Complex Chronic Pain

Complex Chronic Pain | Dr. Ali Ghahary

As of last year, one in five Canadians were said to be living with chronic pain. Chronic pain is characterized as pain that lasts for 3 months or longer, and when the patient does not find any relief with the usual treatment regimens. In many cases, chronic pain can also often be complex in nature and with unknown triggers, making it difficult to treat. As a result, chronic pain that is left untreated can also result in other health problems, such as high blood pressure and insomnia, and can even have an impact on mental health – leading to depression and anxiety.

Among one of the most common types of chronic pain disorders that people are diagnosed with is a condition known as fibromyalgia. Fibromyalgia is a painful condition that is characterized by having pain and tenderness (usually described as generalized soreness, aching, or even burning) throughout various areas of the body – although it is often felt in the muscles and tendons. Its exact cause is unknown, though it’s not uncommon for it to show up following something like a motor vehicle accident or other traumatic injury, or the result of a viral infection.

Patients with fibromyalgia will usually have a certain degree of pain on an almost daily occurrence, although there are also times where it may be more intense than other days. There may also be certain things that trigger a fibromyalgia flare, such as stress, or even changes in the weather. Because fibromyalgia can be debilitating, it can also have an effect on one’s ability to carry out their day to day activities, such as going to work, school, or their ability to socialize with friends and family, can result in memory problems (sometimes referred to as “brain fog.”) Fibromyalgia also often coincides with depression and anxiety by as much as 30% of cases, and those individuals may also have an increased sensitivity to pain.

In order to diagnose fibromyalgia, physicians will try to rule out any other potential causes of the patient’s pain by sending them for complete blood workups, or certain medical imaging tests. In some cases, this process can take several months or years. In cases where testing returns as being normal, then a diagnosis of fibromyalgia will be considered. Once the diagnosis has been rendered, then the treatment plan can begin. As fibromyalgia and other types of chronic pain aren’t often relieved with over-the-counter medications such as acetaminophen or ibuprofen, other lines of treatment, such as anti-epileptics or anti-depressants are often prescribed. These medications are known to help reduce pain, but also have other benefits such as relieving anxiety and improving sleep. That being said, it may take several weeks before the medication itself kicks in and one notices any improvement.

Headaches and migraines are another type of complex chronic pain, though also very common and frequently diagnosed in people of all ages – children and adults. When one has a complex migraine, it often comes with attacks of prolonged aura (i.e. disturbances such as flashes of light, or blind spots), which can last for many hours or even last several days at a time, in addition to persisting/prolonged pain. Like fibromyalgia, the same types of medications are often used to treat chronic migraines. However, it’s also important to rule out any potential problems that could be contributing to the patient’s headaches and migraines, such as hormonal changes, vision problems, – or even brain tumours.

If you are suffering from chronic pain, it’s recommended that you keep a chronic pain journal so that you can document your level of pain, any known triggers, anything you find beneficial, as well as to help keep track of your medications. This will also help your team of doctors in finding the right treatment plan, or adjusting your treatment plan when necessary.