Chronic Pain Management
Understanding Chronic pain
Definition
In 2020, the IASP — International Association for the Study of Pain defined pain as ‘An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage,”
is the definition of pain by
The various components of pain
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Sensory: this corresponds to the physical characteristics of pain:
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its location (where does it hurt?)
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its quality (burning, pulling, stabbing, etc.)
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its intensity
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its evolution over time
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Emotional: this reflects the unpleasant nature of pain, which can be:
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more or less bearable
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distressing, agonising, even exhausting
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Pain: a subjective experience
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It is unique sensation and specific to each individual.
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Its perception depends on many factors: emotional, contextual, cultural or physiological.
This subjectivity often makes pain difficult to describe and communicate.
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Acute pain vs chronic pain
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Acute pain:
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It is brief and useful.
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Its role is to alert the body to danger (mechanical, chemical or thermal).
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Example: when you burn yourself, specialised nerve endings send an alarm signal to the brain to trigger a protective response.
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Chronic pain:
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This persists for more than three months.
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It loses its function as an alarm signal and becomes a disease in its own right.
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This is referred to as pain-disease.
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Examples: certain persistent muscle or joint pains, chronic migraines, neuropathic pain (lesion or hypersensitivity of the nervous system).
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The consequences of chronic pain
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It has physical and psychological repercussions.
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It can cause lasting changes to: the nervous system, posture, sleep, or even behaviour in response to pain (anticipation, avoidance, fear of movement).
Chronic pain characteristics
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Persistence over time: pain persists well beyond the expected healing time, often more than three to six months.
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Independence from initial stimulus: whereas acute pain is directly linked to an injury or illness, chronic pain may persist even after the initial cause has disappeared, or even without an identifiable cause.
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Emotional modulation: Chronic pain is often associated with mood disorders, such as depression, anxiety and feelings of hopelessness, which can aggravate pain perception.
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Central sensitization: Chronic pain is often linked to a phenomenon of central sensitization, where the nervous system becomes hyper-reactive, amplifying the response to normally innocuous stimuli (such as light touch).
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Functional impairment: Chronic pain sufferers may experience a reduction in their ability to function in daily life, with disruption of sleep, mobility, and social and professional activities.
Why pain becomes chronic ? What are the factors ?
Biological Factors
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​Nerve or neuropathic damage: Damage to the nervous system, as in neuropathic pain (e.g. diabetic neuropathy, postherpetic pain), can lead to persistent pain.
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Prolonged inflammation: Chronic inflammatory diseases, such as arthritis or fibromyalgia, can perpetuate pain due to the continuous activation of nociceptors (pain receptors) .
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Neuronal plasticity: lasting changes in pain processing at the level of neural circuits, such as hyperexcitability of spinal cord neurons or loss of natural inhibitory mechanisms, can maintain pain .
Psychological factors:
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Stress and anxiety: Chronic stress and anxiety are major factors in the transition to chronic pain.
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Depression: Depression is frequently associated with chronic pain, not only as a consequence, but also as an aggravating factor. It contributes to a heightened perception of pain and makes pain management more difficult.
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Catastrophism: A tendency to exaggerate the negative consequences of pain can reinforce sensitization pathways in the brain, thereby increasing perceived pain .
Social Factors
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​Social isolation: Lack of social support, whether at home or at work, can aggravate chronic pain by increasing stress and anxiety levels.​
Economic Factors
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Unemployment or financial problems can create a vicious circle where psychological stress and material difficulties reinforce pain and reduce opportunities for treatment or rehabilitation .
Behavioral factors
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​Physical inactivity: Physical deconditioning is common in patients with chronic pain. Prolonged inactivity can aggravate pain by reducing muscle strength, flexibility and endurance.
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Self-medication: Prolonged use of medications, such as opioids, without comprehensive pain management can lead to dependency and worsen pain through phenomena such as opioid-induced hyperalgesia.
Dr Charbel Kortbawi, osteopath and chronic pain specialist
Osteopathy in the management of chronic pain
Osteopathy plays an essential role in the management of chronic pain.
Using gentle, non-invasive manual techniques, it aims to restore the body's structural and functional balance.
Its objective is to reduce tension, improve mobility and promote natural recovery mechanisms.
Numerous scientific studies demonstrate the effectiveness of osteopathy in relieving chronic musculoskeletal disorders, such as:
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Chronic low back pain
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Neck pain
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Tension headaches
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Persistent joint pain
These approaches are safe, have no side effects, and contribute to a lasting improvement in patients' quality of life.
A comprehensive and personalised approach
Dr Charbel Kortbawi, osteopath in Paris 16 and Beirut, specialises in chronic pain management.
His approach is based on the latest scientific data and combines:
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Osteopathy
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Neuroscience
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Functional rehabilitation
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Therapeutic patient education: This involves actively engaging the patient in understanding and managing their pain.
Each treatment plan is tailored to the patient's profile.
The objectives are to:
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Restore joint mobility
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Reduce muscle tension
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Improve function and posture
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Strengthen autonomy in the face of pain