We deal with two kinds of chronic pain in clinic: primary and secondary. In both cases, pain has been present for at least three months. The difference between the two comes down to the cause. If your pain is a side effect of another chronic condition, like osteoarthritis, it is secondary. If the pain cannot be explained by another structure, it might be primary. Of course, this still means there’s a grey area- if you don’t have a diagnosis yet, does that technically mean your pain is primary?
The official definition of primary pain is:
Pain in 1 or more anatomic regions that persists or recurs for longer than 3 months and is associated with significant emotional distress or significant functional disability (interference with activities of daily life and participation in social roles) and that cannot be better explained by another chronic pain condition.PAIN, June 2015
Examples of primary pain conditions include:
To have conditions that cause primary pain might sound at odds with the definitions above. If arthritis causes secondary pain, why doesn’t fibromyalgia? The difference is that the primary pain conditions are functional. This means that although the symptoms are there, and usually quite universal between patients with the same condition, they can’t be diagnosed by biopsy, scan, or blood test. This is to say they are not structural, like arthritis is. It is not to say that your pain is not real.
The Many Factors in Chronic Pain
Pain is complicated and personal. By the age of 40, most people will have at least one bulging disc, but most people over 40 do not have lower back pain.
Some medications can make you more sensitive to pain, and there is an association between smoking and chronic pain. Poor or insufficient sleep is also linked to higher rates of pain.
Words can hurt too. Even finding something unexpected on the results of an MRI can lead to pain in that area. This is part of the reason why the NHS does not recommend routine imaging for simple back pain.
Stress and Pain
The definition of primary chronic pain referred to emotional distress. It doesn’t specify if it means distress is a cause or an effect, but we know that it can be either (or both). You can read more about the mechanical effects of stress on breathing, and how that can cause neck, shoulder, and abdominal pain here.
Looking more holistically than that, anxiety is interwoven with chronic pain. Stress can contribute to other factors that feed into pain, such as poor sleep. It can also hinder healing after an injury.
If you recognise the links between your pain and stress, try to tackle it from all angles. Talking therapies and medication can work really well alongside osteopathic treatment in chronic pain conditions. We may want to refer you back to your GP to help with this.
Chronic Secondary Pain
Chronic pain caused by constant structural irritation is quite different to primary pain. Secondary pain is divided into 6 categories. Among these are:
- Post surgical or post traumatic pain
- Musculoskeletal pain
- Neuropathic pain
These are causes that we might see in patients who present to us. Although the chronic pain will still be more complex than acute pain, it may be simpler to manage in some ways. For these patients, we look at both the pain science side of things, and the structural cause. If we can make progress with both, or either, the pain should soon become manageable.