COMPLEX CHRONIC PAIN

As healthcare professionals, we have many patients who suffer from long term chronic pain.  Often they have other comorbidities, such as depression or anxiety.  There may be a history of childhood trauma, or a family history of addiction.They may have other health risk factors such as:  circulatory, respiratory, or gastrointestinal problems/risk factors.  Economic and social circumstances may be contributing to their stress and amplifying their pain. When we see multiple behavioral health issues, health risk factors, and other economic or social stress, we understand that pain is influenced by many other factors.  In this course, we refer to this as “complex chronic pain”

Successful treatment of Complex Chronic Pain requires a comprehensive understanding of the many ways patients may present and the many factors that contribute to the development of complex chronic pain.  This requires skillful interviewing about sensitive subjects such as childhood trauma and experiences, family and social supports and current economic and psychological stressors.

Clinical Presentation

Features that may support a diagnosis of complex chronic pain

• Central Pain Syndrome – Pain not caused by an injury or out of proportion to injury and pain spreading to new areas or vaguely located. Fibromyalgia is a common example.
• Pain exacerbated with any psychological distress – pain is amplified when patient is depressed or anxious.
• Fear of movement or activity – patient believes that movement will cause further harm.
• Pain catastrophizing – pain is central to their life experience and disproportionately impacts their life.
• Hyperalgesia – This is when pain is amplified; can occur with some medications or medical conditions.
• Allodynia – Pain with non-painful stimuli, such as leg pain from having sheets touching the skin.

Contributing factors

• Poor sleep
• Poor nutrition
• Decreased activity level
• History of childhood trauma or PTSD
• History of personal or family addiction
• Psychological comorbidities such as depression or anxiety
• Social isolation or lack of social support
• Chronic socio-economic stress like unemployment, homelessness, financial problems