But what is chronic pain?

Chronic pain is pain that persists over long periods of time, usually for twelve weeks or more. This does not mean that there is no break from pain during that time.  However, a person who suffers from chronic pain will experience some pain almost on a daily basis. The pain may be intermittent, but it will be there.  

Chronic pain may be felt anywhere in the body, and it may present differently in everyone who is affected.  The cause of the pain and the part of the body that is affected may have some effect on what the pain feels like.  Some sufferers may refer to a dull ache or throbbing pain that seems always to be present. Others may feel a burning sensation or describe the pain much like “needle pricks.”

Common Causes of Chronic Pain

Some causes of chronic pain may be associated with normal physiologic changes, such as arthritis.  However, many times it is the result of an external factor, for example, an auto accident or injury at work.   

The Relationship Between Auto Accidents and Chronic Pain

About six million people are involved in auto accidents annually.  Many of these accidents result in injuries. It is estimated that 26% of the people injured in an auto accident develop chronic pain from those injuries.  

Injuries that are sustained in auto accidents can result in damage to the muscular, skeletal, and nervous systems in the body.  When an auto accident occurs, the sudden impact may cause injuries to muscles, tendons or ligaments, as they may become torn or sprained.  

Victims of car accidents may develop chronic headaches, back or joint pain, and often experience emotional trauma as a result of the injury.  Depending upon the severity of the initial injury, many victims of auto accidents may be affected by chronic pain for years after the crash.

Whiplash, the Most Common Cause of Chronic Pain After an Auto Accident

The most common cause of chronic pain after an auto accident is whiplash.   In fact, it is estimated that whiplash is the result of more than one million injuries each year.  

Whiplash is a neck injury that results from an abrupt forward or backward jerking of the head, much like the cracking of a whip. It occurs primarily in rear-end collisions.

Although whiplash primarily affects the neck, sufferers may experience long-term symptoms that affect the whole spine.  It may result in bulging discs between the vertebrae of the spine. This can cause pain or the feeling of numbness in the arms and shoulders as nerves are compressed.  

The pain of whiplash may not be felt right away, but once it manifests, it may last for years.

Work-Related Injuries That Result in Chronic Pain

There are instances when someone may experience a traumatic injury at work, such as a fall, that could result in chronic pain.  However, the most common worker’s compensation injuries are associated with repetitive movements or motions.   The overuse of specific body parts can often result in swelling of tendons and may produce feelings of stiffness and pain, especially around the joints.  

Individuals whose work requires heavy lifting, such as those who work in warehouses or at construction jobs, often experience chronic pain.  The wear-and-tear associated with heavy lifting or twisting in these jobs can cause inflammation of the joints, as well as nerve pain. Low back pain or strain is common among individuals who are required to lift heavy objects often.

Additionally, people who perform repetitive motions, such as typing, or working with their hands in confined areas (such as an auto mechanic) may develop a chronic condition called tendonitis.

Headaches

Some research indicates that 50 percent of the adult population reports headaches during the course of a year.  It is estimated that more than 90 percent of those people report a lifetime history of headaches. Headaches are considered chronic when they occur for at least 15 days each month for at least three consecutive months.

Migraine headaches may be the result of central nervous system disorders, vascular system disorders, or injury.  While not all migraines are chronic, if the underlying cause is not treated, they may develop into a chronic condition.

Victims of auto accidents often report headaches days, or even months, after the incident.  Whether it is the sudden jolt of an impact or emotional stress from the accident, this complaint is very relevant.

Back Pain

Back pain is one of the leading causes of chronic pain among adults.   Because of the far-reaching effects that it has on the body, back pain is commonly linked to long-term disability and loss of time at work.   Often occurring in the lower back, the pain may be caused by an injury or may develop progressively due to arthritis, osteoporosis, or normal wear-and-tear.

According to the Mayo Clinic, car and motorcycle accidents are the leading cause of chronic back pain and spinal injuries, and they account for over 35% of new injuries each year.

A major complaint of many back pain sufferers is fatigue.  The body’s natural response to pain is to “guard.” When a person guards the painful area, they often unconsciously tense their muscles.  The tensing of muscles results in fatigue. Without proper treatment of the cause of back pain, fatigue may become chronic, as well.  

Common factors that contribute to back pain may include:

• • Slipped or bulging discs, typically caused by twisting or lifting injuries
  • Fractures– Many times, individuals who have osteoarthritis experience what is known as compression fractures.  Also, any fall or accident, such as a motor vehicle accident, may result in the fracture of one or more bones.
  • Strain or trauma related to pulled or torn muscles, ligaments, or tendons, such as is seen with an auto accident or work-related injury

• Neuropathy (nerve damage) – While some nerve damage may be attributed to age or a physiologic factor, such as diabetes, an accident or injury can result in nerve damage, as well.  For example, a car accident that causes a sudden jolt or trauma may result in nerve damage.

Many physicians recommend some physical therapy to help educate patients on ways to manage chronic back pain.  Often, physical therapists can teach proper stretching and other exercises that have been proven to help alleviate back pain.  It is essential to have a primary care provider who communicates well with the other members of your care team and to be proactive in your plan of care.  

