Chronic Pain

Chronic pain can be a symptom of many different conditions, including:

• Stroke – this kind of chronic pain is also called CPSP or Central Post-Stroke Pain
• Heart failure
• Angina
• Long Covid

What is chronic pain?

We all experience pain sometimes. Usually, it’s because we have been injured in some way – we might have been hit by something, or cut, or have an infection, for example.

However, some people experience chronic pain – pain which lasts for a long time and doesn’t necessarily have an obvious physical cause. “Chronic” just means “lasting a long time”.

Chronic pain can feel like:

• Burning, stabbing, or sharp pains anywhere in the body
• Itching or tickling
• Aches in the joints or anywhere else
• Burning or warmth
• Feeling “fidgety” or small, uncomfortable twitches
• Pins and needles
• Painful numbness

Chronic pain can be a result of all kinds of illnesses and disorders, or it can be from a physical injury that never fully healed. It may be consistent, or it may come and go. It may or may not be triggered by your surroundings.

Chronic pain can be physically and emotionally demanding. It may affect your mood. It can also make it difficult to sleep or to focus, which can lead to fatigue.

There are many things you can do to help manage your pain.

Understanding pain

Pain is natural. It is our body’s way of telling us when something is wrong. However, like any process in the body, the way we experience pain is a complicated thing and it can go wrong. Your body may also keep telling you that something is wrong long after you already know!

There are three main steps in how we process pain:

1. The stimulus
   This is the thing which causes pain – an injury, an infection, or anything like that. We have nerve endings all over our body which are specialised to pick up on things like heat, cold, pressure, or stretch. Any of these can be triggered to tell your body that something is wrong.
2. Transmission
   Your nerves carry the information from the nerve endings back to your brain, usually through the spine. This is a very fast process, but not immediate.
3. Processing
   There is no one part of your brain that processes pain. Instead, different sorts of pain and pain from different parts of the body are processed all over the brain and the upper spinal cord. This is where you become consciously aware of pain, and where responses to it (like pulling away from a hot stove) are triggered.

If any one of these three steps goes wrong, it can be responsible for chronic pain. For example, you might have a stimulus that keeps happening, like a consistent swelling or an injury that doesn’t heal. You might have damage to the nerves which transmit pain, which can cause them to activate too easily or too often. You might also have damage to the brain or spinal cord which affects your ability to process pain.

One important thing to remember when you have chronic pain is that your body may still need to warn you of something. It is important to be aware of what your pain usually feels like, so you can notice if it suddenly changes.

Types of chronic pain

There are four main kinds of chronic pain.

1. Unhealed injury
   Sometimes, an injury that causes pain doesn’t heal properly, or doesn’t have a chance to heal fully at all. For example, if you have a respiratory condition, you may experience chronic chest or throat pain because damage in these areas hasn’t had a chance to heal.
2. Hyperalgesia (high-per-al-JEEZ-ia)
   This is a kind of chronic pain where things which would normally hurt (like a small cut or bump) hurts more than it usually would.
3. Allodynia (ah-lo-die-nia)
   This is a kind of chronic pain where physical sensations which shouldn’t hurt (like being touched lightly, or being warm or cold) cause pain or discomfort. You may also hear it referred to as hypersensitivity.
4. Idiopathic (id-ee-oh-pathic) pain
   This is pain which has no clear physical cause at all. It is often caused by damage to your nervous system, or to the parts of the brain which process pain.

You may experience any or all of these types of pain at the same time.

How is chronic pain treated?

Chronic pain is a symptom, not a disease, and the only way to cure it is to successfully treat the problem causing it. However, there are a lot of treatments that can make your pain less severe in the short term, and which you can use to manage times when your pain is especially bad.

Medication

You may find that over-the-counter pain medications such as ibuprofen, aspirin or paracetamol help to reduce your pain. Make sure you read the label thoroughly and do not take more than recommended. If possible, speak to a health professional before getting into the habit of regularly taking painkillers.

If your pain is very bad, your doctor may offer you prescription medications such as opioids. These can help with even severe chronic pain: however, they have a range of side effects and are often very addictive. You should make sure, before starting these painkillers, that you have had a frank and open discussion with a health professional about the possible side effects, and that you understand the options.

Some people also find that cannabis derivatives, such as hemp oil or CBD medication, is effective against chronic pain.

If your pain is caused by a problem with the nerves in your skin, you may be offered capsaicin patches or gel. This helps by overstimulating the nerves, temporarily reducing pain in the area. You should only use capsaicin on the advice of a health professional, as it can be damaging to the skin.

TENS

TENS (transcutaneous electrical nerve stimulation) is a technique that can help with pain caused by the nervous system. You will have small electrodes attached to your skin, and a low-voltage electric current is passed through them. This stimulates the nerves under the skin. Many people find that this relaxes their muscles and lessens their pain.

Lifestyle changes

Many people find that their chronic pain is made worse by specific foods. Consider if your pain is worse after eating certain things – common “trigger foods” are tomatoes, red meat, and red wine – and try cutting them out of your diet where possible. A generally balanced diet may also help with chronic pain. For more information, we have a booklet on Healthy Eating.

Exercise can also be a big factor in chronic pain. It isn’t as simple as “exercise more” – unfortunately, you may find that some exercise, especially high-impact exercise and exercises that involve lifting weights, can make your pain worse. At the same time, exercise can strengthen your muscles, support your nervous system, and improve your overall health in a way that reduces pain. If you are struggling to find ways to exercise safely with chronic pain, it may help to speak to a physiotherapist or occupational therapist. Seated exercises, gentle and relaxed stretches, and low-impact exercise like walking or yoga can all be great ways to build your strength without triggering worse pain.

Complementary therapies

There are a range of complementary, non-medical therapies which some people find helpful for chronic pain. You should always ensure that anyone you go to for these therapies is properly trained, and that you know who to contact if there is a problem with their work.
Some complementary therapies which have limited evidence to suggest they may be helpful are:

• Acupuncture and acupressure – these traditional practices aim to redirect energy in the body. How they work is not well understood, but there is scientific evidence suggesting that they may help with pain and muscle spasms when properly applied.
• Aromatherapy – the use of scented oils can help to relax the body and affect how your brain processes information. The evidence for aromatherapy is very mixed, but many people report that a mixture of aromatherapy and massage therapy helps them to relax and reduces pain.
• Oxygen therapy – breathing concentrated oxygen, particularly under hyperbaric (high-pressure) conditions, can help to boost your body’s function for a short period. In some people, this helps pain.
• Massage therapy – massage, particularly facial massage and myofascial release, can help to relax muscle tension which may cause pain. It can also loosen trapped nerves which can make pain worse. IMPORTANT – massage therapists may ask you to take your clothes off so they can touch your skin directly. Remember that you do not have to do anything that makes you uncomfortable.
• Meditation and mindfulness – using techniques to relax yourself and to recognise and understand your pain is a powerful tool in managing that pain.