Chronic Pain Research and Support

Chronic pain is a debilitating medical issue for the millions of individuals throughout the Commonwealth of Nations and the United States. Many conditions can cause people to have to cope daily with chronic pain, with no end in sight. Each condition that causes chronic pain are researching treatments and ways to best manage the effects.

Chronic pain has two characteristics that are different than acute pain. First, chronic pain lasts longer than six months. Second, and most importantly, chronic pain is pain that occurs in addition to the pain of the original health condition. In fact, the original, underlying condition may or may not have healed. It doesn’t really matter. Chronic pain is pain that has become independent of the underlying injury or illness that started it all.

Once pain has become chronic, attempts to fix the underlying injury or illness that started it tend to fail to reduce pain. The mistake that patients and some healthcare providers make is to think that chronic pain is just a long-lasting version of acute pain. However, chronic pain is pain that has taken on a life of its own. Chronic pain is pain that is occurring over and above the pain of the underlying injury or illness that started it all. As such, attempts to cure the original health condition commonly miss the mark.

TSC has decided to concentrate our support in the area of chronic pain to two serious, though poorly understood, conditions. The first being Complex Regional Pain Syndrome (CRPS) and Fibromyalgia.

Our Chairman, Paul Borrow-Longain, was diagnosed with CRPS after an accident when he was 18.

Complex Regional Pain Syndrome (CRPS)

Complex regional pain syndrome (CRPS) is a form of chronic pain that usually affects an arm or a leg. CRPS typically develops after an injury, a surgery, a stroke or a heart attack. The pain is out of proportion to the severity of the initial injury.

Complex regional pain syndrome is uncommon, and its cause isn’t clearly understood. Treatment is most effective when started early. In such cases, improvement and even remission are possible.

The cause of complex regional pain syndrome isn’t completely understood. It’s thought to be caused by an injury to or an abnormality of the peripheral and central nervous systems. CRPS typically occurs as a result of a trauma or an injury.

Complex regional pain syndrome occurs in two types, with similar signs and symptoms, but different causes:

  • Type 1. Also known as reflex sympathetic dystrophy syndrome (RSD), this type occurs after an illness or injury that didn’t directly damage the nerves in your affected limb. About 90 percent of people with complex regional pain syndrome have type 1.
  • Type 2. Once referred to as causalgia, this type has similar symptoms to type 1. But type 2 complex regional pain syndrome follows a distinct nerve injury.

Many cases of complex regional pain syndrome occur after a forceful trauma to an arm or a leg. This can include a crushing injury, fracture or amputation.

Other major and minor traumas — such as surgery, heart attacks, infections and even sprained ankles — can also lead to complex regional pain syndrome.

It’s not well-understood why these injuries can trigger complex regional pain syndrome. Not everyone who has such an injury will go on to develop complex regional pain syndrome. It might be due to a dysfunctional interaction between your central and peripheral nervous systems and inappropriate inflammatory responses.

If complex regional pain syndrome isn’t diagnosed and treated early, the disease may progress to more-disabling signs and symptoms. These may include:

Tissue wasting (atrophy). Your skin, bones and muscles may begin to deteriorate and weaken if you avoid or have trouble moving an arm or a leg because of pain or stiffness.
Muscle tightening (contracture). You also may experience tightening of your muscles. This may lead to a condition in which your hand and fingers or your foot and toes contract into a fixed position.

Fibromyalgia

Fibromyalgia is a chronic condition of widespread pain and profound fatigue. The pain tends to be felt as diffuse aching or burning, often described as head to toe. It may be worse at some times than at others. It may also change location, usually becoming more severe in parts of the body that are used most.

The fatigue ranges from feeling tired, to the exhaustion of a flu-like illness. It may come and go and people can suddenly feel drained of all energy – as if someone just “pulled the plug”. Fibromyalgia Syndrome (fibromyalgia for short) is a common illness. In fact, it is as common as rheumatoid arthritis and can even be more painful. People with mild to moderate cases of fibromyalgia are usually able to live a normal life, given the appropriate treatment.

If symptoms are severe, however, people may not be able to hold down a paying job or enjoy much of a social life. The name fibromyalgia is made up from “fibro” for fibrous tissues such as tendons and ligaments; “my” indicating muscles; and “algia” meaning pain.

Fibromyalgia is not new, but for most of the last century it was difficult to diagnose. Part of the problem has been that the condition could not be identified in the standard laboratory tests or x-rays. Moreover, many of its signs and symptoms are found in other conditions as well – especially in chronic fatigue syndrome (CFS).

Two Canadian doctors developed a way of diagnosing fibromyalgia in the 1970s and in 1990 an international committee published requirements for diagnosis that are now widely accepted.

Once other medical conditions have been ruled out through tests and the patient’s history, diagnosis depends on two main symptoms:

  • widespread pain for more than three months together with 
  • pain in at least 11 out of 18 tender point sites when they are pressed.

“Widespread pain” means pain above and below the waist and on both sides of the body. The “tender points”, or spots of extreme tenderness, are rarely noticed by the patient until they are pressed.

Over the coming months TSC will be announcing relationships with chronic pain research and support charities and organisations within Commonwealth countries and the United States of America.

Links to useful resources will be added to our website as relationships are developed.

For more information on our commitment to chronic pain, please send your enquiries to: pain@tsccommonwealth.org