Understanding Chronic pain

By Dr James Yu, Interventional pain specialist & anaesthetist at Prince of Wales Private Hospital

What is Chronic Pain?

Chronic or persistent pain is pain that lasts for more than 3 months, or in many cases, beyond normal healing time. The defining characteristic is that chronic pain is ongoing and experienced on most days of the week.

How common is Chronic Pain?

Chronic pain is common. 1 in 5 Australians aged 45 and over are living with chronic pain.

What are the symptoms and complications associated with Chronic Pain?

Apart from unpleasant persistent pain, chronic pain can affect a person’s physical function, ability to work, exercise and socialise. People with chronic pain are more likely to experience mental health conditions, including depression, anxiety, sleep disturbance and fatigue.

What are the myths around Chronic Pain?

There are many myths about chronic pain. Although chronic pain can be a symptom of a known illness or injury, it can also exist without a clear reason at all. 

It is different from acute pain which pain developed due to injured or damaged tissue. This acute pain usually disappears once the tissue has healed. 

Chronic pain is more complex. It may result from damage to body tissue from an acute or chronic condition, or changes in the nerves or nervous system that result in the nerves continuing to signal pain after the original condition has healed.

What are the causes of Chronic Pain?

Chronic pain can result from injury, surgery, musculoskeletal conditions such as arthritis, or other medical conditions such as cancer or migraines. In some cases, there may be no apparent physical cause. In my practice, the 3 most common chronic pain presentations are lower back pain, neuropathic pain and arthritic pain.

What are the treatment options for Chronic Pain?

Due to the complexity of chronic pain, the recommended treatment options are combination treatments which aims to reduce the pain intensity, increase physical capacity, improving mental health and quality of life.

The management of chronic pain will sometimes require the multi-disciplinary management consist of pain relief medication, physical therapy, psychological treatment and minimally invasive pain relief interventional procedures.

How do you treat common back pain conditions?

The most common cause of back pain in the over 50 years old is a degenerative lumbar spinal condition, especially facet joint arthritis. If the lower back pain is diagnosed to be due to facet joint arthritis, a very simple and successful treatment option is Radiofrequency Ablation (RFA). This technique utilises needles to generate an electrical current to heat a small area of nerve tissue, shutting down pain signals from that specific area to the central nervous system. RFA, a minimally invasive day procedure, may provide patients suffering from facet joint pain with relief between 9- 18 months. 

What are the treatment options for chronic neuropathic pain?

Neuropathic pain is caused by damage or injury to the nerves that send messages to the brain to signal pain. It can be difficult to treat and it usually requires combination treatments including nerve pain medication, physical and psychological treatment; and nerve block procedures. Sometimes surgery with a neurosurgeon will be required to decompress a specific nerve causing the neuropathic pain.

For patients who have tried everything, including multiple spinal surgeries, yet still struggle daily with neuropathic pain, an advanced therapy called spinal cord stimulation is available. Spinal cord stimulation seeks to block pain signals before they travel to the brain. Small electrodes are inserted in the epidural space near the spinal cord that send electrical impulses to block pain signal transmission to the brain. This procedure requires a trial with temporary electrodes, to test the patient’s response to the stimulation. The treatment has a high success rate, varying from 50% to 80% depending on patients. 

What are the cutting edge treatment options for chronic joint pain from osteoarthritis?

Due to the aging population, we are seeing more osteoarthritis of the major joints (knee, hip and shoulder). Sometimes joint replacement surgery might not be an option if the patient is too young or too old and frail for the joint replacement surgery.

Other treatment options for this group of patients include anti-inflammatory medications, pain killers, simple joint injections, radiofrequency ablation procedures and Platelet Rich Plasma (PRP) injections.

PRP therapy is part of regenerative medicine. It is a simple procedure: after drawing a patient’s blood, we spin it in a centrifuge for about 5-10 minutes, which allows us to collect plasma with a high concentration of platelets (five to ten times more than in normal blood). The PRP is then injected into the patient’s injured joint. While it is a bit more experimental, there is increasing evidence showing its efficacy for extended pain control.