What is chronic pain?
Chronic pain is defined as pain lasting more than 6 months or longer than the time expected for tissue healing. Distinction is made clinically between cancer pain and non-cancer pain, as cancer pain usually worsens as the cancer spreads and increasing medications are required for palliative care. Chronic non-cancer pain (CNCP), on the other hand, is a condition where pain perception is driven by persistent pain signals coming from specific areas of the body and/or there is amplification of pain perception in the central nervous system of the brain.
It is important to appreciate that pain is an inherently subjective experience and the emotional state of an individual has a great effect on the perception of pain. Fear, anger and shame are commonly associated with amplification of chronic pain.
Chronic pain has major debilitating effects that have major repercussions for the individual, their family life and ability to be productive at work. It has been estimated that 18% of Canadians suffer from chronic pain. Employees with chronic pain miss an average of 28.5 workdays a year, which is more than four times higher than the national annual average for work absenteeism, which is seven days. Chronic pain patients are often prescribed opioid medications as a solution that can become part of the problem because of their abuse liability and dependence (addiction) potential.
Chronic Pain Services
Completion of the comprehensive assessment is necessary to determine the diagnoses and develop an effective treatment plan. There are 3 categories of chronic pain patients and recommendations for intervention for each group varies.
Category A – (A is for Addiction) – the individual seeks opioids for perceived pain; however, assessment reveals that addiction is the more pressing diagnosis and pain, although chronic, is manageable once addiction is effectively treated.
Category B – the individual seeking opioids has clearly identifiable etiology for pain and does not have a past history or current active addiction issues. These individuals usually follow directions for treatment and do not change the medication or dosing schedule on their own.
Category C – (C is for Complex) – these individuals have chronic non-cancer pain (CNCP) that requires ongoing opioid therapy, in addition to concurrent substance dependence (Addiction). These individuals require very careful monitoring and structure to ensure that relapse to active addiction is prevented. Simultaneous utilization of recovery resources with agonist opioid therapy is essential, as persistent pain can be a trigger for ‘out-of-control drug use’ and reactivation of addictive behaviours and lifestyle.