Can Chronic Pain Be Prevented?

Our approach to pain management largely depends on what’s causing the pain. When it’s a byproduct of an ongoing health condition, our focus is finding a good pain management strategy to keep discomfort at a minimum. But when it’s rooted in an isolated event or injury, we can focus not only on treatment, but also the prevention of chronic pain. In situations like this, it’s worth asking – can we keep acute pain from becoming chronic?

The answer isn’t simple – pain is complex and unique to each individual – but there are some things that you can do to prevent pain from taking hold in the long-term. And, similar to other chronic diseases like diabetes and heart attacks, one of the keys to prevention is understanding the risk.

Certain events have been identified as being high risk for developing chronic pain:

• Surgeries: Though most all surgeries are painful, some are particularly associated with developing chronic pain: mastectomies, thoracotomies (opening up the chest), joint replacements, amputations, and spine surgeries like laminectomies and fusions. With each of these different types of surgeries, it is  common to experience persistent nerve pain related to the operation. There are ongoing studies looking for ways to block excessive nerve irritation during these surgeries, including starting anti-neuropathic pain medications, like pregabalin, gabapentin, and venlafaxine prior to the surgery. If you have a procedure scheduled, talk to your surgeon ahead of time to see if this would be appropriate for your situation.
• Acute trauma: Acute trauma, like motor vehicle accidents or fall injuries, carries an elevated risk of chronic pain. In my experience, there are usually multiple reasons for this, related to both physical and psychological factors. High-impact injuries from events like falling off of a ladder or getting rear-ended on the freeway cause significant jarring to joints, ligaments, tendons, and nerves of the body, causing a chain reaction that leaves the musculoskeletal system over-tensed and the nervous system over-activated in such an intense way that it may not let up. The emotional response to the injury only serves to further amplify this response. In my practice, behavioral health experts often work with patients to treat anxiety, and even PTSD, that is often associated with going through traumatic injuries. Reducing symptoms of distress early after an injury can play a key role in promoting a quicker recovery and diminishing the chances of progressing into chronic pain.
• Low back pain: Unlike other acute injuries, like a sprained ankle, where rest is a necessary part of the recovery process, low back injuries don’t heal as well with prolonged bed rest. Recovery is quicker when appropriate movements and a return to typical daily activities are started early on after a back injury.  For added guidance on safe exercises and activities, consider working with a movement specialist such as a physical therapist, chiropractor, or Pilates instructor until you feel comfortable doing things on your own.

Past studies suggest that belief patterns also play a role in the development of chronic pain. For example, catastrophizing, when we think the absolute worst about a given situation, can lead to feelings of anxiety, depression, fear, and hopelessness. Catastrophizing is a known risk factor for developing chronic pain, while feeling more optimistic seems to be associated with improvements in health and well-being. One theory on how chronic pain can develop is known as fear-avoidance, where pain or even the anticipation of pain creates so much fear about further injury, that a person starts to shut down and avoids certain movements. These behavioral changes brought on by high levels of fear are felt to increase the likelihood of developing more widespread and lasting pain. One way that I help my patients change unhealthy perceptions is by approaching things in a very slow and deliberate fashion. Each little accomplishment along the way builds confidence, and the more confidence that is built, the easier it is to wash away negative feelings like fear and anxiety that stand in the way of recovery.

With so many different factors contributing to chronic pain, our approach to prevention should be multidimensional – better education, the right medications, exercise and physical therapy, counseling, and even good nutrition. If you are experiencing acute pain, talk to your doctor about how you might leverage these tools to keep your pain from transitioning into a chronic problem.