#35 Chronic pain, mind and emotions

As science has progressed over the last few years, we have come to understand that the old dictum of separating mind from body is ineffective when it comes to chronic pain. This way of thinking about pain can make people think that most pain is psychosomatic, a figment of our imagination, with no physical basis at all. As pain practitioners and scientists evolve past this antiquated way of thinking and start seeing chronic pain as multidimensional, they are increasingly realizing that to see the whole picture they need to look at biological, psychological and social factors. We owe this shift in our thinking to newer methods of studying brain function in living and breathing nerve cells that have shown us that even when we an injury has healed, the brain is still capable of feeling pain from the injury.

We must distinguish acute pain from chronic pain in terms of its function and usefulness. Acute pain serves as a warning that something is or may become harmful to our body. In this sense, pain is necessary. It also prompts us to adapt to the situation or do something about it. For example: we get sore skin after we burnt ourselves staying in the sun for long, we try to avoid or decrease our exposure to the sun or use hats and sunscreens. But it is also possible for pain to become chronic; in some of these cases it can dominate a person’s existence, take over and become the governing force in the sufferer’s life. In previous columns I have spoken repeatedly about the prevalence of chronic pain in Canadian society. While the numbers may vary depending on the research method used to survey people, it is safe to say that 1 in 3-4 Canadians may suffer from persistent pain.

It’s important to remember that many people with chronic pain would often prefer to deal with the problem on their own rather than to go see a doctor. Only a minority of people with more serious physical and psychosocial problems and considerable disability will end up visiting academic tertiary care centers like mine.

I want to make a particular distinction here: not all chronic pains are the same. As we get older, many of us suffer from long lasting or recurrent pains (an example of the most common pain that accompanies aging is pain associated with arthritis in our joints). Many will cope with these pains on their own, take simple over the counter medications, resort to exercises, hobbies or activities that involve some changes in lifestyle to accommodate the difficulties and go on living. Most will bring their complaints to their family doctors (the gatekeepers of the Canadian health care system). As long as we cope and life goes on, we are saddled with chronic pain. However, for some of us, pain takes over our life which is when sadness and hopelessness sets in and when we become very disabled.

In some cases, the physical issues are major. But in many other cases, the original injury is not serious or may have healed long ago, but disabling pain goes on and on, robbing us of life’s pleasures. These are the cases that cause us to suffer from “chronic pain disorder” or “chronic pain syndrome”. It is the chronic pain syndrome/disorder that is harder to treat and will need complex approach addressing both the physical and emotional components of pain. In simple terms, not all people with chronic pain have a chronic pain disorder; however, all people with chronic pain disorder have chronic pain. Additionally, the boundaries between the two are often blurred but one might say that they represent opposing ends of a large spectrum.