Some people have pain caused by injury, illness or rheumatic conditions but it does not become chronic. Pain is often called chronic when it persists for months (at least 3) or years, is typically more severe than expected and interferes significantly with physical and emotional wellbeing. Underlying chronic pain are changes in nervous system functioning which specialised clinicians can identify by skilled sensory testing.
The following conditions commonly contribute to chronicity and severity of your painful arthritis or musculoskeletal disorder. These are potentially relevant whether they have commenced before or after the onset of your painful rheumatic condition. Many of us have inherent resilience factors which can reduce the risk of chronicity.
If you think you are at risk of your chronic pain being influenced by any of these conditions, you might consider completing the related questionnaires (linked below) and passing the responses on to your GP, specialist and/or psychologist.
- Adversity, especially in childhood, includes premature birth, neglect, abuse (verbal, physical or sexual), prolonged illness or hospitalisation, parental illness, poverty, bullying at school. The link is for adults. There is also one for adolescents and children.: Questionnaire
- Multisensory sensitivity is increasingly recognised as important in pain severity and vulnerability. Abnormally high sensitivity to sensations collectively, including touch, smell, taste, hot or cold, light and sound, are measured by various questionnaires including the new and well tested Multisensory Amplification Scale Multisensory sensitivity is a trait and thus heritable, also adversely influenced by past or present iron deficiency and by post-traumatic stress: Questionnaire
- Impaired sleep can be caused by and/or aggravated by chronic pain. In turn, poor sleep worsens the pain experience. The Insomnia Severity Index or the Sleep Condition Indicator are useful brief questionnaires. Restless legs syndrome is relatively common in association with chronic pain and further impairs sleep and should be checked if you answer positively to this question: “When you try to relax in the evening or sleep at night, do you ever have unpleasant, restless feelings in your legs that can be relieved by walking or movement?”: Questionnaire
- Stress, anxiety and depression are each caused by and potentially worsen chronic pain. The Depression Anxiety and Stress Scale 21 (DASS 21) is a widely used and validated questionnaire. High stress may raise the question of post-traumatic stress.: Questionnaire
- Post-traumatic stress should be considered if high stress levels have followed a psychological or physical traumatic event or events. The PTSD Checklist for DSM-5 (PCL-5) is a highly valid and clinically useful self-report tool for screening and monitoring symptoms in adults.: Questionnaire
- Catastrophising about pain, worrying about bad consequences of pain and the underlying reasons for it, are common aggravating factors. The often applied Pain Catastrophising Scale can be accessed by this link: Questionnaire
- Fear of movement is commonly assessed by the Fear Avoidance Beliefs Questionnaire (link below), also by the Tampa Scale of Kinesiophobia. Fear of movement and activity generally is a well researched aggravating influence in chronic pain: Questionnaire
Other considerations which may worsen the pain experience include
- A history of iron deficiency, even if treated
- Sedentary lifestyle and being overweight
Attending to these causal or aggravating influences is at least as important as medicinal treatment of chronic pain.
Written by:
A/Professor G David Champion AM MB BS FRACP FFPMANZCA
