CHRONIC PAIN: INFORMATION RESOURCES ON THE INTERNET
LISA A. MCGUIRE
ABSTRACT. Chronic pain is pain that lasts longer than one month after onset, or pain
that recurs after onset of injury or illness. Millions of Americans suffer from chronic pain
conditions, whether from diseases such as diabetes or HIV infection, or as a result from
injured nerves, bones, or other tissues. The socioeconomic burden of chronic pain is
immense. Estimates of the economic impact alone from healthcare expenses, lost
productivity, and lost wages are $100 billion annually. This article provides a general
overview of non-cancer causes of chronic pain symptoms, conditions, disease burden,
and treatments. Authoritative web sites for chronic pain information and patient resources
are included.
KEYWORDS. Chronic pain, pain medicine, pain management
AUTHOR. Lisa A. McGuire, MLIS (lmguire@umn.edu) is Liaison Librarian, BioMedical Library, University of Minnesota, 301 Diehl Hall, 505 Essex St. SE.,
Minneapolis, MN 55455.
INTRODUCTION
Feeling pain is a universal component of being human. Without the experience of
pain, humans would find it difficult to recognize illness or injury. Sometimes we
experience pain that lasts a short time and dissipates once the body heals. This is called
acute pain. Other times we may have a condition that causes longer-lasting pain, this is
referred to as chronic pain. Chronic health conditions such as fibromyalgia or diabetes
often have chronic pain as a hallmark of that condition. Sometimes chronic pain is
experienced without evidence of injury or disease. Whatever the source, chronic pain can
be a debilitating condition for patients and their families. This article will focus its
attention on non-malignant, or non-cancer causes of chronic pain.
Chronic pain has been defined as pain that lasts more than one month after the
onset of injury or disease, or pain that recurs off and on for a period of months or years,
or is a result of an incurable health condition such as arthritis or diabetes. Pain symptoms
can vary widely depending on the source of the pain. One of the cruel ironies regarding
chronic pain is that the experience of chronic pain can desensitize the nervous system to
the pain sensation. As pain is felt, nerves and cells that are used to send the pain signals
to the brain are stimulated. The repeated stimulation that occurs with a chronic pain
condition can cause these nerves and cells to remain active or “on’ all the time. This
results in a person with a chronic pain condition having a lower threshold for painful
stimuli than someone who does not experience chronic pain. Pain intensity is also
affected by this constant stimulation of pain cells and receptors. Persons with chronic
pain conditions may feel more fearful or nervous of experiencing pain. Constantly feeling
nervous or anxious about experiencing pain increases production of prostaglandins,
which can intensify the pain sensation.1
Pain incidence in the United States is staggeringly high. Recent estimates
conclude that pain affects more Americans than diabetes, heart disease, and cancer
combined. Data from national surveys show that among adults age 20 and over who
reported pain, 42% of those reported pain that lasted a year or more. The most commonly
reported pain locations included low back (27%), followed by headache or migraine
(15%), neck pain (15%), and facial pain (4%).2
Back and lower extremity pain is exceedingly common in our modern world with
a high rate of disability among active and sedentary people. Back pain can be localized in
the spine, with injuries to the discs or bone. Back pain that spreads to the legs is called
sciatica and is also very common. Hip and knee pain is often caused by arthritis or
bursitis, while foot pain can be a result of damage to nerves (neuropathy), plantar
fasciitis, or vascular diseases to name a few.3
Most of us will experience a headache at some point in our life but for millions of
Americans headaches can be a weekly, monthly or even daily occurrence. Chronic,
recurring headache conditions are often quite disabling. The World Health Organization
ranks migraines as one of the top twenty causes of disability worldwide.4 Headaches that
are the primary disorder include cluster, migraine, and tension-type headache. Secondary
disorder headaches, or those that are a symptom of another medical problem include
rebound headache and sinus headaches. No matter what the cause, recurring headaches
are extremely costly to society. More than one million lost school days occur annually,
with 160 million lost work days are due to headache disorders. The vast majority of
chronic headache sufferers never seek treatment from medical professionals which results
in headaches that become increasingly intractable and difficult to treat.5
Like back pain, pain in the shoulder or neck is also very common. Poor posture
while sitting at a computer or straining the neck forward to better read a computer screen
can be a cause of neck pain. Myofascial pain syndromes are a series of conditions with
aching muscular pain as a hallmark.6 Repetitive strain and overuse injuries are also
common causes of neck, hand, and wrist pain. One of the most common repetitive strain
conditions is carpal tunnel syndrome. Often time these types of painful syndromes can be
prevented by undergoing an ergonomic assessment in the workplace. Setting up a
monitor, mouse and chair in the proper position can result in better posture and
positioning of the head, neck, hand, and wrist that can prevent chronic pain due to
occupational injuries.
