Chronic Pain

Before we look at chronic pain in Singapore, let’s take a look at the statistics of chronic pain in the United States for comparison. Women, minority groups, elderly persons (especially nursing home residents), and individuals with cancer are at appreciable risk of suboptimal pain assessment and treatment. Effective pain management presents a significant challenge for physicians, other healthcare professionals, and their patients. In a large epidemiological survey conducted in US, Europe and Australia, chronic pain is found to afflict one in five.

Some 75 million Americans experience persistent pain, and at least 9% of the US adult population is estimated to suffer from moderate to severe nonmalignant pain. Patients with persistent pain can be especially difficult to treat. In one survey conducted for the American Pain Society, 47% of those with moderate, severe, or very severe pain had changed physicians at least once since their initial visit for pain relief. When asked why, they cited continued suffering (42%), the physician’s lack of knowledge (31%), not taking the pain seriously enough (29%), and unwillingness to treat it aggressively (27%) as reasons for the change. Reasons for the failure to report pain to the doctor are as follows: Thinking one can “see the pain through,” underestimating the level of pain, the fear that pain portends a serious illness or poor diagnosis, concerns about the side effects of opioids, confusion of the appropriate clinical use of opioids with addiction, unwillingness to take more pills or injections, satisfaction with pain management, despite moderate or severe pain.

Signs and Symptoms
Some of the common signs and symptoms of chronic pain include: Pain beyond 6 months after an injury, Allodynia—pain from stimuli which are not normally painful and/or pain that occurs other than in the stimulated area, Hyperpathia—increased pain from stimuli that are normally painful, Hypersensation—being overly sensitive to pain. Signs of major clinical depression will occur daily for 2 weeks or more, and often include many of the following: A predominant feeling of sadness; feeling blue, hopeless, or irritable, often with crying spells, Changes in appetite or weight (loss or gain) and/or sleep (too much or too little), Poor concentration or memory, Feeling restless or fatigued, Loss of interest or pleasure in usual activities, including sex, Feeling of worthlessness and/or guilt.

Pain serves an important function in our lives. When you suffer an acute injury, pain warns you to stop the activity that is causing the injury and tells you to take care of the affected body part. Chronic pain, on the other hand, persists for weeks, months, or even years. Some people, often older adults, suffer from chronic pain without any definable past injury or signs of body damage. Common chronic pain can be caused by headaches, the low back, and arthritis. Unfortunately, there is scant objective evidence or physical findings to explain such pain.

Until recently, some doctors who could not find a physical cause for a person’s pain simply suggested that it was imaginary—“all in your head.” This is unfortunate because we know that all pain is real and not imagined, except in the most extreme cases of psychosis. Emerging scientific evidence is demonstrating that the nerves in the spinal cord of patients with chronic pain undergo structural changes. Psychological and social issues often amplify the effects of chronic pain. For example, people with chronic pain frequently report a wide range of limitations in family and social roles, such as the inability to perform household or workplace chores, take care of children, or engage in leisure activities. In turn, spouses, children, and co-workers often have to take over these responsibilities. Such changes often lead to depression, agitation, resentment, and anger for the patient suffering from chronic pain and to stress and strain in family and other social relationships.

How is depression involved with chronic pain? Depression is most commonly associated with chronic pain. It is thought to be 3 to 4 times more common in people with chronic pain than in the general population. In addition, 30 to 80% of people with chronic pain will suffer from some type of depression. The combination of chronic pain and depression is often associated with greater disability than either depression or chronic pain alone. People with chronic pain and depression suffer dramatic changes in their physical, mental, and social well-being—and in their quality of life. Such people often find it difficult to sleep, are easily agitated, cannot perform their normal activities of daily living, cannot concentrate, and are often unable to perform their duties at work. This constellation of disabilities starts a vicious cycle—pain leads to more depression, which leads to more chronic pain. In some cases, the depression occurs before the pain. Until recently, we believed that bed rest after an injury was important for recovery. This has likely resulted in many chronic pain syndromes. Avoiding performing activities that a person believes will cause pain only make his or her condition worse in many cases.

Depression associated with pain is powerful enough to have a substantial negative impact on the outcome of treatment, including surgery. It is important for your doctor to take into consideration not only biological, but also psychological and social issues that pain brings. What is the treatment for chronic pain and depression? The first step in coping with chronic painis to determine its cause, if possible. This is what we do best at our office. Addressing the problem will help the pain subside. In other cases, especially when the pain is chronic, you should try to keep the chronic pain from being the entire focus of your life.

Here are some tips that others have found useful whether you decide to visit at our pain clinic in Singapore:

Stay active and do not avoid activities that cause pain simply because they cause pain. The amount and type of activity should be directed by your doctor, so that activities that might actually cause more harm are avoided. Relaxation training, hypnosis, biofeedback, and guided imagery, can help you cope with chronic pain. Cognitive therapy can also help patients recognize destructive patterns of emotion and behavior and help them modify or replace such behaviors and thoughts with more reasonable or supportive ones.

Distraction (redirecting your attention away from chronic pain), imagery (going to your “happy place”), and dissociation (detaching yourself from the chronic pain) can be useful. Involving your family with your recovery may be quite helpful, according to recent scientific evidence. 

Feel free to discuss these or other techniques with your doctor. He or she may suggest some simple techniques that may work for you or may refer you to another health care provider for more in-depth training in these techniques.