Chronic Pain and its Treatment, a Holistic View

What is chronic pain?

Chronic pain is a disease that causes widespread and constant pain and anguish, and which fills both patients and the health professionals who treat them with dread.

There is often no clear cause and traditional treatment and pain control efforts are often unsuccessful. This can cause great distress and a sense of despair.

However, recent research and the shift towards a more comprehensive approach to pain treatment bring hope. By combining traditional and psychosocial interventions, professionals can now help their patients cope better with their experience of chronic pain.

Pain is a difficult subject to tackle

Chronic pain is a difficult subject to broach. It is fraught with fear, misunderstanding and a whole myriad of negative connotations and expectations. There are, however, significant advances being made in various fields. These allow us to understand this phenomenon and therefore manage it better.

The International Association for the Study of Pain (1) defines pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage".

In the simplest terms, pain is the sensation we feel when our body is injured or under threat of being injured. From here, we can assume that there is usually an obvious cause for the pain and that when the damage or threat of damage is healed or removed, the pain should disappear. But what if it doesn't? Or what if there is no obvious cause? Or what if the cause can't be removed?

That's when we start talking about chronic pain. This type of pain doesn't necessarily have an obvious cause that can be treated or resolved. It can last for months or even years. It affects the pain sufferer's quality of life and is often accompanied by multiple associated illnesses. As you can imagine, this can lead to a cycle of pain, stress and depression.

The John Hopkins Hospital in the US refers to this cycle as the terrible triad of chronic pain: suffering, sadness and insomnia.

The causes of chronic pain

The causes of chronic pain are varied and uncertain(2). It can result from a wide range of underlying conditions, injuries, diseases or syndromes, and often involves a combination of physiological, psychological and social factors.

Some common causes of chronic pain include the following:

• Injuries or trauma may not heal properly or may cause persistent pain even after the injury has healed.
• Degenerative diseases such as osteoarthritis, rheumatoid arthritis and degenerative disc disease cause inflammation.
• Neurological diseases such as neuropathy, multiple sclerosis or fibromyalgia cause abnormalities in nerve function or in the processing of pain signals.
• Chronic diseases such as cancer, autoimmune diseases, inflammatory bowel disease or endometriosis cause inflammation, tissue damage or nerve involvement.
• Musculoskeletal problems related to muscle tension, myofascial trigger points or imbalances in muscle strength and flexibility lead to conditions such as chronic back pain or tension headaches.
• Psychological factors such as emotional stress, anxiety, depression or past traumas can cause central sensitisation, amplification of pain signals or altered perception of pain.
• A genetic predisposition to chronic pain conditions or certain hereditary characteristics related to pain can increase the susceptibility to developing chronic pain.
• Lifestyle factors such as poor posture, a sedentary lifestyle, inadequate ergonomics, obesity, smoking or unhealthy eating habits contribute to musculoskeletal pain or aggravate existing pain conditions.
• And sometimes there may be no clinical reason for chronic pain. How can there be pain without a cause?

Apparently, this type of chronic pain occurs as a result of faulty neuronal circuits. The brain's circuits don't work as they should. Either they are too sensitive or they are misinterpreting the signals the body is sending, causing the body to feel pain when there is no physical stimulus for pain.

Psychology and pain are closely related

Psychological research into pain management has revealed several intriguing findings that are useful when it comes to managing chronic pain. Some particularly interesting findings include the following.

Pain catastrophisation refers to our tendency to increase the value of the threat of pain and to feel powerless in the face of pain. Consistent research findings indicate that if we engage in pain catastrophising, we experience greater pain intensity, disability and psychological distress.

Psychological interventions aimed at catastrophising pain have been shown to be effective in reducing pain and improving functioning in individuals with chronic pain.

The placebo effect

This is a phenomenon (3) that occurs when you experience a reduction in pain or an improvement in symptoms after receiving an inactive treatment that you believe to be real.

Psychological research has explained some of the mechanisms behind the placebo effect, including the role of expectations, conditioning and the release of endogenous opiates in the brain that help control pain.

Neuroscience and chronic pain

Neuroscience and the study of neuroplasticity (4) have revealed that the brain has a remarkable capacity to reorganise and adapt in response to pain.

Interventions such as physiotherapy, cognitive training and mindfulness meditation can cause structural and functional changes in the brain that can reduce the perception of pain and improve pain management outcomes.

Mindfulness-based interventions

These interventions have been shown to reduce pain intensity and improve quality of life by altering brain activity and improving pain coping skills.

The changes in brain activity associated with mindfulness practice can improve the psychological factors that influence how pain is experienced, such as pain acceptance and emotional regulation (5).

These results emphasise the importance of psychological factors in the perception of pain and the potential of psychological interventions to complement traditional treatments. In fact, it could be argued that, given the above research findings, psychological interventions are an integral part of successful pain management.

A combined approach to managing chronic pain is fast becoming the gold standard. This is not surprising, given that it is a systemic problem that requires a holistic and systemic approach. Combining traditional approaches with psychology allows for a more comprehensive approach to pain relief.

Traditional methods, such as medication and physiotherapy, address the physiological aspects of pain, while psychological interventions target the emotional and cognitive components.

Including psychological interventions in pain management strategies will help patients develop coping strategies, manage pain-related distress and reframe negative thoughts about their condition. This integrated approach not only reduces the intensity of pain, but also improves the general well-being and quality of life of individuals living with chronic pain.

References:

(1) What is pain?

(2) The causes of chronic pain

(3) The placebo effect

(4) Neuroscience and chronic pain

(5) Mindfulness and chronic pain

Article images courtesy of Freepick