Chronic pain is pain that persists or resumes for > 3 months, persisting > 1 month after acute tissue damage has been resolved or accompanying nonhealing damage. It is caused by chronic diseases (e.g. cancer, arthritis, diabetes), lesions (e.g. disc herniation, torn ligament) and a large number of primary pain syndromes (e.g. neuropathic pain, fibromyalgia, chronic headache). Medicines from different groups and psychotherapy are used for treatment.
Chronic pain is caused by long-lasting nociceptive or neuropathic impulses that occur in the presence of long-lasting and intractable diseases (e.g. cancer, rheumatoid arthritis, disc herniation). In some cases, even small lesions may lead to long-term changes (sensitization) in the nervous system, from peripheral receptors to the cortex, which may lead to the generation of sustained pain perception in the absence of a continuing pain stimulus. As a result of sensitization, a slight pain in an almost resolved disease is perceived as a pronounced pain. The persistent pain is further aggravated by psychological factors. Thus, the source of chronic pain is usually a combination of several physical processes. In some cases (e.g. chronic lower back pain after trauma), the source of pain is obvious; in others (e.g. constant headache, atypical facial pain, chronic abdominal pain), the true source of pain may not be as obvious.
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In most patients, physical processes are certainly involved in maintaining chronic pain, which in some cases (such as in cancer) are the main factor. However, even in these patients, psychological factors are involved in the formation or perception of pain. Patients who need to continuously prove that they are ill in order to receive health care, insurance coverage or improved working conditions may subconsciously reinforce the perception of pain, especially when there is a trial. This reaction is different from the simulation of an illness, which means knowingly exaggerating symptoms to obtain secondary benefits (e.g. extra leisure time, payment for disability). Different factors in the patient’s environment (e.g. attitudes of family members, friends) may also perpetuate patterns of behaviour that lead to persistence of chronic pain.
Chronic pain can lead to or exacerbate psychological problems (e.g. depression). It is often difficult to distinguish between psychological causes and effects.