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Oxford University Hospitals NHS Foundation Trust
OxPARC

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Chronic pain

Chronic (long term) pain is a debilitating condition in which overwhelming pain signals affect everyday function and quality of life. It may have an underlying cause such as trauma, wear and tear, infection, inflammation or abnormal cell growth. However, by far the majority of young people with long term pain do not have such an underlying condition. They have a pain syndrome in which the pain pathway itself is at fault.

Chronic pain alone affects 8% of young people aged 13 to 18 years and 10% of adults. Younger children can also be affected. There is often an identifiable onset to the pain. Persistence of the pain is complex and due to a combination of factors.

Many young people find their own way to manage chronic pain until it disappears. Others benefit from the support of their GP, local physiotherapist and alternative therapies (such as osteopathy and herbalism). However some young people have pain that continues despite these strategies to disrupt schooling, family life and social contact and require support from specialist services.

What forms of chronic pain are there?

Aside from illnesses such as arthritis and infection, there are many conditions in which pain is the only or major symptom (fatigue and stiffness may also feature). These pain syndromes overlap in many ways and are grouped by the type of management they require.

Why does chronic pain occur?

Just like any other part of the body (kidneys, lungs, skin) the pain system can go wrong and act in a way that is not protective. It can send messages that do not signal tissue damage or inflammation.

Pain may persist because of problems anywhere along the complex pain pathway - in nerves, the spinal cord or in the brain. Disruption may also occur with any of the feedback pathways or other normal coping mechanisms of the body.

What does chronic pain do to us?

All pain triggers the body's protective mechanisms whether tissue damage is present or not. And instinctively we worry about unknown harm and act to protect ourselves physically and emotionally. This causes confusion and makes things worse.

A vicious cycle may occur to promote more pain:

  • Pain causes us to rest or avoid specific movements resulting in stiffness, weakness and reduced stamina
  • Activity including school and social contact are missed which causes loss of confidence and self esteem
  • Tablets may cause side effects
  • Sleep may be affected
  • A low mood and frustration exacerbates the pain and further withdrawal from activity occurs

How is chronic pain managed?

There is much that can be done to get a young person back to doing what they need to and what they enjoy.

We cannot treat the pain directly, because it is the pain system itself at fault, but it is possible to refocus attention to stopping the vicious cycle and improve quality of life.

By normalising life and activity, the pain system is retrained and eventually the pain disappears.

See treatment of chronic pain for more about these principles.