What is Chronic Pain?
Pain is usually a symptom of an underlying condition that needs diagnosis and treatment. This statement is generally true with conditions of recent onset (acute) or conditions that are progressive. However, in many patients pain may continue once a diagnosis has been made and treatment of the underlying condition completed. Also there are some conditions where a diagnosis has been made but treatment is only palliative rather than curative (many forms of arthritis, for example). Further, there are a number of patients who continue to experience pain even though no diagnosis can be made. All these patients suffer from chronic pain, i.e. pain lasting a long time. Chronic comes from the Greek word chronos meaning a period of time, usually defined as more than 3-6 months. Chronic pain is no longer giving important information, in contrast to acute pain, and it is deemed reasonable to treat chronic pain on a symptomatic basis. Because chronic pain patients occur in every medical and surgical specialty there arose a need for a team who had a special interest and expertise in treating the most difficult cases of chronic pain. Hence the development of the new multi-disciplinary specialty of pain management or pain medicine, as it is also known.
Chronic pain conditions fall into 4 main groups:
- Pain caused by acute injury that continues after the expected healing time
- Pain that is caused by recurring or degenerative disease such as arthritis (nocicepive pain)
- Pain arising from damaged nerves (neurogenic, neuropathic pain)
- Pain caused by malignancy
In order to effectively manage these multiple causes of chronic pain a wide range of therapies may be required.
Role of the Pain Clinic
- Decease the intensity of pain
- Increase general level of activity
- Decrease drug consumption
- Return to employment or full quality of life
- Decrease further use of health care services
- Patient education
At Fairyhill Medical patients referred to the pain clinic are seen and assessed by a Consultant who is trained in pain management. At the consultation a history of the primary pain problem is taken as well as a physical examination. Patients are asked to complete a questionnaire: The Brief Pain Inventory. Following the consultation a treatment plan is discussed, this includes review of current medication, previous treatment and surgery.
Treatment plans can consist of alteration of medication, diagnostic tests, MRI, CT, plain X-rays, blood tests, physiotherapy, Cognitive Behavioural Therapy, TENS and interventional procedures that are either diagnostic or aimed at relieving pain.
Specialists trained in pain management may offer such treatments as nerve blocks and epidural steroid injections, injections in joints or around nerves for diagnosis and treatment of pain. Pain Specialists and Neurosurgeons specializing in pain management may offer surgical treatments such as spinal cord stimulator implant systems, intraspinal drug infusion pump implants to treat severe intractable chronic pain that does not respond to other therapies.