Chronic Pain

Pain

• Acute Pain is short- term pain, which resolves fairly rapidly.
• Chronic pain is a long- term complex condition, a disease in its own right.

The above terms refer to the duration of the pain and not the intensity. Chronic pain can be just as severs as acute pain.

Acute pain is a short-term condition and it is possible to put life on hold while dealing with it. With chronic pain the condition is long term, frequently lasting many years and impinging on all aspects of life. Chronic pain has a bio-psycho-social effect on the person in pain. Not alone are there medical issues to deal with, but problems arise in the areas of: family, relationships, employment, finance, and social life. These problems lead to feelings of isolation, helplessness, fatigue, depression, anxiety, guilt and self-doubt.

Chronic pain is a very real condition and can destroy peoples lives, the Irish Chronic Pain Association is working to support people with pain, while at the same time striving to increase awareness of chronic pain among health care professionals and the general public.

The ICPA encourages people with chronic pain to be pro-active in the treatment and management of their chronic pain. Engaging in self-management of chronic pain can improve the quality of life.

Active self-management enables you to become a person again rather than remaining a patient

Neuropathic pain (a particular type of chronic pain) results from nerves which have been damaged either by trauma or neuropathy. The causes of nerve damage may be overt trauma (such as in an accident), toxicity (to drug or contaminant), compression (of nerves as with a tumour), ischaemia (oxygen starvation), infectious (as in post-herpetic neuralgia), immune-mediated (as in autoimmune conditions (multiple sclerosis / fibromyalgia) or metabolic (as in diabetic neuropathy). As a result of damage, normal communicating pathways of the central nervous system are altered.

At present there is no cure for nerve damage, however, the pain can be treated and managed. In many cases drugs offer only partial relief and do not eliminate the pain entirely.

Analgesics (pain killers) are used in the treatment of pain, Paracetamol is used for mild pain and Opioids are used for severe pain. Analgesics are used to control pain in tissue and bone, but may not be particularly effective when dealing with neuropathic (nerve) pain. Neuropathic pain can, in some instances, be characterized by problems such as allodynia (perception of pain to a normally innocuous stimuli), hyperalgesia (enhances pain sensitivity to a given noxious stimulus) and spontaneous pain. When confronted with neuropathic pain, which is unrelenting and unresponsive to many analgesics, it is necessary to think laterally.

Drugs such as anticonvulsants, muscle relaxants or antidepressants can be used in combination with other drugs to relieve neuropathic pain. Most people with chronic pain will be on a combination of drugs. Chronic pain is a complex condition requiring a multidisciplinary approach to treatment and management, including pharmacotherapy, interventional therapy (nerve blocks), neuromodulation (spinal cord stimulators) physiotherapy, psychological therapy and support.

Dose-limiting side effects of drugs can pose a major problem for some people with chronic pain. In addition opiophobia – the under prescribing of opioid pain killers by clinicians, because of a fear of patient addiction – can result in an under treatment of pain and the development of a more complex chronic pain condition.

Chronic pain is a condition in its own right. Many health care professionals associate pain with a medical condition e.g. appendicitis, broken arm, leg or tooth abscess. As a result they find it difficult to accept on-going chronic pain with no accompanying evidence available from scans, X-rays or blood tests. This makes the situation very difficult for a person with chronic pain, as the lack of understanding and belief by the clinician is a huge obstacle for the person to overcome. There are pain specialists; pain clinics and pain management programmes in Ireland but these services are inadequate for the needs of the large number of people in pain.

Consequences of Chronic Pain

• Pain in Europe survey revealed that 13% of Irish population and 27% of Irish households are affected by chronic pain.
• Chronic pain is the most common reason people visit their GP.
• 21% of people with chronic pain say the pain is sometimes so bad they want to die.
• Average age of sufferers 48
• On average sufferers had lived with chronic pain for 4. 9 years
• Nearly 19% had lived with pain > 20 years.
• 67% reported experiencing chronic pain on daily basis
• 50% of chronic pain suffers say being in pain leaves them
  • Feeling tired all the time
  • Feeling older then they really are
  • Feeling helpless
  • Feeling alone
• 34% felt pain impacted on employment
• 15% of sufferers report losing a job
• 1 9% diagnosed with depression as a result of chronic pain

Economic Impact of Chronic Pain

• Across Europe chronic pain accounts for nearly 500 million lost working days every year, costing the economy an estimated €34 billion.

Addressing the Problem of Chronic Pain

• The lack of understanding and acceptance of chronic pain is having a detrimental effect on the people in pain. It is essential to have chronic pain accepted, as a condition in its own right. The ICPA is working in Ireland and with the European Pain Network, in Europe, to achieve this objective.

• It is important for the Irish Chronic Pain Association, the Clinicians and the policy makers, to focus, not alone on the size of the problem but also on the solutions.

• Key points in addressing the problem:

1. The education of health care professionals, particularly at primary care level to ensure prompt diagnosis, treatment and management of chronic pain, thereby preventing the development of a more complex chronic condition.

1. An effective referral system to pain specialists and pain clinics, timely access is essential to optimise care, treatment and quality of life.

1. The efficient co-ordination of existing services to ensure equitable access to these services.