What is Chronic Pain?

Chronic pain is one of the most common reasons people seek medical help. In 2016, the CDC conducted a survey on US citizens and discovered the following:

• 50 million adults suffer from chronic pain
• 19.6 million adults have high-impact chronic pain symptoms
• Approximately 30% of patients report severe pain lasting for more than 6 months. 

When severe pain lasts for more than 3 months, it is known as high-impact chronic pain. This type of pain is commonly associated with disabilities that limit a patient’s daily activities. 

What exactly is chronic pain? What causes it and why should this be a concern?

Contrary to what most people believe, pain is not necessarily a bad thing. It is a signal that our body uses to communicate. Without it, we would never know if something was wrong.

For example, if you’ve ever touched a hot stove, be grateful that you felt pain. It’s your body’s way of saving you from further injury. However, when pain lasts for more than 12 weeks, it becomes a concern.

Most tissue-related injuries heal within that timespan. Pain that continues to persists afterward, can signify a serious problem that should not be overlooked.

When it comes to cancer-related pain, there are two types: malignant and chronic. It is important to know the differences between these two types, as treatment differs depending on the situation. If you want to learn more about the effects of chronic pain and how to treat it, read on.

What is the burden of chronic pain?

It makes you less productive.

• People that suffer from chronic pain often find their lives turned upside down. Many are unable to work and find themselves distracted by their pain. As a result, their productivity sharply declines and many are forced into early retirement.

It negatively affects your sleep.

• Sleeping with a leg cramp is difficult. Multiply that pain exponentially, and it’s not hard to see why people with chronic pain have difficulty sleeping. Those with chronic pain often wake up tired, as their sleep quality is poor.Many people who suffer from chronic pain often complain about sleep disturbances. In the US, approximately 10% of people attribute insomnia to chronic pain. One survey in Australia revealed pain to be the number one reason behind poor quality of sleep. As well, people with chronic pain tend to take longer before falling asleep, have longer nighttime awakenings, and shorter durations of sleep.The science behind the link of chronic pain to sleep disturbance is complex and not yet completely understood. We do know that when our body experiences pain, it activates the stress-response system at the hypothalamus. It increases the levels of certain hormones that can make you more alert and awake.Science does not yet fully understand the link between chronic pain and sleep disturbances. However, we do know that when our body experiences pain, it activates the body’s stress-response system, also known as the hypothalamus. When the hypothalamus is activated, it triggers an increase of certain hormones in our bodies. These hormones are responsible for keeping us alert and awake, which spells disaster before bedtime.Serotonin is involved in pain modulation and pain transmission. Neurotransmitters like serotonin also play an important role in the pathophysiology of sleep disturbance.
•  According to Johns Hopkins Medicine (2014), the release of serotonin into the spinal cord can make non-pain sensing nerve cells sensitive to pain. This results in an increase of “pain signals” that are perceived by the brain. Lastly, infections and inflammatory diseases involve the widespread release of cytokines like interleukin-1 and tumor necrosis factor. Both of these promote the perception of pain and affect the different stages of sleep.

It costs you a lot of money.

• Over-the-counter painkillers, doctor visits. as well as sick leaves from the office can be costly. If you add them all up, the total estimated socioeconomic burden of chronic pain amounts to billions of dollars a year. Researchers looked into the cost of chronic pain drugs that were prescribed for a year in the US. Overall, prescription medications for pain reached $17.8 billion a year.From 2000 to 2007, the total outpatient visits related to chronic pain was approximately 690 million times. From these visits, 29% of the patients had been taking at least 5 medications for their chronic pain. Compared to other drugs, analgesics and NSAIDs took up $1.9 billion, opioids took up $3.6 billion, while other adjuvant treatment for chronic pain took up $12.3 billion. Among these adjuvant treatments, the most common type was antirheumatics/immunologics which are often prescribed for forms of arthritis and other diseases of the joints. 

Chronic pain lowers the quality of your life. 

• Chronic pain affects your sleep, your presence at work, your productivity, as well as your medical costs. It’s no surprise that from a holistic standpoint, it can also lower your quality of life.Quality of life can be defined by the way you view your position in life. This includes factors such as culture, expectations, and concerns. It encompasses not just your physical health but also your psychological and emotional state, the quality of your relationships and the features of your environment. The World Health Organization estimates the number of “chronic pain days” a year to be 22%. When added up, it results in 21.5 million days of chronic pain from patients. Chronic pain affects more than just the patient – the people around them can also be affected. People that suffer from chronic pain often feel they are a burden to their loved ones. For example, a family could be preparing for a vacation, only for one person’s arthritis to flare up and postpone the trip. Others may have difficulty walking independently, and rely on family members to take care of them.Additionally, a study done in Australia found that poor quality-of-life was associated with chronic pain and musculoskeletal disorders. Another study done in Europe supported these findings, as more than half of the respondents reported that they experienced constant pain.