Persistent pain in the head, face, or neck may also be caused by what is referred to
as a neuropathic pain condition. Neuropathic pain syndromes can be caused by trauma,
medical illness such as diabetes or HIV infection, or repetitive injuries such as carpal
tunnel syndrome, to name a few. While the precise cause of neuropathic pain syndromes
is not fully understood, it is believed that this type of chronic pain occurs when nerves are
injured or damaged. Symptoms of these painful conditions include experiencing a
burning sensation, or an electric, shock-like sensation to the touch.
Once damaged, nerves can continue to send pain messages to the brain, even
when an injury to say, a tooth, has been repaired by a procedure such as a root canal,
which is called atypical odontalgia or phantom tooth pain. Another chronic pain
condition that often affects the face is trigeminal neuralgia (TN). The trigeminal nerve is
the main nerve that decodes sensations to the face. When affected with TN, sufferers are
often afraid to perform such routine activities such as shaving, or brushing hair in hopes
of avoiding the shock-like pain sensation.7
The burden of chronic pain conditions on society in the United States is immense.
From an economic standpoint, the annual costs including healthcare expenses, lost wages,
and lower productivity from chronic pain is estimated to be $100 billion.8 Besides the
economic impacts of chronic pain on society, the psychological and social impacts of
chronic pain on an individual and their family is also vast. Many chronic pain sufferers
indicate a lower quality of life from their condition. Over 75% of chronic pain patients
reported feeling depressed, have disturbed sleep patterns, lower energy levels, and an
increased inability to concentrate.9 People often cannot work steady hours or help with
household chores. Spouses or partners of chronic pain patients often have additional
responsibilities at home, may need to get a new job or work additional hours at a current
job, or have added child- care duties. This often results in spouses or partners of chronic
pain sufferers feeling depressed, chronically fatigued and resentful towards their
spouse/partner in the first place. Children of chronic pain patients may also feel resentful,
angry or sad over the changes that chronic pain often make on quality family time.
Chronic pain often can negatively affect a person’s relationships with family, friends, and
co-workers.10
A “front-line” physician such as a family practice doctor, internist, or pediatrician
is often seen first for a painful condition or injury. If acute pain turns into a chronic
condition in and of itself or if the pain is due to a chronic disease state, patients are often
referred to specialists for continued treatment. Pain medicine is a board-certified specialty
from the American Board of Pain Medicine (ABPM). Physicians with this certification
come from fields such as anesthesiology, neurology, psychiatry and many others. They
are required to pass a rigorous examination from the ABPM to receive this specialization
in pain medicine.11 Other specialties within clinical medicine such as anesthesiology,
physical medicine & rehabilitation, neurology, and psychiatry also provide a separate
certification examination in pain medicine from within their respective accrediting
boards. Patients can usually search for a physician certified in pain medicine (sometimes
referred to as a diplomate) on an accrediting board’s web site.
Treatments for chronic pain conditions are varied and dependent on the cause of
the pain. Medications, psychological counseling, physical therapy, occupational therapy,
complementary and alternative therapies, and surgical procedures may all play a role in
alleviating chronic pain and allowing a patient to manage symptoms in order to retain a
higher quality of life. Lifestyle changes are also important for the chronic pain sufferer.
Maintaining a regular sleep and exercise schedule is important, as well as refraining from
using alcohol and tobacco. Often times treatment regimens for chronic pain do not
entirely eliminate the pain condition. Instead, the goal is to reduce pain intensity and
duration to maintain a higher quality of life.12
Another option for treating chronic pain is enrolling in a multidisciplinary pain
program. A multidisciplinary pain program focuses on teaching the patient how to cope
and live with a chronic pain condition with the goal of improving a patient’s quality of
life. A pain program takes a team approach to health care with physicians from physical
medicine and rehabilitation, neurology, anesthesiology, and psychiatry, along with
nurses, psychologists, physical and occupational therapists, family counselors, and other
health or social support workers in an integrative system of care and support.13 These
types of programs are usually offered in a hospital or a rehabilitation center and may
require a concentrated time commitment of two weeks or more of daily attendance. Since
there is a significant time commitment for these programs, choosing one within
commuting distance of one’s home is very important. Some programs offer inpatient
services, others do not. Family members are also usually included in the care process
with support groups and counseling offered.
