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Expert Talk: Dr Farah Ingale Shares Advice On How To Deal With Chronic Pain Syndrome

Severe, continuous and debilitating pain is only a fraction of what chronic pain syndrome looks like. The diagnosis of chronic pain syndrome can take months, if not years. Research says that chronic pain syndrome, as opposed to chronic pain, has the added component of certain recognizable psychological and socioeconomic influences. While there are several studies being conducted on this topic, not much is known about it, especially to common folks. So what is CPS, how is it different from other pain disorders and what are its effects on the body?

TC46 connected with the Director of Internal Medicine, Dr Farah Ingale of Hiranandani Hospital, Mumbai. Here, she talks about the effects of CPS on mental health, the major causes, treatment options and pain management techniques.

1. What is chronic pain syndrome?

Unlike acute pain, this condition called ‘Chronic Pain Syndrome’, doesn’t go away after your initial injury or illness has healed. It’s marked by pain that lasts longer than six months and is often accompanied by anger, depression, anxiety, loss of sexual desire, and disability. This is seen amongst those with chronic and painful conditions, such as arthritis. It is common among:

  • Those who are depressed
  • Those who smoke
  • Those who are obese
  • Women
  • Those who are older than 65 years of age

2. How does it affect your mental health?

It can affect your ability to function at home and work. You may find it difficult to participate in social activities and hobbies, which could lead to decreased self-esteem. It is also common for people with chronic pain to have: 

  • Sleep disturbances
  • Fatigue
  • Trouble concentrating
  • decreased appetite
  • Mood changes

3. What are the signs and symptoms of chronic pain?

The primary symptom of CPS is persistent pain that lasts weeks to years. Other signs and symptoms of chronic pain include the following:

  • Frowning
  • Grimacing
  • Appetite changes
  • Poor sleep
  • Fearful expression
  • Teeth grinding
  • Fidgeting

4. What are the major causes of chronic pain syndrome?

Pain areas include:

  • The back
  • Joints
  • Mouth and face
  • Muscles and bones
  • Neck

Pain can be caused by psychological factors.

  • Sensory: Pins and needles sensation, or sensitivity to pain
  • Psychological: Depression or fear
  • Also common: Anxiety, fatigue, headache, or sleep deprivation

5. What are the risk factors of this condition for women?

The risk factors for women include:

  • Arthritis and other joint problems
  • Back pain
  • Headaches
  • Muscle strains and sprains
  • Repetitive stress injuries: When the same movement is made over and over, it puts a strain on a body part
  • Fibromyalgia: A condition that causes muscle pain throughout the body
  • Nerve damage
  • Lyme Disease

Chronic pain after breast cancer treatment is a major clinical problem, affecting 25% to 60% of patients. Development of chronic pain after breast cancer treatment, as well as other surgical procedures, involves complex pathophysiology that involves pre, intra-and post-operative care.

6. How is CPS diagnosed?

Although more severe acute postoperative pain increases the risk of chronic pain following Breast Cancer surgery, few studies have examined the characteristics of patients who develop greater acute pain. To identify risk factors for acute pain and its persistence one month following breast cancer surgery, a sample of 114 women scheduled for Breast Cancer surgery was assessed preoperatively for demographics, clinical, and emotional functioning variables that were hypothesized to be associated with acute pain severity.

  • Laboratory or imaging evaluations are needed to confirm the diagnosis like MRI & CT scan
  • The nerve block will also help to diagnose & treat the cause
  • Laboratory tests like ESR, RA factor, Thyroid function test, ANA (Anti-Nuclear Antibody), Vit- D level & CSF (Cerebro Spinal Fluid) 

7. What are the differences between chronic pain syndrome & fibromyalgia?

Even though the symptoms overlap, Chronic Pain Syndrome and Fibromyalgia are two different disorders. With Chronic Pain Syndrome, there is usually an identifiable trigger such as Arthritis or an injury. Fibromyalgia, on the other hand, often arises without a cause. Ironically, Chronic Pain Syndrome and Fibromyalgia often co-exist together. If Fibromyalgia pain continues, it can lead to Chronic Pain Syndrome.

The most common symptoms of Fibromyalgia are:

  • Widespread pain
  • Fatigue
  • Sleep apnea
  • Restless Leg Syndrome
  • Cognitive difficulties

Symptoms of Chronic Pain Syndrome are:

  • Joint pain
  • Muscle aches
  • Fatigue
  • Insomnia
  • Burning pain
  • Mood swings

8. What treatments are best-suited for chronic pain syndrome?

Milder forms of pain may be relieved by over-the-counter medications such as Tylenol (Acetaminophen) or Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) such as Aspirin, iBuprofen, and Naproxen. Both Acetaminophen and NSAIDs relieve pain caused by muscle aches and stiffness, and additionally, NSAIDs reduce inflammation (swelling and irritation). Topical pain relievers are also available, such as creams, lotions, or sprays that are applied to the skin in order to relieve pain and inflammation from sore muscles and Arthritis. Other treatment options include: 

  • Nerve block
  • Patient controlled Analgesia
  • Trigger point injections
  • Intrathecal drug delivery
  • Spinal cord stimulation implant
  • Trans-cutaneous Nerve Electrical Stimulus
  • Bioelectric therapy

9. What are some ways to better manage chronic pain?

  • Behaviour modification, using Cognitive Behavioral Therapy
  • Acupuncture
  • Psychotherapy
  • Biofeedback
  • Hypnosis
  • Occupational therapy
  • Physical therapy
  • Relaxation techniques, such as meditation, visual imagery, or deep breathing
  • Medications to help control pain, such as anti-inflammatory drugs, antidepressants, anticonvulsants, and opioids
  • Nerve blocks
  • Surgery to treat any underlying conditions

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