Understanding and Treating Chronic Pain: A Path to Relief

Mr. Kim, aged 51, had been suffering from an unidentified pain for over six months, which also resulted in insomnia. The lack of a specific diagnosis led to misunderstandings, with some perceiving him as mentally ill or defective. However, after being finally diagnosed with chronic pain and undergoing spinal nerve stimulation, his condition showed significant improvement.

Chronic pain refers to persistent discomfort that lasts for more than six months, despite ongoing conservative treatment. When the pain becomes centralized and the neurotransmitter system is affected, the pain intensifies even without external stimuli. It can manifest in various areas of the body, such as the back, waist, neck, chest, or head. Conditions like back disease, rheumatism, degenerative arthritis, migraine, or trigeminal neuralgia can progress into chronic pain. Additionally, trauma resulting from accidents or falls can also lead to chronic pain.

One of the most common types of chronic pain is ‘complex regional pain syndrome’ (CRPS). This neurological disorder causes the initial pain in a specific body part to worsen over time. Patients may experience skin discoloration, hair loss, weakened bone density due to poor blood circulation, and ultimately lose the ability to use the affected joints. Other forms of chronic pain include chronic headaches, myofascial pain syndrome, post-surgical pain syndrome, peripheral polyneuropathy, and phantom limb pain.

The primary symptom of chronic pain is the persistence of pain even without a triggering stimulus. In fact, the pain often becomes more pronounced in the absence of any external stimuli, hence numerous reports of aggravated pain at night. Additionally, patients with arthritis or neuropathy may experience increased pain in response to changes in weather or environment. Chronic pain can also be accompanied by various physical, sensory, and psychological symptoms, such as digestive system disorders, lethargy, and emotional imbalances.

The exact cause of chronic pain remains unclear; however, it is believed to be a combination of genetic and environmental factors. The prevailing theory suggests that the somatosensory nerves, responsible for detecting and transmitting pain signals to the spinal cord and brain, become excessively sensitized. As a result, pain signals are produced even in the absence of any stimuli, thus causing chronic pain.

Diagnosing chronic pain often involves a process of exclusion, whereby potential diagnoses are systematically ruled out. Several tests are conducted to identify any underlying lesions, such as fractures or inflammation, that may be causing the pain. A diagnosis of chronic pain is established when a patient reports experiencing pain without any identifiable structural or physiological abnormalities.

The initial approach to treating chronic pain involves medication. Tricyclic antidepressants are typically prescribed as they regulate pain transmission pathways in the brainstem. Additionally, nervous system drugs and anticonvulsants may be employed, and complementing these medications with physical therapy can enhance the treatment’s effectiveness.

In cases where drug treatment proves ineffective, nerve blocks can be performed. Nerve blocks involve anesthetizing the nerves along the pain transmission pathway. The specific method employed for nerve blocks varies depending on the type of pain experienced by the patient.

If chronic pain persists despite medication and nerve blocks, surgical treatment may be considered. Surgical options involve identifying and severing somatosensory nerve transmission pathways or utilizing electrical stimulation methods. For instance, individuals with phantom limb pain or peripheral neuropathy may benefit from the surgical cutting of somatosensory neurotransmission pathways in the spinal cord. In cases where the centralization of chronic pain causes alterations in the brain’s neurotransmitter system, intervening by disrupting the pain perception process can be beneficial.

Electrical stimulation techniques can also be applied to the spinal cord and brain. One prevalent surgical procedure is spinal nerve stimulation, where a low-frequency electrical stimulation device is implanted inside the patient’s body. By controlling the electrical stimulation, patients with spinal nerve stimulators can manage their pain effectively. Deep brain stimulation or cerebral cortical stimulation are utilized when abnormal pain is originating in the brain.

Maintaining a healthy lifestyle is vital in preventing chronic pain. This includes following a balanced diet, getting sufficient sleep, and engaging in regular exercise suitable for individual capabilities. Engaging in stress-reducing activities and hobbies can also aid in tension relief.

Although chronic pain can be challenging to treat, it is not an incurable condition. Collaborating closely with healthcare specialists and undergoing appropriate treatment can significantly improve the quality of life for individuals with chronic pain. It is crucial to note that chronic pain can often be misunderstood as malingering due to the absence of visible abnormalities. However, it is a legitimate condition caused by abnormalities in the somatosensory nervous system, necessitating understanding and support from those surrounding the affected individual.

Instead of fixating on complete pain eradication, it is advisable to continue with daily activities while receiving suitable treatment with a positive outlook. Regular exercise can enhance blood circulation and increase muscle mass, promoting pain relief. It is worth noting that while narcotic analgesics may provide initial relief, their prolonged use can further exacerbate pain intensity and potentially lead to drug addiction. Therefore, it is best to avoid relying on them for chronic pain management.

