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What is Chronic Pain?

Evidence-based Overviews | Prevention | Treatments | Self-Management | Associated Conditions |
Decision Aids and Toolkits | Work AccommodationChronic Pain Organizations | Pain Services in Canada

Pain is defined as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage" by the International Association for the Study of Pain (IASP).

When thinking about chronic pain, it is important to realize the difference between chronic pain and acute pain. Acute pain is a normal reaction to an injury that provides an early warning system that an injury has occurred. Acute pain does not last very long, as the majority of injuries will normally heal within three months.

Chronic pain is pain that doesn’t go away after three months. Chronic pain can be intermittent (occurring on and off). It may vary with intensity during the day or it can be persistent. Chronic pain can result from a known cause, such as surgery or inflamed joints, or a consequence of a disease process, such as rheumatoid arthritis. Many times the cause is unknown.

Chronic pain can be an abnormal processing of pain where the original injury or cause of acute pain has resolved, but the warning system has failed to shut off. When this occurs the warning bells are still going off, however it is no longer signaling “danger” or “harm” but rather indicating a problem of pain processing.

There are different types of chronic pain. Two of the major, non-cancer chronic pains are:

  • Musculoskeletal Pain - Pain that affects the bones, muscles, ligaments and tendons. Musculoskeletal pain can result from various causes including sports or occupational injuries, motor vehicle collisions, repetitive strain injuries and disease processes, such as, arthritis.
  • Neuropathic Pain - A complex, multi-faceted state of chronic pain that may have no obvious cause. It can involve damaged tissue, injury or malfunctioning nerve fibers or changes in brain processing. An example of neuropathic pain is phantom limb syndrome. The brain still receives signals from nerves that originally carried impulses from the now missing limb. Other types of neuropathic pain include numbness, burning, "pins and needles" sensations and shooting pain.

 If you are suffering from chronic pain, there are many effective treatments and self-management techniques that you can use to increase your functionality.

Experiences of Chronic Pain

Pain is a very complex experience and many factors contribute to how an individual perceives, responds to and manages their chronic pain. Everyone brings a unique mix of cultural, family and social adaptations to their pain experience. Some people appear to be better able to manage their chronic pain than others. There are social and psychological benefits to maintaining relationships and usual activities as much as possible at home and at work. People who take an “active" role in learning and practicing coping behaviors tend to experience less of the following:

Stepping Stones Social Isolation - Some people with chronic pain may lose their friends, strain their family relationships and wear down social supports. With this loss of community comes a loss of interaction and engagement with people or activities that previously helped them cope with their pain. 

Psychological Shifts - A person’s mental health and overall attitude toward life can greatly affect their pain experience. For example, research has shown that for people with low back pain, feelings of helplessness, fear and a ‘glass-half-empty’ perspective are linked to poorer health outcomes. Conversely, those with a strong sense of psychological wellbeing and a more positive outlook on life tend to cope better with chronic pain.

Work/Career Shifts - Some people with chronic pain struggle to keep their jobs.  Sometimes the challenge is convincing employers to let affected employees modify their jobs or their workloads so that they can manage their pain while continuing to work. Research has shown that workers who return to work earlier have better health outcomes. Being engaged in work reduces focus and attention on pain. The reduction of focus on pain actually changes how the brain processes pain experiences.

Self-redefinition – Chronic pain can lead to fundamental changes in how people see themselves and their lives. These changes affect how they feel.  Fortunately, there are several new ideas around thinking, feeling and “being” - or acting - that can help people recognize and control what’s going on with their bodies. 

If you are feeling the effects of any of the above issues, it's important that you talk with your doctor. You may also consider joining a local support group of others who live with chronic pain.

Evidence-based Chronic Pain Overviews  

  
Sponsor Organization
Chronic Pain Conditions
Canadian Pain Coalition
Chronic Pain Information
National Institute of Neurological Disorders and Stroke
Chronic Pain Overview
National Institutes for Health
Chronic Pain Overview
Arthritis Research Foundation (UK)
Chronic Pain Overview
MayoClinic
The Relationship between Mental Health, Mental Illness and Chronic Physical Conditions
Canadian Mental Health Association

Prevention

Preventing chronic pain may be possible – depending on its cause. Many people are surprised to learn that, not all, but many cases of chronic pain can in fact be prevented.

Associated Conditions  

DepressionDepression

People with chronic pain are at a higher risk of experiencing depression. Depression and pain can produce a cycle where one feeds into the other causing higher pain levels and greater depression. While using medication, exercise or other treatments for chronic pain is beneficial, it’s also important to pay attention to your mental state. You could start by finding ways to lower your stress levels, engage in positive thinking and seek counseling with a trained psychologist or counselor.