It can make you prone to depression. 

• Depression and chronic pain have more in common than you might believe. Clinical depression can manifest itself as chronic pain, and chronic pain can lead to clinical depression. People with chronic pain-induced depression tend to have poorer outcomes compared to those who suffer from chronic pain alone. Overcoming one or the other is difficult, as the two illnesses “fuel” one another in a vicious cycle.In a systematic review of several studies, the prevalence of depression in patients that consulted for orthopedic and rheumatologic-related pain was 52%. In population-based studies, these numbers went down to 18%. For primary care clinics, it ranges between 5.9% to 46% (Bair et. al., 2003).The link between pain and depression is based on several underlying mechanisms. One of these is Brain-Derived Neurotrophic factor – or BDNF. BDNF is an important protein involved in neuroplasticity in the brain. People with depression were found to have lower levels of BDNF in their blood. As this protein is involved in regulating signaling pathways in the spine, lower BDNF levels may play a role in increasing pain perception – especially those related to nerve pain or neuropathic pain. Another possible mechanism is the body’s inflammatory response. In infections and immunologic disorders, the body produces an excess of inflammatory factors. Recent studies link inflammation to both pain and depression.

Ketamine for Chronic Pain

Ketamine is most effective with neuropathic pain like Complex Regional Pain Syndrome, post-herpetic neuralgia (shingles) and phantom limb pain.

Most Common Causes of Chronic Pain

Fibromyalgia

Fibromyalgia, or FM is characterized by widespread musculoskeletal pain, cognitive disturbance, psychiatric conditions, fatigue, and various somatic symptoms for at least 3 months. The exact cause and the underlying mechanisms that cause FM are not yet known. This disorder mainly affects muscles, tendons, and ligaments, but without any evidence of inflammation. 

On physical exams and laboratory work-ups, the patient appears normal. As a result, some practitioners believe that the pain a patient experiences is psychogenic. Recent studies however, postulate that pain felt by patients with fibromyalgia, involves the somatosensory system – which is the body’s center for pain regulation. 

The musculoskeletal pain of fibromyalgia usually involves at least six different sites. These sites include the upper back and spine, the lower back, the legs, the chest, and the arms. Patients that often compare the pain they feel to that of someone who has the flu. Some patients report joint pain similar to synovitis, but there’s little evidence that leads to that outcome.

Fatigue and sleep disturbances are also a common finding in fibromyalgia. Many patients have reported sleeping for at least 8 hours, but still feeling tired. They also report feeling fatigued after doing simple activities. Emotional fatigue may play a role in these outcomes.

Some patients also complain of headaches and changes in sensation. Numbness, crawling and tingling sensations in their extremities, can also manifest in patients with fibromyalgia. By the time patients are diagnosed with fibromyalgia, approximately 30-50% have also been diagnosed with depression and/or anxiety. 

Chronic Nerve Pain

Nerve or neuropathic pain is characterized by burning sensations in nerve distributions, which can be extremely painful. It can indicate nerve damage, or a generalized disease of the central nervous system, When this pain persists for more than 12 weeks, it becomes chronic neuropathic pain.

One well-known type of neuropathic pain is phantom limb syndrome. People who are missing limbs due to amputation often experience pain where it used to be. This is because the brain still receives pain signals from malfunctioning nerve pathways.

Other causes of nerve pain include direct damage to nerve cells. Patients with uncontrolled diabetes may also experience chronic nerve pain. It can also originate from infections such as Herpes virus, Syphilis, HIV, and from nervous system disorders like multiple myeloma and multiple sclerosis. 

Treatment for nerve pain differs from musculoskeletal pain. Stronger painkillers may be prescribed, as well as anticonvulsants and antidepressant drugs.

Complex Regional Pain Syndrome (CRPS)

Like fibromyalgia, Complex Regional Pain Syndrome is a disorder of the somatosensory system. However, CRPS can also be due to inflammation and is usually preceded by an inciting event 4 to 6 weeks earlier. This event involves accidents that result in a fracture, crush injury, sprains, or undergoing surgery. A small percentage of people with CRPs do not have an identifiable inciting event. Postmenopausal women are also at higher risk of CRPS.CRPS has specific sensory, motor, tropic and autonomic changes. Symptoms include acute pain, redness, and swelling in the affected limb. This pain is often described as a stinging or tearing sensation that is felt deeply. It worsens when the limb is moved or touched. Pain is felt most intensely at night and when there are temperature changes. Some patients also experience abnormal pain sensations like allodynia, which is defined as sensation of pain from a stimulus that doesn’t cause pain. For example, someone who feels pain from brushing their hair may be suffering from allodynia. People with CRPS may also experience decreased sensations in the distal parts of their limbs. Overtime, the affected limb’s motor movements may become limited. This is due to the abnormal pain response and sensations that manifest from CRPS. The autonomic component of CRPS is responsible for changes in temperature, sweating, and edema. Trophic changes like localized hair growth or skin atrophy may also be observed in patients with CRPS.Chronic pain is extremely bothersome. Patients with chronic pain often feel intense pain at the slightest touch or stimuli. Additionally, many people with chronic pain live a lesser quality of life. This is due to interruptions in their sleep, over-dependence on family members, and emotional hardships. 

