Take a look at this video where two noted chronic pain physicians discuss the nature of chronic pain.
Read the full transcript »
What is Chronic Pain? Dr. Ken Follet: Chronic pain is usually considered to be pain that lasts or persists longer than three to six months, but it's also convenient to think of it as a pain that outlasts the normal healing time following an injury or surgery. Dr. Nagy Mekhail: Actually, I would like to call chronic pain as a disease. It is not a symptom. Acute pain that happens after surgery or an injury is a good pain. The pain that, we call it acute pain, that's the pain that warns us about something wrong. If I get up two flights of stairs and I feel chest pain, that's a very good sign that tells me, go, check your heart. On the other hand, chronic pain is a disease by itself. People who had multiple back surgeries and everything by MRI, by examination is okay, but these people are suffering from lingering pain 24 hours a day. That starts to affect their quality of life, they become depressed. They cannot engage in the functions that they'd like to do everyday. That's chronic pain. Dr. Ken Follet: Many, if not most people, experience chronic pain at some point in his or her lifetime. Nagy Mekhail: Our brain and spinal cord is a structure that every part of the body has a representation. Representation in this spinal cord or the brain. And when this part is suffering, the areas of the brain and spinal cord start to discharge continuously. After a while, sometimes this discharge or then processing becomes autonomous. In the beginning you have to have a stimulus to cause the pain, an injury or herniated disc or shingles that starts the process, but after a while this process can go on, on, on, and on 24 hours a day by itself. And that's why we call it a disease, actually it is not, it is not just a symptom. And because the brain cells or the spinal cord cells become hyper excited, will become very sensitive. Sometimes actually, they go on and on without any evoked response. Dr. Ken Follet: There are seem to be two components. There is, what's called a discriminative component, that is where is the pain? How intense is the pain, but there's also an emotional component that we refer to as affective component which is more the emotional part, how bad does it hurt, the element of suffering. Both of those who work together in the brain to cause the overall pain experience. Nagy Mekhail: It is estimated that about 68 million Americans suffer from some sort of chronic pain. This is staggering statistics and actually pain -- people don't go to work because of pain more than common cold and that costs the American employers about $78 billion a year. There are about 500 million working days lost because of chronic pain. Dr. Ken Follet: Chronic pain is extremely common. Pain is one of the most common reasons that people see physicians in the United States. What are the two types of chronic pain? Dr. Ken Follet: I generally think of pain as one of two types; either nociceptive pain or neuropathic pain. The distinction is important because sometimes the strategies for treating each of those types of pain can vary a little bit. Nociceptive pain in a sense is tissue pain, if you break your arm it hurts. If cancer affects a certain part of the body, the tumor can injure or cause inflammation to the tissues surrounding the tumor, that hurts. But that's a normal type of pain, the body's own pain signaling mechanisms are activated as a result of that injury or disease and the body sends normal pain signals. So it's a good warning system. Dr. Nagy Mekhail: Neuropathic pain in simple terms is the pain that is either from damage or inflammation or injury of the peripheral or central nervous system elements. Dr. Ken Follet: In contrast, neuropathic pain comes from an injury or some kind of disorder of the nerves or the nervous system in the body. This function of the nerves somehow causes pain. So, a neuropathic pain is different and that it's really an abnormal function of the nervous system rather than the normal function of the pain signalin