For years, painful knee arthritis hobbled you. Then, you had a knee replacement. Hurrah! So … why are you still in pain?
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There are a lot of reasons for chronic pain. Different from acute pain, chronic pain doesn’t go away after an injury or illness — in some cases, there are even unknown reasons for why it happens.
Tara-Lin Hollins, MD, tells us a bit about the various causes of chronic pain, how it’s different from regular pain and what to know about treatment options.
What is chronic pain?
The best way to understand what chronic pain is to figure out what it’s not. In general, pain specialists understand pain by breaking it up into two categories:
- Peripheral pain. This is the sharp or aching pain you feel locally, and it can occur due to things like injuries, infections or exposure to toxins. Peripheral pain is usually your body’s warning sign that something is wrong and that there’s an issue that needs to be addressed. This kind of pain is often treated with over-the-counter medications.
- Centralized pain. Centralized pain, on other hand, is a more complicated type of pain facilitated by your brain and spinal cord. It’s a continuing pain — sometimes referred to as neuropathic pain — that happens when nerve damage occurs. When this happens, your body isn’t sending pain signals correctly, and you then feel chronic pain.
Think of the last time you went to a rock concert or loud show. When you’re in the venue with the music blaring and you’re experiencing the loudness in your ears, that’s kind of how peripheral pain affects your body — instantly and in the moment. But let’s say after the band ended their show and you went home, you kept hearing that ringing in your ears. This is how centralized pain affects you — through a long-lasting, lingering effect.
“We’re realizing more and more that addressing only peripheral pain is not enough for patients who also have centralized pain,” says Dr. Hollins.
While the type of pain you’re experiencing can be hard to decipher at times, working with a pain specialist can help you get a clear answer on whether you’re dealing with peripheral or centralized pain (or a combination of both).
Common causes of chronic pain
Centralized pain is typically the type of pain associated with chronic pain. Traditionally, doctors thought centralized pain only occurred with nerve injuries such as spinal cord injury or stroke. But we now know there are a host of other conditions that can lead to chronic pain. And understanding them is a helpful step in knowing how to manage your pain and improve your quality of life.
Some well-known cause of chronic pain include:
- Fibromyalgia. This consists of widespread pain throughout your joints, muscles and bones, usually in the form of a dull ache or soreness.
- Arthritis. Pain from arthritis also occurs in your joints, usually in the form of a dull ache. It happens from the damage that arthritis does to your joints.
- Irritable bowel syndrome (IBS). Abdominal pain and cramping can occur due to IBS, as a result of the connection between your gut and brain. Chronic pain from IBS often consists of cramping and sharp pain in your abdominal area, or even back pain.
- Chronic low back pain. Consistent pain in your lower body can come from a variety of sources, including a pre-existing injury or a specific condition, like sciatica or a herniated disk.
- Chronic headache or migraines. While headaches and migraines are different, you can have chronic pain due to either one. Your headaches or migraines are considered chronic if you experience them 15 or more days out of the month.
- Endometriosis. This condition affects your pelvic and abdominal area and can cause chronic pelvic pain during your menstrual cycle or even before and after it. It can also cause digestive problems and general stomach pain.
- Chronic fatigue syndrome. Someone with chronic fatigue syndrome will likely experience body aches, headaches and sore throat, paired with symptoms like extreme exhaustion, fatigue and sleep disturbances.
How chronic pain is treated differently
Typically, healthcare providers treat peripheral pain with medications to decrease inflammation, injections or surgery to correct the underlying issue.
For example, anti-inflammatory drugs (NSAIDs) are used to treat inflammatory pain from osteoarthritis. But these medications are often not equipped to tackle pain problems caused by your central nervous system.
For centralized pain, providers can use medications that act on your brain or spinal cord, such as:
Seeing a psychologist can also be critical in addressing central sensitization. A pain psychologist would be ideal, but any psychologist who offers cognitive behavioral therapy (CBT) can also help. Learning stress management techniques and addressing anxiety are effective treatments as well.
How treating chronic pain has changed
Historically, pain specialists asked you to score your pain on a scale from 0 to 10 to see how well treatment was working. But it’s important to acknowledge that this format may not work best for everyone, especially if you experience chronic pain.
For example, two people can have a pain score of 8, but one may spend all day on the couch, while the other goes out shopping and interacts with their family.
In a lot of cases, healthcare providers will try to test how you engage in everyday activities and how your pain is affecting your ability to do them. Instead of treating a number, pain specialists look for functional improvement. They often find that when your centralized pain is treated, you can do activities you previously curtailed due to your pain.
So, if you’ve lived for years with spine pain, knee pain, headaches, arthritic pain or persistent pain after a successful surgery, consider seeing a pain specialist. You may need help for centralized pain — and available treatment options may help relieve your symptoms and then, you can live your life more easily.