Chronic Pain Syndrome

Chronic Pain Syndrome, What is it?

Chronic Pain Syndrome is complicated.  It is a descriptive term used when an individual’s normal pain patterns and behaviors undergo changes and may begin to impact the individual’s life and wellbeing.

Acute and chronic pain are different. Acute pain may last up to 12 to 24 weeks. Acute pain is a normal protective response.  A person gets injured, experiences pain, heals, and resumes previous activities and lifestyle.  Chronic pain, on the other hand, is pain that lasts longer than six months and can last for years. For some, the pain never ends – despite the injury itself being healed.

CPS can be related to any number of conditions.  Despite varying types of treatment, the pain persists and doesn’t respond to treatment.  This can be difficult to understand, especially if there is no visible injury or it occurred long ago.

Recent specialized research into pain has brought a new way to think about pain and how to treat pain.

Years ago, it was believed the local injury site was the source of all pain, but recent research shows that pain starts with the brain. What is known today is that pain is a safety mechanism; it happens for protection. When something gets injured, the local injury site sends a signal to the brain that something has happened. The brain interprets that signal to decide if danger is present and if it should send the signal of pain or not.  This is a good thing for an acute injury.  It becomes a problem when this pain signal from the brain doesn’t shut off despite the injured area being long ago healed.

As an example of how powerful the brain and this concept is, consider phantom limb pain, which can occur after an amputation. Despite the individual knowing the limb, or part of it, is no longer there, he or she will still feel pain and have the sensation as if the limb is still there. He or she may even feel tingling and hot or cold sensations even though the limb is gone. This phenomenon can last for months and sometimes years.

CPS can be devastating on many levels.  CPS can affect every aspect of life for those who have it and for their loved ones and friends.  Daily activities like caring for oneself,  family, and household and sleep are all impacted.  Employment and relationships can be difficult to maintain.

Without proper treatment, CPS may lead down the path to prescription medication abuse and possibly other drug abuse, such as alcohol and opioids.  A best practice for treating CPS is to include multiple types of health care providers and approaching the patient with care targeted toward many different levels, but actively coordinated by different specialties who work together.

What causes chronic pain syndrome?

The simple answer is science doesn’t fully understand what causes chronic pain syndrome. The triggering event is usually an injury of some sort. The injury can be as simple as a scrape or sprain or as complex as a response to a surgery. For unknown reasons, the signal between the injury site and the brain never shuts off. The injured area may have long ago healed, yet the brain is still interpreting a threat to the system, so it, therefore, continues to send the protective response of pain.

Symptoms of Chronic Pain Syndrome

The most common symptom with CPS is persistent, severe pain lasting more than six months. Other symptoms may include stiffness, fatigue, weakness, and poor circulation.  Some behaviors that may accompany CPS may include anxiety, fear, depression, increased use of medications, and relationship issues.

How is chronic pain syndrome diagnosed?

Diagnosing CPS is just as complex as the condition itself. There is no specific test to determine if someone has CPS; however, a combination of assessments is needed to understand the problem.  An in-depth medical history review and physician interview is the first step.  It is necessary to understand when the pain started and what symptoms the individual is experiencing.

Since there is not one special test to diagnose, it can be difficult.  Sometimes providers and patients are looking for something else and may run tests, imaging studies, and refer to other providers looking for an answer.  When little information is gained from that, CPS is sometimes then considered.

Many different types of health care providers are involved and work together in the care of someone with a diagnosis of CPS since it affects so many areas of one’s life.  This is known as an interdisciplinary approach.

In some cases, diagnostics may include psychological assessments. A psychiatrist commonly performs these assessments.  Results from these tests provide information on how much the pain symptoms have affected the individual emotionally, mentally, and in relationships with others.

Treatment of Chronic Pain Syndrome

There is no known cure for CPS. The condition can be well-managed in some cases, while others may struggle with the symptoms for years despite their best efforts. Treatment varies widely, but research proves the best likelihood of success comes with an interdisciplinary approach.  The goal of the team is to improve the quality of life by managing symptoms, reducing medications, restoring functional activities, and preventing relapse.

The team of providers and the patient needs to work together for the best outcomes.

A physician will work with the patient to manage symptoms. He or she will monitor medications prescribed and will help manage any flare-ups of symptoms.

The psychiatrist or psychologist will work with the individual on dealing with the difficult emotions that can come along with CPS. He or she will work with the individual to address any symptoms of fear, anxiety, or depression.

Physical and occupational therapists (PT and OTs) focus on slowly restoring functional movements and eventually returning to functional activities, which is a process that takes time. The PT and OT and patient work together to establish realistic goals and timeframes to achieve goals.

Education about pain is an integral part of the therapy and recovery process. Understanding how pain works and how to slowly restart activity is important.  PT’s and OT’s who treat this condition understand the proper progression and which treatment strategies work best, but will always customize the treatment plan for an individual patient and will help the patient understand what is happening and why.

The process of slowly introducing exercises and activities helps retrain the brain. The goal is over time the brain no longer senses a threat, or injury, and therefore begins to shut off the pain response.

There is no one-size-fits-all with treatment. Collectively, the individual and medical team work together on customizing a program that manages the symptoms, improves overall health and well-being, and restores function.

Next Steps

As consumers of health care, all patients have a choice in finding the right provider who meets their needs.

In all states, patients can see a PT first, without a physician’s order.  However, every state has different regulations and insurance carrier coverage may vary.  Physical Therapy Direct Access By State offers information on direct access in each state.

Find A Clinic will direct patients to a physical therapy provider in their geographical area and will help them identify one in their region that has top national outcome rankings.

 

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