Today chronic pain sufferers and their families have access to a large amount of
information resources on the Internet. This is due in part to the evolution of pain
medicine and pain management as specialties within many clinical medicine fields. This
increased awareness may also result in patients finding information sources on the
Internet that are created by drug companies, biomedical device manufacturers, or
companies offering a “miracle cure” that attempt to persuade readers with examples of
“evidence” for treatments that may be little more than advertisements. This list below
contains authoritative information resources on chronic pain for patients and families.
WEB RESOURCES ON CHRONIC PAIN
The Merck Manual Home Edition. Pain – Introduction.
< http://www.merck.com/mmhe/sec06/ch078/ch078a.html?qt=pain&alt=sh>
The Merck Manual Home Edition is a popular general consumer health reference
book which is available for free online. Each article is updated and revised by physicians
in a timely manner. This introductory article on pain provides a good overview of the
differences between acute and chronic pain and the pain pathways that exist in the human
nervous system.
American Pain Foundation. Pain Facts and Figures.
< http://www.painfoundation.org/newsroom/reporter-resources/pain-factsfigures.html>
The American Pain Foundation is a non-profit organization whose mission is to
serve people suffering with pain through information, advocacy and support. This site
includes a library of articles on pain conditions, links to web sites organized by
conditions, and a locator tool to link patients with organizations that provide support and
information. The Newsroom section of this site contains statistical data on pain
conditions and burden of disease of use to health reporters.
National Institute of Neurological Disorders and Stroke. Pain: Hope Through
Research
<http://www.ninds.nih.gov/disorders/chronic_pain/detail_chronic_pain.htm#125113
084>
The National Institute of Neurological Disorders and Stroke (NINDS) is part of
the National Institutes of Health. NINDS is charged with reducing the burden of
neurological disease among all segments of society. This site from NINDS has overview
information on pain, definitions of acute versus chronic pain, a history of pain treatments
from ancient times to the present, an A-Z listing of pain conditions, treatments, and
medications, as well as a listing of organizations that support patients with various
conditions.
National Pain Foundation. Headache Overview
< http://www.nationalpainfoundation.org/cat/12/headache>
The National Pain Foundation is a non-profit organization whose mission is to
advance functional recovery of persons in pain through information, education, and
support. All information on the NPF web site is peer-reviewed. The Diseases &
Conditions section of their web site lists several pain conditions besides headache,
including fibromyalgia and cancer pain. Each condition is described in detail with
sections on causes, signs & symptoms, diagnosis, prognosis, therapies, a glossary, and
articles that address various components of the condition. The Providers section of the
web site offers a Clinical Content area that is intended for practitioners, but consumers
can easily understand much of the information here as well. The content is mirrored from
the Diseases & Conditions area but with additional citations and articles written by
physicians.
American Academy of Physical Medicine and Rehabilitation. Overview of Neck
Pain
< http://www.aapmr.org/condtreat/pain/neckpain.htm>
The American Academy of Physical Medicine and Rehabilitation is the society
that represents physical medicine and rehabilitation physicians who are also known as
physiatrists. Physiatrists are experts at diagnosing and treating pain by viewing the
patient holistically. This site lists conditions and treatments that physical medicine and
rehabilitation physicians routinely diagnose and treat. The site also has an online
directory that can consumers can use to identify physiatrists in the United States and
other countries.
American Academy of Pain Medicine. AAPM Facts and Figures on Pain.
< http://www.painmed.org/patient/facts.html>
The American Academy of Pain Medicine (AAPM) is an organization for
physicians who practice the specialty of pain medicine in the United States. AAPM
promotes best clinical practices, research, advocacy, and continuing medical education
for its members. Consumers may wish to start at the Patient Portal to research general
information or to find a physician. The Clinical Information section of the web site has
research findings from AAPM meeting abstracts, clinical guidelines, and updated news
articles.
