Chronic Pain: The Elephant in the room that no one wants to see

Based on the questions asked and interest shown by the readers, I would like now to venture exploring with you other issues relating to “chronic pain” (a subset of which is neuropathic pain we discussed in the previous 6 columns).

Chronic pain of one sort or another affects approximately 1 in 3-4 Canadians (depending on the statistics used). In raw numbers, this means 3-4 million people in Ontario alone and 9-12 million people across the nation. Chronis pain is no “small business”. The term “chronic” means pain that is present daily or very often, for weeks and years. It can be constant or come in spells, can be there at rest or appear only with movement, weather change, touch etc. The term is an all-inclusive “umbrella” under which many types and pain mechanisms can be classified. Pain may be the result of damage or disease to the nervous system (neuropathic pain), the musculoskeletal system (muscles, bones, ligaments etc), the internal organs (heart, kidneys, urinary tract, gut) in which case is called “visceral pain”, or a mix of those types. Why, should you as member of CARP, be interested in learning about chronic pain? Because, I bet you know some loved one with chronic pain or you may have chronic pain yourself (or if you don’t now, you may in the future, as chronic pain increases as we grow older).

Acute pain is relatively straightforward as in the following example: You break a bone and it hurts. Once the fracture is stabilized in a cast, the pain stops. We can also understand why a chronic injury like bad knee arthritis or a permanently damaged nerve can hurt for long. But chronic pain is often not straight forward at all. What about disabling pain from an injury that seems to be quite insignificant? What about ever-lasting pain from an injury which (for all practical purposes) has healed long ago? What about pain that seems to start in one part of the body, localized to the site of a sprain or other injury, and then spreads everywhere? Chronic pain brings limitations. Sometimes the limitations make us change activities, but we still go on with life. But some other times, chronic pain becomes so debilitating that life seems to stop and with it, our ability to work, enjoy life and fulfill our role as spouses, parents or friends. Chronic pain can be strange and difficult to understand in many fronts and not just where it comes from. Here is a long list of questions: Why do two people with the same injury seem to be affected very differently? Why do women seem to suffer from a lot of painful conditions unlike men? Why do people with the same condition respond differently to the same treatment? Why do kids who come from homes with relatives who have chronic pain seem more prone to develop painful conditions later in life? What is the reason that people from different cultures and races feel and express pain differently?