Joint Pain

Joint pain is another widespread source of chronic pain among American adults.  While joint pain may be associated with age or infection, it is often the result of an injury or accident.  Any time a joint is pulled or twisted out of the normal position or rotation; it can result in an injury to that joint.  Car and sports accidents are common sources of joint pain.

A few diagnoses related to chronic joint pain include:

• Bursitis is caused by swelling of the fluid-filled sacs that cushion the joints
• The inflammation of joint tendons causes tendonitis.  Injuries from sports accidents or strains often lead to this type of joint pain.

Chronic Nerve Pain

Chronic nerve pain, neuropathy, affects one out of every 10 Americans.  The most common causes are compression of bones against nerves or damage from an accident.  Additionally, some drugs affect the myelin sheath (the protective coating) of nerves.

Chronic neuropathy pain includes:

• Sciatica is caused by nerve compression.  People who sit for extended periods, such as in an office, and have few breaks may begin to experience sciatic nerve pain.  It presents with the sensation of shooting pain down the leg, which begins at the hip. Sciatica is a chronic condition.  Although symptoms may be relieved periodically, it almost always reoccurs, especially if a permanent change in routine is not adopted.
• Carpel tunnel syndrome may be the result of a work or sports injury.  It is commonly seen in people who work in positions that require repetitive motion of the hands and wrist.  One example would be a secretary who is using her or his wrist to type for several hours each day. Also, athletes who play sports, such as tennis, may experience carpal tunnel syndrome.

Long Term Effects of Chronic Pain

Long-term injuries, such as the ones mentioned in this article, often result in people being unable to perform activities that were once a part of everyday life.  Tasks that were once simple and effortless become more difficult. Sitting or standing for long periods may produce increased pain.

Individuals who suffer from chronic pain may experience lack of sleep.  Lack of sleep can produce feelings of anxiety or other health issues. This, in turn, may increase the need for more medications and medical treatments.  For many, the cycle of chronic pain and medications seems to be unending.

What Is “Chronic Pain Syndrome”?

In addition to chronic pain, some people may experience more than one chronic condition.  In fact, according to WebMD, “about 25% of people with chronic pain will go on to have a condition called chronic pain syndrome (CPS).”  Chronic pain syndrome occurs when an individual has symptoms other than pain. Some examples may include chronic depression or chronic anxiety.  While depression or anxiety can be a stand-alone diagnosis, if they occur about chronic pain, a person will be diagnosed with Chronic Pain Syndrome.   

What Are the Psychological Risks Associated with Pain?

Human emotions play a huge role in a person’s overall well-being.  When it comes to pain, emotional reactions appear to have an impact more significant than many realize.  People who feel sadness or anxiety tend to dwell on their pain. The result is often an exacerbation (relapse or worsening) of the pain.  Many of these individuals are at higher risk of experiencing a disability related to their chronic pain.  

On the other hand, people who consciously make an effort to become more healthy and to find ways of relieving pain, rather than dwelling on it, have an increased likelihood of gaining control over their pain and living a healthier life.  That is not to say that these individuals do not experience pain. They do, however, learn coping mechanisms that help them to live a more fulfilled life, despite their pain.

Is There a Connection Between Chronic Pain and PTSD?

Post-Traumatic Stress Disorder, also known as PTSD, is a person’s emotional response to a traumatic event or events.  While most people associate PTSD with events such as taking part in a military conflict or experiencing a personal attack, people who live with chronic pain may develop symptoms of post-traumatic stress disorder.  

When a person who is accustomed to living a very active or independent life is suddenly affected by chronic pain, they often have to adjust their activities and lifestyle to accommodate the pain.  For some, this is a very traumatic event. Individuals who were once the primary source of income for their family may experience emotional trauma because of their inability to work related to pain.  They often find that coping with the change in lifestyle is too much to bear.

With increased awareness and a proactive movement focused on mental health, many physicians and other health care providers encourage patients with chronic pain to seek counseling in addition to traditional pain management treatment.   

Living with and Managing Chronic Pain

No matter what area of the body is affected by chronic pain, the main objective of a treatment plan is to treat the underlying cause of the pain.  Physicians today seek to find measures to treat pain that is focused on both the physical and psychological health of sufferers.

Unfortunately, many people who suffer from chronic pain may never receive permanent relief.   Although pain may not be permanently relieved, there are ways to manage it and to help improve the quality of life for those affected.  

Some common measures to help relieve chronic pain include:

1. Exercise:  Many people who experience pain say that it hurts to exercise.  However, when a body is in motion and exercises, chemicals in the brain, called endorphins, are released.  Endorphins not only have a direct effect on mood, but they also block pain receptors. Encouraging individuals who are dealing with chronic pain to participate in low-impact exercises, such as walking, bicycling, swimming, or stretching, seems very helpful in relieving pain.  

