Chronic pain

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Chronic pain is defined as persistent pain that lasts longer than 3 months, beyond the normal healing time for an injury or illness. It can be constant or intermittent, and affects both physical and emotional well-being. Chronic pain is not just a symptom — it is considered a complex condition that can become a disease in itself.

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🧠 HOW CHRONIC PAIN WORKS

• Originates from nerve damage, ongoing inflammation, or sensitization of the nervous system

• May persist even after the original cause has resolved

• Often involves central sensitization: the brain continues to perceive pain even without physical damage

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🚨 COMMON TYPES OF CHRONIC PAIN

Type	Example Conditions
Neuropathic	Diabetic neuropathy, post-herpetic neuralgia, sciatica
Musculoskeletal	Arthritis, fibromyalgia, low back pain
Visceral	Chronic pelvic pain, irritable bowel syndrome (IBS)
Headache-related	Chronic migraines, tension-type headaches
Mixed/Complex	Complex Regional Pain Syndrome (CRPS)

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🔍 SYMPTOMS BEYOND PAIN

• Fatigue

• Sleep disturbances

• Mood swings, depression, anxiety

• Reduced mobility or activity

• Poor concentration ("brain fog")

• Social withdrawal

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🧪 DIAGNOSIS

Chronic pain is diagnosed clinically, supported by imaging or tests when necessary.

• Patient history: pain duration, character, location, triggers

• Physical exam

• Imaging (MRI, X-rays): rule out structural causes

• Blood tests: check for inflammation or autoimmune disease

• Pain questionnaires: quantify impact (e.g., Brief Pain Inventory)

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💊 TREATMENT STRATEGIES (Multimodal Approach)

There is no single cure for chronic pain — effective management often requires a comprehensive, multidisciplinary approach.

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🔹 1. Medications

Class	Examples	Notes
NSAIDs	Ibuprofen, naproxen	Short-term use only (GI/renal risks)
Antidepressants	Amitriptyline, duloxetine	For nerve pain and mood
Anticonvulsants	Gabapentin, pregabalin	For neuropathic pain
Topical agents	Capsaicin, lidocaine patches	Local relief
Muscle relaxants	Tizanidine, cyclobenzaprine	For spasticity
Opioids	Morphine, oxycodone	Used sparingly due to risk of dependency

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🔹 2. Non-Drug Therapies

Therapy	Benefit
Physical therapy	Improves mobility, reduces stiffness
Cognitive Behavioral Therapy (CBT)	Changes pain-related thoughts and behaviors
Mindfulness & relaxation	Meditation, yoga, guided imagery
Acupuncture	Evidence-supported for some pain conditions
Chiropractic/manual therapy	May relieve musculoskeletal pain
Massage therapy	For muscle tension and stress relief

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🔹 3. Interventional Procedures

Procedure	Used For
Nerve blocks	Local pain or diagnostics
Trigger point injections	Muscle-related pain
Epidural steroid injections	Spine-related pain
Radiofrequency ablation	Disables nerves sending pain signals
Spinal cord stimulation	For severe, refractory neuropathic pain

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🔹 4. Lifestyle & Integrative Care

• Regular low-impact exercise: walking, swimming

• Anti-inflammatory diet: rich in omega-3s, fruits, vegetables

• Sleep hygiene

• Pacing & energy conservation: avoid flare-ups by balancing rest/activity

• Support groups & education

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🩺 WHEN TO SEE A SPECIALIST

• Pain lasts longer than 3 months

• Pain interferes with daily activities

• Pain is not responding to standard treatments

• Consider referral to:

  • Pain specialists

  • Neurologists

  • Rheumatologists

  • Behavioral therapists

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🧭 CHRONIC PAIN VS. ACUTE PAIN

Feature	Acute Pain	Chronic Pain
Duration	<3 months	>3 months
Cause	Injury, surgery, illness	May or may not be known
Function	Protective	Often no useful purpose
Response to treatment	Usually resolves	Can be resistant