Nearly 1 in 5 adults in South Africa experience chronic pain. Pain is the body’s natural response to indicate that something is “wrong,” as in injury or illness. The International Association for the Study of Pain (IASP) defines pain as, “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.” Usually, once the source or cause of the pain has been treated and healed, the pain goes away. This describes “acute” pain. However, many people continue to feel pain long after the cause has been treated, sometimes even if the treatment was successful. Pain that persists or continues to come back after 3 months is called “chronic pain.”
Chronic Pain Syndrome (CPS) is more than just the experience of chronic pain alone. The pain is accompanied by other life-altering symptoms, most often depression and anxiety, due to the chronic pain.
In patients with CPS, the symptom of chronic pain is accompanied by a combination of symptoms that disrupt daily activities: depressed mood, anxiety, poor sleep quality, fatigue/tiredness, family problems, job loss, loss of sex drive, physical disability, irritability, guilt, and/or suicidal thoughts. Physical dependence and overuse pain medications and subsequent substance abuse is often also present.
The exact cause of CPS is not well understood. It is complex with many factors and is both mental and physical, but almost always begins with a painful health condition, injury, or infection. Examples include:
It is believed that people with chronic pain syndrome may have a functional problem with the nervous system, which transmits pain signals, resulting in an increased perception or sensation of pain. CPS is also believed to be a learned behavior, a result of positive or negative reinforcement in response to the pain stimulus. This means that a person may repeatedly have a specific behavior (depressed mood for example) that is stimulated by the presence of pain. Once the pain stimulus is gone, the behavior continues.
Chronic pain syndrome can affect people of all ages and genders. Women are more likely to develop it. People diagnosed with major depression or other mental health disorders, or with chronic painful health conditions, are more likely to develop CPS.
Diagnosing Chronic Pain Syndrome can be difficult. Your healthcare providers will ask about the duration, location, type, and severity of pain. They will likely perform blood tests, imaging studies, and physical examination to determine if there is an underlying health condition responsible for the pain that has not been treated yet. If there is no other treatable cause of the pain, a diagnosis of CPS may be made if there are other physical and psychological symptoms present, as outlined above, in addition to chronic pain.
Treatment for CPS is complex and requires multiple treatment modes together, including medications, physical therapy, and psychological therapy. Medications commonly used are non-steroidal anti-inflammatory drugs (NSAIDs), antidepressants, anti-seizure medications known to reduce pain, and muscle relaxants. A physical therapist may recommend exercises and stretches, massage, heat and cold therapy, and/or a procedure called transcutaneous electrical nerve stimulation (TENS). Psychological therapy can include counseling (individual and/or group) and relaxation methods such as deep breathing and meditation. In some extreme cases, a nerve block/epidural or surgery to correct an underlying physical problem may be used.