This information was provided by Professor Jung Mun-Young from the Department of Neurosurgery at Soonchunhyang University Bucheon Hospital.

[Source: Giho Ilbo – Morning newspaper, KIHOILBO]

Professor Jung Mun-Young, Department of Neurosurgery, Soonchunhyang University Bucheon Hospital

Mr Kim (51), who had been suffering from an unknown pain for over six months, was suffering from insomnia. As there was no name or clear cause for the disease, they were misunderstood as mentally ill or defective because they were not properly diagnosed and treated. She was diagnosed with chronic pain and after receiving spinal nerve stimulation, the pain improved.

Chronic pain generally refers to pain that causes discomfort in daily life that persists for more than 6 months despite continued conservative treatment. When chronic pain is centralized and the neurotransmitter system is damaged, the cause of the pain is resolved and the pain becomes excessive even without stimulation.

The area of ​​the pain is varied, such as back, waist, neck, chest, headache, etc. Various diseases such as back disease, rheumatism, degenerative arthritis, migraine or trigeminal neuralgia develop into chronic pain. In some cases, the pain caused by trauma caused by an accident or fall can become chronic.

The most representative type of chronic pain is ‘complex regional pain syndrome’ (CRPS). It is a sensory nerve disease where the pain that started in a certain part of the body becomes more and more severe, and on top of that, skin color changes or hair falls out, and bone density weakens due to poor blood circulation, making it impossible to use joints. In addition, there are chronic headaches, myofascial pain syndrome, pain syndrome after spinal surgery, peripheral polyneuropathy, and phantom limb pain.

The main symptom of chronic pain is pain that occurs even in the absence of a stimulus that causes the pain. Typically, the more there is no stimulation, the more pronounced the pain, so there are many complaints of pain at night. In addition, arthritis and neuropathy patients often have a characteristic that the pain becomes more severe depending on the weather or environmental change. It can be accompanied by various physical, sensory and psychiatric symptoms such as digestive system disorders, lethargy, and emotional changes.

The cause of chronic pain is still not clear. It is thought to be caused by a combination of environmental and genetic factors. The main principle is that somatosensory nerves that detect pain and transmit it to the spinal cord and brain become sensitive to pain, and pain signals are produced even though there is no stimulus that can cause pain, causing pain.

Chronic pain is diagnosed by ‘diagnosis by exclusion’, where possible diagnoses are eliminated one by one. A number of tests are performed to find lesions that cause pain, such as fractures or inflammation. Chronic pain is diagnosed when a patient complains of pain although there is no abnormal structure or physiological abnormality as a result of the examination.

The primary treatment is medication. Tricyclic antidepressants, which regulate the activity of pain transmission pathways in the brain stem, are used first. In addition, there are cases where nervous system drugs or anticonvulsant drugs are used, and the effect of the treatment can be increased by combining physical therapy.

If drug treatment does not improve, a nerve block is performed. A nerve block is a treatment that anesthetizes the nerves in the pain transmission pathway. There are many different methods of nerve block, and it is performed in an appropriate way depending on the type of pain.

For chronic pain that persists even after drug treatment or a nerve block, surgical treatment is considered. There are methods of discovering and cutting somatosensory nerve transmission pathways and electrical stimulation methods. In the case of fantasy pain in the limb or peripheral neuropathy, it is effective to use the method of cutting the somatosensory neurotransmission pathway of the spinal cord. If the centralization of chronic pain changes the neurotransmitter system in the brain, it is useful to break the previous target that feels pain in the brain.

Electrical stimulation methods can also be performed on the spinal cord and brain. The most popular pain surgery is spinal nerve stimulation, which you can think of as inserting a low frequency electrical stimulation machine into the patient’s body. Patients with spinal nerve stimulators can control their pain through their preferred electrical stimulation. When abnormal pain occurs in the brain, deep brain stimulation or cerebral cortical stimulation is used.

A healthy lifestyle is the most important to prevent chronic pain. You can eat a balanced diet regularly, get enough sleep, and do regular exercise that suits you. Relieving tension and reducing stress through hobbies can also help.

Chronic pain is difficult to treat, but it is not an incurable disease. If you work closely with a specialist and undergo treatment, you can definitely improve your quality of life. In addition, chronic pain can be misunderstood as malingering because there is no visible way to express the abnormality, but it suffers from clear symptoms due to abnormalities in the somatosensory nervous system. Therefore, it is a disease that requires understanding and support from those around it.

It is recommended that you continue with your daily life while receiving appropriate treatment with a comfortable mind rather than thinking ‘I need to get rid of the pain completely’. Furthermore, it is good to improve blood circulation and increase muscle mass through regular exercise. Unlike the effect of the initial treatment, narcotic analgesics eventually increase the intensity of pain and cause drug addiction, so it is better not to use them.

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Giho Ilbo – Morning newspaper, KIHOILBO

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