American Board of Pain Medicine
< http://www.abpm.org/>
The American Board of Pain Medicine is the organization that accredits
physicians with a specialization in pain medicine. Qualified candidates sit for an
examination that if successfully passed designates them as diplomates in the field. The
organization also accredits pain medicine residency programs in the United States.
Interested consumers can search for physicians with this specialization in the Diplomates
section.
FamilyDoctor.org. Chronic Pain
< http://familydoctor.org/online/famdocen/home/common/pain/disorders/551.html>
FamilyDoctor.org is the health information portal for consumers from the
American Academy of Family Physicians. The chronic pain monograph focuses on
treatments for chronic pain and what patients should tell their family physician at an
office visit when they experience pain. There is a link on this page to a section on
FamilyDoctor.org dedicated to various pain disorders, including pain disorders in
children.
American Chronic Pain Association
< http://www.theacpa.org/default.asp>
Penney Cowan founded the American Chronic Pain Association in 1980. Ms.
Cowan founded the group as a result of her experiences as a chronic pain patient, in
particular her experience at a pain management program at the Cleveland Clinic. Today
the organization is known for its national network of support groups. The web site has
helpful articles on coping with chronic pain, information on how to choose a
multidisciplinary pain program and an online video presentation on pain medications and
treatments. They publish a quarterly newsletter, sell books and videos via an online store,
and list pain conferences and volunteer opportunities on the events calendar.
CONCLUSION
Chronic pain conditions are incredibly complicated to diagnose and treat. Treatment
goals more often than not focus on increasing quality of life, rather than offering a
permanent cure. These Internet sites provide a wide array of information resources and
support mechanisms for people with chronic pain and their caregivers, family members,
and friends. Many of these sites offer health consumers a search option to find a
physician who specializes in pain management. Finding a specialist in pain medicine or
pain management can help increase quality of life satisfaction for the millions of
Americans who live with chronic pain everyday.
REFERENCES
1. Merck Manual Home Edition. “Introduction: Pain.” (August 2007). Available:
<http://www.merck.com/mmhe/sec06/ch078/ch078a.html?qt=pain&alt=sh.>Acce
ssed: September 18, 2009.
2. American Pain Foundation. “Pain Facts and Figures.” (July 2009). Available:
<http://www.painfoundation.org/newsroom/reporter-resources/pain-factsfigures.html>. Accessed: September 18, 2009.
3. National Institute of Neurological Disorders and Stroke. “Pain: Hope Through
Research.” (August 2009). Available:
<http://www.ninds.nih.gov/disorders/chronic_pain/detail_chronic_pain.htm#1251
13084>. Accessed: September 25, 2009.
4. Leonardi M, Steiner TJ, Scher AT, Lipton RR. The global burden of migraine:
measuring disability in headache disorders with WHO’s Classification of
Functioning, Disability and Health (ICF). J Headache Pain 2005;6:429-440.
5. National Pain Foundation. “Headache Overview.” (2009). Available:
<http://www.nationalpainfoundation.org/articles/737/headache-overview>.
Accessed: September 25, 2009.
6. American Academy of Physical Medicine and Rehabilitation. “Overview of Neck
Pain.” (2009). Available: <http://www.aapmr.org/condtreat/pain/neckpain.htm>.
Accessed: September 28, 2009.
7. National Pain Foundation. “Neuropathic Pain in Head and Neck.” (2009).
Available: <http://www.nationalpainfoundation.org/articles/461/neuropathic-painin-head-and-neck-#Treatment>. Accessed: September 28, 2009.
8. American Academy of Pain Medicine. “AAPM Facts and Figures on Pain.”
(2009). Available: <http://www.painmed.org/patient/facts.html>. Accessed:
September 21, 2009.
9. Ibid.
10. Brody, Jane E. “Chronic Pain: A Burden Often Shared.” Available:
<http://www.nytimes.com/2007/11/13/health/13brod.html?_r=1> . Accessed:
September 18, 2009.
11. American Board of Pain Medicine. (2009). Available: <http://www.abpm.org/>.
Accessed: September 28, 2009.
12. FamilyDoctor.org. “Chronic Pain.” (March 2009). Available: <
http://familydoctor.org/online/famdocen/home/common/pain/disorders/551.html>
. Accessed: September 28, 2009.
13. American Chronic Pain Association. “Managing Chronic Pain.” (September
2009). Available: <http://www.theacpa.org/people/pain_program.asp>. Accessed
September 25, 2009.