Some Treatment Options for Chronic Pain

Besides medication, there are a number of alternatives for the treatment of chronic pain. Drugs like opioids and NSAIDs have associated risks with prolonged use. Opioids may induce tolerance and dependence, and NSAIDs can cause kidney damage. Those who are diabetic, hypertensive, or taking other medications are especially at risk. However, there are ways to manage chronic pain without the use of medication.

Acupuncture

• Acupuncture is a well-known traditional Chinese medicine practice. It is based on the principle of yin and yang, as manifestations of Qi. The belief is that illnesses, specifically pain, is caused by blockages in the flow of energy in the body. The needles used in acupuncture target specific points that would remove this blockage. Scientifically, it is believed that insertion of these needles in the target points result in the production of the body’s natural painkillers called endorphins. It is reasonable for people with chronic pain to undergo acupuncture. Each year, approximately 3 million Americans receive acupuncture for chronic pain. The use of acupuncture for chronic pain is backed by many studies, including a meta-analysis in 2012. Here they found that people who received acupuncture report less pain compared to those who underwent fake or no acupuncture treatments. The coverage of this study involved people who had neck pain, osteoarthritis and chronic headache. If you’re thinking of trying acupuncture, remember to choose a licensed or certified acupuncturist. Your primary caregiver can give you some recommendations. Talk about what type of acupuncture would be ideal for you and how often should you have those sessions

Antidepressants

• We mentioned earlier how depression and chronic pain are closely related. As a result, it makes sense that antidepressants can also help in the management of chronic pain. By reducing the effects of depression, the effects of chronic pain follow suite.The pain control from antidepressants are mediated by their noradrenergic function – the ability to increase the force of skeletal muscle contractions, rate, and force of contractions of the heart. Examples of norepinephrine reuptake inhibitors that are used for pain include duloxetine and milnacipran. FDA approved drugs like milnacipran can also be used for the treatment of fibromyalgia. It is important that noradrenergic activity is balanced well. It should not be in excess or aching, as both spectrums can cause pain.Other types of antidepressants like TCAs (tricyclic antidepressants) are also commonly prescribed for pain. This includes Amitriptyline, Nortriptyline, and Doxepin.Antidepressants are not over-the-counter medications – they must be prescribed by a physician, as they have associated side effects and risks. It’s also important to screen for depression in patients that complain of chronic pain. This way, a holistic approach can be used in the management of chronic pain.

Ketamine

• Ketamine is a phenylpiperidine derivative that has been in clinical use since the 1970s. It was initially used as an anesthetic, and is currently used in a wide range of pharmacologic applications. Among these is its role in treating chronic pain. Several randomized control trials have shown evidence that ketamine produces prolonged pain relief. While some side effects like dizziness and somnolence were cited, many physicians argue that the benefits of ketamine outweighs the risks.Ketamine works by binding to the body’s NMDA receptors. This results in an antihyperalgesic effect, which reduces pain sensitivity. In comparison, hyperalgesia refers to an abnormally high sensitivity to pain. At lower doses, ketamine also enhances analgesia (the inability to feel pain) by interacting with opioid receptors.Its role in chronic nerve pain, phantom limb pain, fibromyalgia and migraines has been studied extensively. It is often used as an alternative therapy for nerve pain management that is refractory to other medications. A single infusion of ketamine has been reported to provide complete pain relief in phantom limb pain. At lower doses, it can be used to treat severe chronic nerve pain. According to one study, researchers performed ketamine infusions 4 hours a day, for 5 days at a specific dose. The resulting outcome was found to reduce the pain of CRPS by 21.4%. .Despite what results say, the safety profile for oral ketamine is poor. An incorrect dose of ketamine may result in psychedelic symptoms. This is why ketamine is often administered in hospitals and clinics where patients are carefully monitored. A licensed health care provider should be responsible for administering this type of drug. Chronic pain is more than just a sensation, it’s a way of life. People that suffer from chronic pain go through numerous hardships and emotional challenges. Many live lives of lesser quality, and feel as though they’ve lost control.

The Injection & Infusion Clinic of ABQ can help. We offer ketamine infusions to provide pain relief to those suffering from chronic pain. Besides dealing with chronic pain, we also have solutions for depression, fibromyalgia, CRPS, and PTSD. If you’re looking for a healthcare clinic that makes every patient feel cared for, give us a call at 505-445-4300 today!  We are located conveniently in Albuquerque, New Mexico.  We do require a referral for pain ketamine infusions.  You can self-refer for mental health ketamine infusions.