Resources

​"Psychology Works" Facts Sheet: Chronic Pain

​Canadian Psychological Association
Depression Overview Canadian Mental Health Association ​
What is Depression? Mood Disorders Society of Canada​
Depression Fact Sheet Here to Help Canada​
Depression Treatments ​Canadian Mental Health Association
Depression and Pain

Harvard School of Medicine​

Chronic Pain Decision Aids and Toolkits

  
Sponsor Organization
A Mindfulness-Based Stress Reduction Workbook
Canadian Pain Toolkit - People in Pain Network
People in Pain Network
Chronic Pain Notebook
American Pain Foundation
Communication Tools
American Chronic Pain Association
Complex Regional Pain Syndrome
Arthritis Research UK
Handbook of Adult Resilience - History of the research on resilience
Living Beyond Your Pain: Using Acceptance and Commitment Therapy to Ease Chronic Pain
Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach Workbook
Managing Chronic Pain: A Cognitive-Behavioral Therapy Approach Workbook
Online Pain Assessment Tool
Canadian Pain Coalition
Online Pain Toolkit
Pain Resource Centre
Canadian Pain Coalition
Pain Toolkit
Pain BC
Pain Toolkit
Patient Decision Aids
Ottawa Hospital Research Institute
The Mindfulness Solution to Pain: Step-by-Step Techniques for Chronic Pain Management
The Pain Toolbox: Treatment Options for Pain - Beyond Medications, Surgery and Injections
Pain BC
Tools of Change
Youth Pain Toolkit in Development
People in Pain Network

Work Accommodation Information 

  
Sponsor Organization
Employees with Chronic Pain
U.S. Department of Labor
Employers Advice
Sheffield Aches and Pains
MS Society - Self-management toolkit for the workplace
MS Society
Work Accommodation Ideas with Chronic Pain
US Department of Labor

Chronic Pain Organizations 

  
Age-Well Canada
Alberta Caregivers Research
American Pain Foundation
Arthritis Society of Canada
BC Directory of Health Researchers and Trainees
British Columbia Society of Occupational Therapists (BCSOT)
Canadian Association on Gerontology
Canadian Neuropathy Association
Canadian Pain Coalition
Canadian Pain Society
Cochrane Musculoskeletal Group
Dieticians of Canada
Families and Work Institute
Independent Living Institute
National Alliance for Caregiving
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Neil Squire Society
Pain BC
Physiotherapy Association of British Columbia - Find a Physiotherapist

Chronic Pain Services in Canada  

The Problem

The Canadian health system does not adequately support most people with chronic pain. Effective chronic pain management programs, services, and drugs are not always available or accessible to all Canadians. And while guidelines about how best to manage chronic pain have been developed, they are not fully supported by the current health system.

Chronic pain is a serious health problem in Canada. Overall, between 10 and 12 per cent of Canadians live with chronic pain. The numbers more than double for seniors. In a 2005 survey, close to one in three Canadians aged 65 and over (27%) reported living with chronic pain. This number rose to 37% among those living with two or more chronic conditions.

Canadians with chronic pain also face:

  • Unequal access to appropriate treatment due to geography
  • Shortage of knowledge on which programs, services are over-used and which are under-used
  • Unequal financing of treatments that result in the over-use of some forms (such as injections) and the under-use of others (such as counseling)
  • No credentialing of clinics and centres providing chronic pain services.

Finally, there is little to no information about how people in particular social groups - such as those living with a mental illness and/or addiction problems and those in rural and remote communities - manage chronic pain.

Chronic pain can impact life in many ways. It can prevent individuals from fully participating in employment, leisure activities and hobbies. It may affect their sense of self-worth, emotional well-being and overall quality of life. For about half of chronic pain suffers, it worsens their economic situation (from the costs of medication, treatment, etc.).

Addressing the Problem

The McMaster Evidence Brief: Supporting Chronic Pain Management across Provincial and Territorial Health Systems in Canada recommended the following options to better support people living with chronic pain:

  1. Create a model patient registry/ treatment-monitoring system in a single jurisdiction.
  2. Create a national network of centres with a coordinating “hub” to provide support for chronic pain-related matters.
  3. Broker and support a patient-centred and primary healthcare-based for chronic pain management. This model should be cross-payer and encompass all relevant disciplines.

Note: These three options are not mutually exclusive. They could all be pursued or elements from each could be targeted to create a fourth option.

References

Pain Definitions

Physiology of Pain

  1. Reference: Can Psychol_Soc Comm Mod.pdf
  2. Chapter 10 Psych Assessment_10-01-04.doc

Chronic Pain & Canada

  1. Supporting Chronic Pain_2009-12-09.pdf (McMaster Evidence Brief)
  2. Chronic Pain Report (Oct 28, 2010(?)

​Reviewed by Marc White PhD, Scientific & Executive Director, CIRPD (See Review Criteria)

Last Modified: 1/26/2016 3:55 PM

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