1. Reduce stress.  Feelings of anxiety or stress increase the body’s perception of pain.  Therefore, reducing stress is essential in helping to reduce pain. Simple ways to help calm stress in the body are to listen to calm or peaceful music, take time to read, go for a drive or a short walk in the fresh air.  The idea is to take the focus off of pain and things that cause stress and to free your mind so that you can begin to relax.

• Stop smoking. Many people know that a common risk factor related to smoking is hypertension (high blood pressure.)  For the same reason that smoking leads to hypertension, it can also result in pain. Smoking affects the blood vessels, causing them to constrict.  Constricted blood vessels can lead to poor or painful circulation. When blood flow is restricted, it can lead to tissue death, which increases pain.

• Nutrition:  Diet is an essential part of maintaining well-being.  Achieving and maintaining a healthy weight will decrease the stress that is put on a body’s joints, and therefore, will relieve some pain.  It is recommended that individuals who suffer from chronic pain eat a low-fat, low-sodium diet and consume fruits, vegetables, and whole grain bread.  Lean meats, low-fat cheese, and 1% or skim milk are recommended.

• Physical Therapy.  While exercise is a great way to release endorphins and help relieve pain, some individuals may need a more guided approach to pain management.  Some physicians like to refer their patients to physical therapy, even if for a short period. Physical therapists can teach patients strengthening exercises and ways to avoid movements that may contribute to chronic pain.   This type of approach is especially helpful when treating back, knee, or other joint pain.

• Behavioral Therapy: A common type of therapy known as cognitive behavioral therapy has been proven to be helpful for people who suffer from chronic pain.  The objective of cognitive behavioral therapy is to help pain sufferers learn ways to cope with their discomfort and limit the extent to which the pain interferes with their daily life.

Frequently Asked Questions About Chronic Pain

What is the best medication for chronic back pain?

Several medications are used to treat chronic back pain.  

• Over-the-counter pain relievers like Acetaminophen (Tylenol) and anti-inflammatory drugs like Ibuprofen (Motrin®, Advil®, etc.) may help relieve some back pain.
• COX-2 inhibitors, like Celecoxib (Celebrex®), are used to relieve arthritic pain and pain associated with sprains, strains, whiplash, and low-back pain related to injuries and trauma, like auto accidents.
• Anti-depressant medications, like Duloxetine (Cymbalta®) or venlafaxine (Effexor XR®), and anti-seizure medicine like pregabalin (Lyrica®) and gabapentin (Gralise®, Neurontin®) and have shown to be effective in managing chronic back pain.
• Opioids are powerful and highly addictive medicines like Hydrocodone (Zohydro ER®), hydrocodone-acetaminophen (Zyfrel®), Oxycodone (OxyContin®), and oxycodone-acetaminophen (Percocet®) ) are generally used for intense pain associated with severe injury or trauma, such as surgery or fractured bones. These powerful medications are usually prescribed for a short time, usually a maximum of three days.

Before beginning any treatment regimen for chronic back pain, it is advisable to consult with your primary care provider or a pain management doctor.  A Consultation with our healthcare provider is essential because there may be underlying factors that pain medications may mask. If you are injured during a work-accident in New York, make sure to visit a provider that is Authorized by the NYS WCB in order for our bills to be covered by the workers’ compensation insurance.

How can I deal with chronic back pain without taking medications?

Unfortunately, there is no perfect answer to this.  Every person is different about how they experience pain and what measures relieve pain.  As mentioned in the above article, there are ways to help improve your health, which may help reduce some of the chronic back pain conditions.  For example, low impact exercises like yoga or swimming, staying well hydrated, and getting adequate rest may help alleviate some of the stress on your body that contributes to pain.

What can I do for a loved one with chronic pain?

Having a sound support system is suitable for anyone who suffers from chronic pain.  The most important thing is to understand that, although you may not see a physical reason why your loved one is experiencing pain, that does not mean the pain is not real.  Spend time with your loved one doing things that do not require taxing physical effort. Having the support of family and friends gives an emotional boost to people with pain and helps them to focus on things other than pain.

Is chronic pain a disability?

Many factors are used to determine if something causes a disability.  Chronic pain, however, can lead to disability for many sufferers. Therefore it is vital for sufferers to have a trained healthcare professional who can monitor the progression of pain and document any changes.

Is treatment for chronic pain covered by insurance?

Most of the commercially available insurance plans, including Medicare and Medicaid, cover treatment for chronic pain. For that suffering from chronic pain as a result of an injury associated with a work-related or an auto accident, Worker’s Compensation and NY No-Fault insurance covers the medical treatment of chronic pain as well, as long as proper notices are given to the insurance company and related parties.

Conclusion

Dealing with pain, on any level, can be frustrating and often very disheartening.  Chronic pain can leave those affected feeling frozen with fear and anxiety. This is especially true when the pain is the result of some traumatic event, such as an automobile accident or work-related injury.  If the pain is not managed, the effects could change the trajectory of someone’s life.

Although all chronic pain sufferers may not experience permanent relief from pain, identifying the underlying factors that cause pain can help individuals live a healthier life.  Whether physical therapies, cognitive therapies, or pharmaceutical pain medications are needed, all pain management should be under the supervision of a primary care physician or a pain management specialist.