Neurologically, pain is the body’s alarm system for harm – it signals that something is wrong, whether internally or externally. But like many other systems, our body’s pain receptors can malfunction, eliciting signals where none should be, or repeating the same signals over and over. “Normal” pain is a reaction, acute and short-term, lasting no longer than a few hours, days, or weeks, teaching us to avoid certain stimuli and actions as our body heals.
But when pain lasts 3 to 6 months, it may be diagnosed as chronic pain. This can not only affect morale but leaves a lasting impact on our emotional and physical health. About a quarter of patients diagnosed with chronic pain also struggle with symptoms beyond pain, collectively described as chronic pain syndrome.
What Is Chronic Pain Syndrome (CPS)?
Syndromes are a connected collection of symptoms rather than diseases with a central cause. CPS is characterized by chronic pain symptoms coupled with debilitating depression, anxiety, loss of endurance, and more. A patient diagnosed with chronic pain syndrome is experiencing more than just pain over the course of several months or years and may require treatment for a collection of mental and physical symptoms rather than a treatment plan focusing exclusively on pain management.
The main characteristic of chronic pain syndrome is the need for a mix of treatments to address the results of the long-term pain. Chronic pain syndrome has no single cause but is usually the result of many typical causes of chronic pain and regular stressors, maladaptive or harmful coping mechanisms, repeated injuries, physical and emotional trauma, and more.
CPS Signs and Symptoms
Signs of chronic pain syndrome vary from individual to individual, with the chief characteristic being diagnosed chronic pain alongside other disruptive symptoms. These can include:
- Loss of libido
- Suicidal thinking
- Substance abuse
- Relationship issues
- Loss of interest in hobbies
- Severe changes in appetite
- Constant mental and physical fatigue
- Trouble concentrating or performing at work or home
- Anxiety (panic attacks, unwarranted spikes in heart rate, constant irrational worries)
- Job loss
Perhaps the most common symptom coupled with chronic pain is depression. Depression is a long-term consistently low mood, separate from healthy reactive sadness, in the sense that it is often pervasive and perpetuating, with thoughts and emotions that highlight negativity and downplay joy.
Depression increases pain sensitivity and can be made worse by chronic pain – creating a difficult and vicious cycle. Treating pain will not always necessarily relieve depression. This is one instance where a multimodal approach might be necessary to tackle multiple debilitating symptoms.
Chronic pain conditions can cause chronic pain syndromes. These conditions (and causes) can include:
- Joint pain
- Multiple surgeries
- Repeated stress injuries
- Neuropathy (nerve damage)
- Inflammatory bowel disease (IBD)
- Osteoporosis and repeated fractures
- Rheumatoid arthritis (RA) and other auto-immune conditions
Neuropathy can be caused by physical trauma, Lyme disease, poisoning, repeated injuries, infections, shingles, medication, and more. Certain risk factors also affect the chances of a chronic pain diagnosis leading to chronic pain syndrome. Experts believe that the roots behind chronic pain syndrome are both physical and mental.
Those who are more susceptible to a cascade of psychiatric and medical changes following neuropathy or other causes of chronic pain may develop multiple symptoms requiring a longer and more complicated treatment process, rather than pain management focused solely on the original cause of the chronic pain.
Who Is Most Likely to Struggle With CPS?
Risk factors describe certain characteristics that are more likely to be associated with a condition. The risk factors associated with chronic pain syndrome include:
- Medical and family history: a history of chronic pain and/or depression seems too often to predict chronic pain syndrome. Depression and its many forms can be hereditary. Thus patients with a family history of mood disorders may be more susceptible to chronic pain syndrome after an injury or condition causing long-term pain. Depression’s ability to prolong and deepen pain through low mood and heightened pain perception may also play a role.
- Smoking cigarettes: Statistically, smokers seem more likely to develop chronic pain syndrome than non-smokers, particularly when the pain is tied to fibromyalgia or arthritis.
- Obesity: the links between chronic pain syndrome and obesity may be related to the physical stress of added weight (on the joints), fluctuations in hormones and mood caused by rapid weight gain, and the complex interactions between psychological health and metabolic diseases associated with obesity.
- Age: chronic pain conditions are generally more common among the elderly, including chronic pain syndrome.
- Sex: Women are more susceptible to chronic pain syndrome. Different theories include hormonal differences and women generally having a greater number and density of certain nerve fibers than men (which may heighten the perception of pain).
These risk factors do not predicate chronic pain syndrome but seem to contribute to it or make it more likely.
Chronic Pain Syndrome and Fibromyalgia
CPS and fibromyalgia are not the same things, though they can and often do co-occur. Whereas chronic pain syndrome is chronic pain coexisting with other symptoms that require a tailored treatment plan, fibromyalgia is a specific nervous system disorder that causes severe muscle and joint pain with accompanying psychological symptoms, often without a specific trigger or known cause.
Fibromyalgia is not always chronic. It is often accompanied by mood changes and irritability because of widespread pain and increased sensitivity and may cause chronic pain syndrome. Still, the two are set apart by how fibromyalgia is one disease with a single, albeit unknown cause presumably within the central nervous system. Chronic pain syndrome describes a collection of similar symptoms with several different causes.
Treating Chronic Pain Syndrome
Treatments for CPS differ based on the nature of the pain and accompanying symptoms. Common treatments include:
- Non-opioid pain management
- SSRIs and other antidepressants
- Non-invasive surgical interventions in severe cases
- Pain medication (where applicable) and talk therapy
- Bone density medication for osteoporosis and accompanying fractures
- And substance abuse treatment (inpatient/residential treatment plans, or outpatient treatments)
- Nerve blocks
If you or a loved one struggles with chronic pain and worsening mood or mental health symptoms, you may need more than pain management by your side. Seek help from CLS Health pain management specialist Dr. Moustafa Ahmed today.