FAQ

“Chronic pain” is a generally defined as constant or intermittent pain that persists for longer than three to six months after initial onset.  It extends well beyond the normal time expected for healing of tissue, and is distinct from what we call “acute pain” in that it is no longer behaving like the defensive warning system that helps to protect our bodies from harm.  In fact, in chronic pain patients, changes to the structure, chemistry and function of their nervous systems at the cellular level cause the ‘symptom’ of pain to evolve into a disease in its own right.

In the early stages it may not be easy to make this distinction.  However, over time clear patterns emerge that are common to most patients with chronic pain:

• Pain persists for longer than 3-6 months, or longer than the predicted time for tissue healing after injury
• Pain is often disproportionate to an initial triggering event (injury, trauma) in both scope and duration, or may not have an obvious triggering event at all
• Pain is felt in a part of the body unrelated to an initial triggering event
• The pain does not respond very well to over-the-counter pain medications
• The pain may be felt with a combination of sensations, including numbness, tingling, burning, and ‘pins and needles’
• Visible changes may also occur, such as swelling or colour changes in an affected limb
• The pain may be intermittent or constant; it may be associated with certain movements or activities, or may be completely unpredictable.  This is in contrast to an episode of acute pain, which is generally constant and predictable, but generally lessens over time from the initial triggering event.

Studies from around the world demonstrate that approximately 20% of the general population suffers from chronic pain.  A Canadian pain study (2002/2003) found that chronic pain occurs in between 17% to 35% of Canadians, with rising incidence as our population ages.

Chronic pain is considered a ‘biopsychosocial’ illness with a complex mix of biological, genetic, psychological and social factors all contributing to its make-up.  A genetically vulnerable individual with certain psychological traits who suffers a particular physical injury may be more likely to enter the ‘chronic pain spiral.’  However, we still cannot predict with any certainty which patient with acute pain will go on to become part of the 20 – 30% that research shows will develop chronic pain.

It can.  In some types of chronic pain (i.e. neuropathic pain) the chemical and physical rewiring of the central nervous system can result in commonplace contacts (such as pricking with a pin or brushing the skin with a soft brush) to be experienced as very painful by the patient.

True “psychogenic” pain is quite rare and requires a very experienced pain psychiatrist to diagnose.  Much more frequently, there are psychological factors that complicate or exacerbate the experience of the patient with most chronic illnesses – including chronic pain.  Therefore, part of the assessment and treatment of patients with chronic pain often involves addressing psychological factors (i.e. pain-related fear or avoidance behaviours). 

However, while it is clear that psychological factors contribute to the experience of chronic pain, it is a mistake to confuse them with the cause of the diagnosis.  Chronic pain is real, and scientific evidence clearly exists to show it is not simply a figment of the patients’ minds.

Understanding about chronic pain is still evolving in Canadian society, and more to the point, within our healthcare community.  Medical training even today does not sufficiently equip most healthcare professionals to truly understand chronic pain as a multidimensional problem with no single root cause.  While much more is now known about chronic pain from scientific, clinical, and societal perspectives, there is a clear lack of broad transmission of this knowledge.  This is why CPM is supporting initiatives to increase education and awareness about chronic pain among medical professionals, patients, and the general public at risk for developing chronic pain.

No.  Addiction is a complex “biopsychosocial” process, including significant psychological and behavioral factors, as well as genetic and environmental ones.  In true addiction, affected individuals begin to use drugs in a manner that has negative impacts on their lives, rather than medically beneficial ones.  Addiction is characterized by the “4Cs”:

• Loss of Control;
• Compulsive use;
• Craving; and,
• Consequences, (or use despite harm).

Addiction is thought to occur in patients with chronic pain in the same proportion as the general population (approximately 7-10%).  Consequently, while it’s true that a patient with risk factors for addiction could develop addictive behaviors when prescribed an opioid medication for pain, it’s also true that someone with no risk factors is very unlikely to develop addiction to prescribed opioids even in high doses. This is why it is so important for physicians to proactively do addiction risk screening as part of the comprehensive assessment process of chronic pain patients.

         Addiction is often mistakenly confused with “physical dependence”, which is the process where the body begins to adapt to the regular use of a specific medication – this adaptation is termed as developing ‘tolerance’ to the drug.  This is a physiological process, and is not the same as addiction. 

However, in order to safely discontinue a drug upon which a patient has developed a physical dependence (and avoid the physiological response of ‘withdrawal’), the dose must be gradually reduced or ‘weaned’ from use over a period of time.   Once this weaning process is completed, the patient does not display drug-seeking behavioursor the ill effects associated with addiction.

Chronic pain has been called a “silent epidemic” by a leading expert in the field. The National Health Population Survey 1996-1997 estimated that chronic pain costs the economy approximately $14,744 per affected person per year.  However, this fails to consider the greater cost (in lost wages, productivity, social welfare costs, and quality of life) of those patients who receive no treatment or inadequate treatment.

         The International Association for the Study of Pain (IASP) estimates the true social cost of chronic pain to be equivalent to that of cancer or cardiovascular disease. This is supported by additional international research which showed, for example, that in Denmark chronic pain patients lost twice as many work days and were 7 times more likely to quit their job for health reasons than the general population.  They also had twice as much contact with health care professionals and made 25% more use of healthcare resources.

         A recent U.S. study calculated that painful conditions cost the U.S. economy an estimated $60 billion per year in health care costs and lost productivity.  An application of the generally accepted “10%” rule would translate this to an approximate $6 billion annual cost to the Canadian economy.  As our population ages and the incidence of chronic pain in  the general population rises as projected, the costs will increase dramatically.

Moulin, Clark, Speechley, Morley-Forster, “Chronic Pain in Canada”, Pain and Research Management 2002

International Association for the Study of Pain, Breivik H, Ventafridda V., Collett B., The Pain in Europe Survey, detailed results and analysis, Euro J Pain 2004