Chronic Pain Syndromes
In most cases, chronic pain starts with an acute injury or illness. If the pain of this injury or illness lasts longer than six months, it’s then considered chronic pain. Sometimes, chronic pain subsequently causes complications. These complications, in turn, can make the pain worse. A chronic pain syndrome is the combination of chronic pain and the secondary complications that are making the original pain worse.
Chronic pain syndromes develop in a vicious cycle because of the cycle of pain causing pain; chronic pain that causes secondary complications, which subsequently make the original chronic pain worse. Chronic pain can lead to some common problems over time. For example, many people tend to have trouble sleeping because of pain. Chronic pain can also affect the roles people have in the family. They miss out on children’s activities, family functions, and parties with friends. As a result, many people struggle with guilt. Guilt isn’t the only emotion that is common to people living with chronic pain. Patients tend to report some combination of fear, irritability, anxiety, and depression. Patients also tend to express that they have lost their sense of direction to life.
These problems cause stress. These stressors can make the pain worse because stress affects the nervous system. It makes the nervous system more reactive and you become nervous. Pain is also a nerve related problem. Whatever the initial cause, pain travels along the nervous system to the brain, which is also part of the nervous system. Once reaching the brain, it registers as pain. When stress affects the nervous system, making it more reactive, the pain signals reach the brain in an amplified way, causing even more pain.
Complex Regional Pain Syndrome
Complex regional pain syndrome (CRPS) is a chronic (lasting greater than six months) pain condition that most often affects one limb (arm, leg, hand, or foot) usually after an injury. CRPS is believed to be caused by damage to, or malfunction of, the peripheral and central nervous systems. The central nervous system is composed of the brain and spinal cord; the peripheral nervous system involves nerve signaling from the brain and spinal cord to the rest of the body. CRPS is characterized by prolonged or excessive pain and changes in skin color, temperature, and/or swelling in the affected area.
The key symptom is prolonged severe pain that may be constant. It has been described as “burning,” “pins and needles” sensation, or as if someone were squeezing the affected limb. The pain may spread to the entire arm or leg, even though the injury might have only involved a finger or toe. In rare cases, pain can sometimes even travel to the opposite extremity. There is often increased sensitivity in the affected area, known as allodynia, in which normal contact with the skin is experienced as very painful.
People with CRPS also experience changes in skin temperature, skin color, or swelling of the affected limb. This is due to abnormal microcirculation caused by damage to the nerves controlling blood flow and temperature. As a result, an affected arm or leg may feel warmer or cooler compared to the opposite limb. The skin on the affected limb may change color, becoming blotchy, blue, purple, pale, or red.
Head Pain and Migraine Disorders
Headaches can be a chronic and recurrently incapacitating illness, symptoms of serious disease, or barometers of emotional stress. Their clinical importance lies also in their association with unusual symptoms, such as visual hallucinations, and in the contributing role, which is usually exaggerated, of psychologic factors. Almost three quarters of Americans have at least occasional headaches. Headaches together with backache and other benign pain disorders cause $55 billion in lost time every year.
Several varieties of chronic headache have distinctive patterns, are associated with unusual symptoms, and are affected by psychologic factors. These are muscle contraction (or tension) headaches, migraines, cluster headaches, postconcussive headaches, and trigeminal neuralgia (tic douloureux). Diagnosis in most cases is based not on physical or laboratory findings, which are usually normal, but on the patient’s description of the headache and of its response to particular medicines.
Emotional symptoms of mood disorders are not the same for all people. Emotional symptoms of depression include thoughts of and attempts at suicide, loss of interest in activities that were pleasurable in the past, unyielding anxiety, sadness or feelings of emptiness, and feelings of worthlessness, helplessness, or guilt. Emotional symptoms of mania include prolonged periods of elation, restlessness, irritability, agitation, or excessive energy, feelings of grandiosity, and impulsive, risky, or hedonistic behavior.
As with emotional symptoms, physical symptoms of mood disorder may differ from one person to the next. Physical symptoms of depression include decreased energy or fatigue, headaches, body aches, pains, cramps or digestive problems, difficulty remembering details, difficulty making decisions and concentrating, loss of appetite or overeating, and excessive sleeping or insomnia. Physical symptoms of mania include racing thoughts and jumping from one idea to the next, pressured or rapid speech, increased goal-directed activities, insomnia, and hypersexuality.
During severe depression, the systems that regulate emotion become disturbed. People in the middle of a severe depression often think only of things that are dark and sad. Physicians refer to this as “selective memory” – only remembering the bad times or the disappointments in life. This type of thinking is a symptom of the illness; it does not define who the person is. With proper treatment, the individual will start to remember the good times and develop a more positive outlook.