 2016. MMWR. Morbidity and mortality weekly report, 67(36), 1001–1006. https://doi.org/10.15585/mmwr.mm6736a2


4. zoppi, lois. (2020, December 21). Pain management techniques: 13 ways to manage chronic pain. Medical News Today. Retrieved May 8, 2022, from https://www.medicalnewstoday.com/articles/pain-management-techniques?msclkid=1bd16306cf4111ec9e6260adda0f5eea


5. Phillips C. J. (2009). The Cost and Burden of Chronic Pain. Reviews in pain, 3(1), 2–5. https://doi.org/10.1177/204946370900300102


6. Bushnell, M. C., Čeko, M., & Low, L. A. (2013). Cognitive and emotional control of pain and its disruption in chronic pain. Nature Reviews Neuroscience, 14(7), 502-511. https://doi.org/10.1038/nrn3516

 

Contributors:

Authors: Sara Giarnieri and Diya Jacob

Editor: Sara Giarnieri

Health scientist: Diya Jacob


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