Chronic Pain

Chronic pain is defined as continuous, long-term pain that has lasted for more than six months, or that prolongs after the time that healing would have been thought to have occurred1. Chronic pain can also occur when no obvious cause for it can be found; this is thought to be due to changes in the body’s nervous system2.

One in five Australians lives with chronic pain including adolescents and children. This prevalence rises to one in three people over the age of 65. The prevalence of chronic pain is projected to increase as Australia's population ages - from around 3.2 million in 2007 to 5 million by 2050.

The total economic cost of chronic pain in 2007 was estimated at $34 Billion, including $11 Billion productivity costs and $7 Billion direct health care costs3.

Chronic pain is Australia's third most costly health condition after cardiovascular diseases and musculoskeletal conditions (also associated with chronic pain). Arthritis and back problems, both associated with chronic pain are the most common causes for people of working age (between 45 and 64) to drop out of the workforce, accounting for 40% of forced retirements - around 280,000 people in 20124.

This has a significant impact on workplace productivity and Australia's economic health, with the lost workforce due to arthritis and back problems alone, estimated to cost the economy over $4 Billion a year in 2012. 

Types of Chronic Pain

Chronic pain can be divided into two classes: nociceptive and neuropathic.2 Everyone will experience nociceptive pain at some point and it includes such things like cutting yourself, a burn or an injury. Conversely, neuropathic pain is caused by a problem with nerve pathways, which means the way that the nerve sends pain messages to the brain is affected.

Neuropathic pain is often described as numbness, tingling or like an electric shock.2 It is a debilitating condition and often is under-diagnosed and under-treated.

1. Brunton S. Approach to assessment and diagnosis of chronic pain. J Fam Pract. 2004;53(10 Suppl):S3-10. Accessed at
http://findarticles.com/p/articles/mi_m0689/is_10_53/ai_n6249279/?tag=content;col1
2. Galluzi. Management of neuropathic pain. Journal of the American Osteopathic Association. 2005;sup 4 (105):S12-S19
3. MBF Foundation (2007) The high price of pain: teh economic impact of persistent pain in Australia - Pain Management Research Institute, University of Sydney.

4. Schofield el al. (2012) Quantifying the Productivity impacts of poor health and health interventions. Health economics, University Sydney Oct 2012. 
  

Causes of Chronic Pain

Chronic pain can occur anywhere in the body. It may follow an illness or an injury that appears to have healed or may develop for no apparent reason. Common types of chronic pain include back pain, headaches, arthritis, cancer pain and neuropathic pain. Chronic pain is thought to be one of the most common conditions for which people seek medical attention.1

Chronic-pain-backache

Backache is the most commonly reported location for chronic pain.2 The causes of back pain can be very complex and it is difficult to obtain an accurate diagnosis. The pain may be a result of earlier injury or trauma or may be caused by arthritis or spinal disc abnormalities. Some patients have Failed Back Surgery Syndrome (FBSS), which is persistent low back and leg pain in those who have not achieved a successful outcome with back or spine surgery. However, in many cases the cause of the pain cannot be determined.

1. Galluzi. Management of neuropathic pain. Journal of the American Osteopathic Association. 2005;sup 4 (105):S12-S19
2. Breivik H et al. Survey of chronic pain in Europe: prevalence,impact on daily life, and treatment. Eur J Pain 2006;10:287–333

Diagnosis

Pain is a personal and subjective experience. There is currently no specific test that can precisely measure and locate pain and so healthcare professionals rely on the patient’s to describe the type of pain and its location.

Being very specific when describing your pain to your doctor can give the best indications as to what may be the cause of the pain, e.g. is it a sharp or dull pain? Does it burn or ache? These descriptions combine to create a pain history and are the first step in evaluating your pain.

Since chronic pain may occur in a variety of locations in the body and for many different reasons, patients and their health professionals need to work together to identify the causes and symptoms of that pain and the appropriate treatment pathway to take1

1. Chronic Pain: Symptoms, Diagnosis, & Treatment. NIH MedlinePlus: the magazine [Internet]. 2011 Spring [cited 2014 Aug 22];6(1):5-6. Available from: http://www.nlm.nih.gov/medlineplus/magazine/issues/spring11/articles/spring11pg5-6.html

Treatment options for Chronic Pain

Chronic pain is one of the most common conditions for which people seek medical attention.1 The goal of treatment should be to improve function and enable individuals to participate in daily activities and return to work without pain.2

http://www.bostonscientific.com/content/gwc/en-EU/health-conditions/chronic-pain/Treatment/_jcr_content/maincontent-par/image.img.Chronic_Pain_treatment.jpg

Level 1

Basic therapies are the first step designed to lessen pain. The goal of these therapies is to reduce pain and improve mobility.

