What is Chronic Pain?

Chronic pain is defined as pain that persists longer than 3-6 months. Unlike acute pain (pain that signals something is wrong and needs to be corrected; such as touching a hot stove or chest pain from a heart attack), chronic pain serves no positive purpose. The longer chronic pain persists, the more difficult it becomes to treat. This is for 2 main reasons. First chronic pain causes changes in the nervous system that often makes the perception of pain worse and can spread to other parts of the body that were never originally affected. Many chronic pain patients who may have persistent low back pain may start to suffer from neck pain or leg pain over time despite the lack of injury at the new location.

The second main reason chronic pain becomes more difficult to treat over time is due to the collateral problems that arise from the pain. Problems such as depression, insomnia, headaches, weight gain and memory loss cause the entire chronic pain experience to be that much more unbearable.

Suicide is the worst collateral effect of chronic pain. Caucasian men, Caucasian women, and Caucasian male workers’ compensation patients with chronic pain in the age range of 35-64 years of age are twice, three, and three times as likely, respectively, as their counterparts in the general population to die by suicide (Clin J Pain. 1991 Mar;7(1):29-36: Semin Clin Neuropsychiatry. 1999 Jul;4(3):221-7. The prevalence of major depression in patients with chronic low back pain is 3–4 times greater than in the general population (Sullivan et al. 1992).

The alarming facts of chronic pain:

• Up to 50% of chronic pain patients consider suicide at some point to end their suffering
• It costs our society (USA) between 100 and 300 billion dollars per year!
• Disables more people than cancer and heart disease combined
• 1 in 3 Americans suffer from some type of chronic pain
• It is the number 1 cause of adult disability in the USA
• Inadequate treatment, inappropriate treatment or undertreatment is the norm
• Low back pain is the 5th most common reason for all physician visits

This list could go on and on. What all these statistics reveal is that conventional and alternative medicine has completely failed to treat chronic pain. What is the answer? I believe it is integrative pain management, NESP programs and the ability of the patient to consistently believe and hold in their minds that they can and will get better. It is key that the patient focuses on what he or she wants and not on what is (chronic pain and the associated problems).

Gregory A. Smith, MD, QME