What is Chronic Pain?
Newsflash!
Recently Health Canada has announced its intent to review all Vioxx-like pain drugs, including Celebrex®. According to Health Canada documents, this popular alternative to Vioxx® is suspected of causing at least 14 deaths and numerous heart and brain-related side effects. Meanwhile, on the other side of the pond...the European Medicines Evaluation Agency has ordered a safety review of four commonly-prescribed Cox-2 inhibitors, amid fears that, like Vioxx®, they could increase the risk of heart attacks and strokes.
The US Food and Drug Administration (FDA) has suggested that Vioxx® may have caused more than 27,700 heart attacks, of which 7,000 may have been fatal, in the four years it has been on the market.
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Arthritis, tendonitis, bursitis, injury, surgery...
Doctors divide pain into two primary categories: acute and chronic. Acute pain is the type of pain experienced when something is harming or about to harm your body. The pain experienced when you burn yourself with an iron, cut your finger open on a broken glass, or when your appendix is about to rupture are all examples of acute pain. This type of pain serves as a warning and is necessary to survival.
Acute pain is generally intense and short-lived and responds well to pain killers.
Chronic pain is another matter altogether. It can range in intensity from a dull, annoying ache, to intense, stabbing pain that happens every time you perform a physical task such as bending over or gripping a door handle. Unlike acute pain, chronic pain appears to serve no useful purpose.
THE CAUSES ARE MANY
A variety of health conditions can lead to chronic pain. The pain may have been caused by an initial mishap or more serious injury or condition, such as a back sprain or serious infection. The pain could also be caused by an ongoing condition such as arthritis and other degenerative joint diseases, digestive disorders, fibromyalgia or cancer.
Many people particularly the elderly suffer chronic pain in
the absence of any past injury or obvious damage to the body.
Common chronic pain complaints include headache, low back
pain, arthritis pain, neurogenic pain (pain resulting from
damage to the nerves), or psychogenic pain, a term used to
define pain that seems to have no apparent physical cause.
PAIN AND INFLAMMATION
Pain results when injury to tissues triggers the release of chemicals that give rise to an inflammatory reaction. This inflammation triggers electrical impulses to the brain, which are interpreted as pain.
The brain responds to intense and/or sudden pain signals
by producing substances called endorphins opiates that help
quell the pain. This is why an injury such as a stubbed toe
hurts briefly and does not continue to cause extreme discomfort
until the bruised tissues have healed. (When natural opiates
fail to quell acute pain, such as that following a tooth extraction,
painkilling drugs successfully suppress the brain's perception
of pain.)
In the case of chronic pain, the naturally-produced opiates
either fail to quell the pain, or are not generated in the
same way as they are by acute pain. Painkillers given for
acute pain are less helpful in alleviating chronic pain and
often are not safe for long-term use. It is therefore important
that the inflammatory process be addressed to prevent or reduce
the pain impulses sent to the brain.
In 1999 and 2001, Dr. Garret Fitzgerald, a University of Pennsylvania cardiologist, and his colleagues published a study suggesting that Cox-2 inhibitors spared the stomach at the expense of the heart. Suppressing both Cox enzymes, as older NSAIDs do, helps the heart, but blocking just Cox-2 raises the risk of high blood pressure, hardening of the arteries and clotting, Dr. Fitzgerald asserts.
THE NUMBERS
Almost three million Canadians (a little over 9% of the population),
have chronic pain or discomfort that affects some often most
of their activities. A further 3% (almost one million) experience
chronic pain or discomfort that does not generally affect
their daily tasks. It is estimated that three out of four
people will experience chronic pain at some time in their
lives. Arthritis and other degenerative joint conditions the
most common causes of chronic pain are on the increase as
the population ages.
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