Learn more

Level 2

A second line of therapy may be required if your pain does not respond to more conservative treatment. Many of these therapies may be used in conjunction with Level 1 treatments.

Learn more

Level 3

When pain persists after Level 1 and 2 therapies have been tried, your Pain Management Specialist may recommend more complex treatment options. Relieving stubborn, chronic pain may take time and patience; your Pain Management Specialist may need to try multiple treatments to find the most effective solution for your unique pain condition.

1. Galluzi. Management of neuropathic pain. Journal of the American Osteopathic Association. 2005;sup 4 (105):S12-S19
2. Management of chronic pain syndromes: issues and interventions. Pain Med. 2005;6 Suppl 1:S1-S20

 

 

Learn More about Chronic Pain

Spinal Cord Stimulation

 

 

How does spinal cord stimulation work?

The technique involves implanting a battery-powered device (about the size of a pocket watch) often called an implantable pulse generator (IPG) under the skin usually in the abdomen, upper buttocks or below the collarbone. The IPG is connected to a lead(s) that stimulates the nerve fibres in the spinal cord to reduce pain signals. This action creates a tingling sensation called paraesthesia. It can be used to treat patients with more than one pain area including patients with back or neuropathic pain.1

Clinical indications for SCS Therapy

Common clinical indications for SCS therapy include:

Failed Back (Surgery) Syndrome (FBSS):

An umbrella term that describes residual pain that persists despite multiple spine surgeries or other interventions - such as spinal manipulation or nerve blocks - to reduce back and leg pain or repair neurological deficits.

Complex Regional Pain Syndrome (CRPS):

A syndrome of various symptoms, most often caused by trauma, including burning pain, hyperaesthesia (increased sensitivity of any of the sense organs, especially the skin to cold, heat, pain, etc.), swelling, hyperhidrosis (excessive and profuse perspiration), and trophic changes in the skin and bone of the affected areas. Peripheral nerve stimulation may also be indicated for treatment.

Peripheral Neuropathy:

Any disease/disorder of the peripheral nerves.

 

Frequently Asked Questions

FAQ#1 - Can I "trial" SCS first?

Patients typically have the opportunity to trial the SCS system before having the surgical implant. Using a temporary, non-implanted (external) system for about one week, the patient has the opportunity to determine whether the SCS system fits their pain needs and lifestyle.

FAQ #2 – Is SCS reversible?

Even though your leads are surgically implanted, they can be disconnected or removed by your doctor, as needed.

FAQ #3 – Can medications work with SCS?

SCS can be used in conjunction with pharmaceuticals, if necessary. For some patients, SCS works well enough that pain medications are no longer needed. For others, it can mean a reduction in the amount of pain medication they need.

FAQ #4 – Will I be totally pain-free with SCS?

People differ in the amount of pain relief they receive with SCS therapy. Many people experience a reduction in pain sensations. The trial procedure will help you determine the amount of relief you may receive.

1. North RB, Wetzel FT. Spinal cord stimulation for chronic pain of spinal origin: a valuable long-term solution. Spine. 2002;27:2584-2591.

Australian Pain Websites

  1. www.painsupport.org created & maintained by people with persistent pain
  2. www.painmanagement.org.au  (Australian Pain Management Association)- has help for patients, their carers & treatment options. It also has a Pain Link Help Line 1300 340 357
  3. www.painaustralia.org.au  Chronic Pain Australia Aims to improve knowledge & understanding of pain & self management of pain.
  4. www.mecfscanberra.org.au/index.html  – although a chronic fatigue syndrome & fibromyalgia site, contains some useful general information on chronic pain

 

Boston Scientific Pain Websites

1.  Control Your Pain:  https://www.controlyourpain.com

2.  The Painful Truth:  www.thepainfultruth.eu