Video and Transcript: Definition of Chronic Pain

Video Transcript: Hi everyone, Doctor Orit Hickman here from Pain Science Physical Therapy. And I just wanted to put together a really quick video to answer or try to address this question of “What is chronic pain?”.

The old definition of chronic pain used to be that if a patient or somebody has pain that's well beyond the time it takes for tissue to heal, then we would call it chronic.

So most tissue, actually all tissue, in the body has a certain amount of time that it takes for it to heal or as long as it'll heal as well as it's going to heal. If we take, you know, bones, for example, 3 to 6 months. Skin can be less than that depending on how big a cut it is, right? For some of you who had a paper cut or even a slice across the hand or somewhere else in the body, it can be a few weeks before it heals fully. If you have something more severe like you, like I mentioned, breaking a bone or if muscle tissue gets injured or damaged during something traumatic or traumatic event, it can take a lot longer for that to truly heal.

But again, with guidelines for tissue healing it's about three to six months.

So what we used to say was that if a patient has had pain that's lasted well beyond the time of three to six months or well beyond the time of normal tissue healing, then we now can say that those symptoms are chronic.

However it's a little bit more complicated than that. In fact, recent research has shown that because we know that pain is produced in the brain in response to some perceived threat or message that's coming from the body, that it more has to do with something that's happening in the brain and that there is a shift in terms of brain activity.

So they've done countless studies where they’ve looked at brain scans. And they've looked at how somebody's brain functions when they're at rest or when they're doing activity. And if somebody's brain is not dealing with chronic pain, it reacts differently, has lights up in different patterns than somebody who has chronic pain.

So, unfortunately, we don't have functional MRI machines hanging out on every block where we can diagnose somebody with chronic pain simply by sticking them in the MRI and scanning their brain.

So in the clinical setting, we look at a lot of different things. Definitely how long have the symptoms been around. That is, that is, one thing that we’ll look at if we're trying to determine if somebody's dealing with symptoms that have become chronic.

Obviously, if we’re talking about, you know, definitely more than six months, more than one year, more than two years, five years, the longer, longer, longer pain has been around, we can definitely give it the term chronic.

We also look at how do the symptoms behave? Are the symptoms constant? Do they have a flare-up to them? Does that mean, does that, you experience periods of time where your pain is a lot worse and then periods of time where your pain is a little bit more quiet?

We also look at how reactive your pain is. For example, we would expect that just moving, if someone comes in with shoulder pain, if we just move the arm up over head and back down again, if the shoulder doesn't have any obvious tissue injury, for example, the patients had an MRI all ready to rule out any kind of tears or any injury damaged in the shoulder. If the shoulder doesn't have any obvious tissue injury, moving the shoulder up overhead really shouldn't cause extreme pain. But, it might, and it might linger for several days, even sometimes several weeks after, making the patient move the arm. So that lets us know just how sensitive or reactive the system is.

So when we talk about chronic, it has, the term has a stigma associated with it. I'm going to tell you that in our clinical setting the patients who were coming in with chronic pain are maybe not what you would expect. Most of the patients that we're seeing are people that have been or continue to be very, very active - runners, cyclist, exercisers. These patients hold down full-time jobs. They can be heads of companies. They run families. They’re very, very busy and yet they live with chronic pain. How that impacts is completely unique.

So every patient has a unique experience when it comes to chronic pain. But these are not people that are addicted to pain medications. These are patients that are trying to live every life to the best that they can while still dealing with constant pain.

So I hope that helps. Certainly in your own personal understanding of a diagnosis that maybe you thought it was one thing and it's really something else. And I hope that it helps you understand if you have another family, if you have a family, member that's living with chronic symptoms to understand really what's that diagnosis when we look at it as clinical professionals, “What are we looking for?”

Thanks have a good one!

Related Web Pages to Link to