Future Prospects for Patients with a History of Chronic Pain
Pain is defined as chronic when it lasts for more than three months. At this point, it stops being just a symptom and becomes a condition in its own right, although it is also associated with many other diseases, such as cancer, arthritis, back pain, complex regional pain syndrome and fibromyalgia. The condition is relatively common and affects between 12% and 30% of adults at any one time. Most cases of chronic pain improve over time and some completely resolve. However, the time scale over which this might happen is unpredictable so determining an accurate prognosis is difficult. Furthermore, in a proportion of patients, symptoms persist for many years. This can have a significant impact on the patient’s ability to perform daily tasks and hold down a job, to the detriment of their overall quality of life. Unfortunately, predicting which patients will recover and which will not remains a major challenge.
Chronic pain is frequently underdiagnosed and undertreated, meaning that many patients suffer, sometimes for years. Disability is also common. Furthermore, there is a lack of effective treatments for chronic pain, partly because the term covers a wide range of disorders, with different aetiologies and with a different patient experience. It is therefore difficult to follow a ‘one size fits all’ approach, as the treatment offered may depend on the type of pain, the cause of the pain if it is known, and the patient’s age and overall health status. Many patients try numerous different pain treatments, most of which provide short-term benefits at best. Not surprisingly, advice on the most appropriate techniques for coping with chronic pain is a priority for patients. Early diagnosis and referral to specialists if necessary is therefore very important. Treatments may include medication, therapies and lifestyle changes.
The medications most commonly used to treat chronic pain are non-steroidal anti-inflammatory drugs and opioids, although many other classes of drug can also be used. Additionally, treatments such as transcutaneous electrical nerve stimulation, nerve blocks and epidural steroid injections may provide some relief. As with any treatment, there is always the potential for complications to occur. The use of opioids is particularly controversial as they can be addictive and many people also build up a tolerance to them over time, leading to the risk of overdose.
Other therapies used in the management of chronic pain include cognitive behavioural therapy, which teaches the patient to think differently about their pain and to adopt coping strategies, occupational therapy, which shows the patient how to carry out everyday tasks in a way that lessens the pain, and physiotherapy. Many alternative treatments, such as acupuncture and hypnotherapy, are also available, although their success rate is questionable. Lifestyle changes include dietary improvement, regular gentle exercise and adequate sleep. The last two, along with techniques such as meditation and breathing exercises, can also help reduce stress, which is often an important contributor to the experience of pain.
As well as pain, patients often report other symptoms, such as depression and anxiety, problems sleeping, fatigue, decreased cognitive function and an overall impact on their quality of life. Therefore, patients presenting with chronic pain need a detailed assessment so that a suitable course of treatment can be planned. Often, an interdisciplinary approach is required, so that all of the different components of the patient’s experience can be targeted. In most cases, the management of chronic pain requires a lot of input from health professionals. Care is usually needed on a long-term basis and should include frequent reassessments of the patient, so that changes in their condition can be monitored and treatment altered to reflect this. It is common for patients to experience periods where their symptoms are better or worse.
There are many similarities between living with chronic pain and any other chronic illness, and the two often occur together. Chronic pain not only affects the life of the patient, but can also severely impact their family members. Many families experience a significant drop in income. Not only is the patient unable to work, but often another family member, particularly their partner, is forced to give up their job and take on the role of carer. There is also a considerable emotional burden. Many family members report feeling emotionally distressed, powerless and isolated, and these feelings can affect their relationship with the affected person. There can be a feeling of grief for the loss of former roles and experiences within the family and frustration at the new roles that have been forced upon them. In many cases, these changes continue as the patient’s condition progresses, and the constant shifts in responsibilities can be difficult to cope with. However, the outlook is not entirely negative, as some families manage to survive the experience and even report that it has strengthened their relationships.
While chronic pain does not kill patients, it can severely affect the way they live. Furthermore, complete resolution of symptoms is unusual, although many cases do improve over time. Patients are likely to require a multidisciplinary approach to care, which may be needed for many years, although the course of the disease is unpredictable in many cases. There will also be a considerable impact on family members. In order to reach a fair settlement during litigation, it is important that all of these factors are taken into account when assessing a compensation claim arising from a chronic pain condition.
Ashburn, M. A., & Staats, P. S. (1999). Management of chronic pain. Lancet (London, England), 353(9167), 1865–1869. https://doi.org/10.1016/S0140-6736(99)04088-X
West, C., Usher, K., Foster, K., & Stewart, L. (2012). Chronic pain and the family: the experience of the partners of people living with chronic pain. Journal of clinical nursing, 21(23-24), 3352–3360. https://doi.org/10.1111/j.1365-2702.2012.04215.x