Chronic Pain Q&A: How to Spot the Differences Between Syndrome and Symptoms
What are the first things that come to mind when you hear the phrase “chronic pain”? Maybe you think of someone you know who has been in pain for years with no clear cause. Maybe you even think of your own health conditions. Perhaps you think of over-the-counter medications, pain management, or pain signals. You may think of mental health or opioid medications.
Understanding the syndrome vs. the symptom of chronic pain
To better understand chronic pain, we spoke with Dr. Jacob Hascalovici, MD, PhD, a neurologist and interventional pain specialist and the Chief Medical Officer at Clearing, who explained the differences between chronic pain “the syndrome” and chronic pain “the symptom,” and why it’s critical to treat both.
For starters, chronic pain is an extremely prevalent, highly disabling disease affecting between 50 to 100 million people nationwide. This condition has arguably emerged as a major catalyst of the global opioid crisis.
The Cleveland Clinic defines chronic pain symptoms as:
- Pain that is ongoing for three to six months (or more)
- Pain that continues even after an injury or illness appears to have healed
- Pain signals that are present even without an apparent direct cause
- Pain that is linked to conditions such as chronic headache, arthritis, nerve pain or fibromyalgia
Chronic pain symptoms can escalate to become chronic pain syndrome, especially if treatment options aren’t effectively managing your pain.
So what is chronic pain syndrome?
You may not have even heard of chronic pain defined as a syndrome before. Chronic pain syndrome is a condition in which the symptom of chronic pain becomes intertwined with other symptoms, such as depression and anxiety. Chronic pain syndrome, in other words, is when symptoms besides chronic pain appear and start to have a significant impact on someone's life.
Chronic pain syndrome can vary in how it impacts each individual person. Some common symptoms of chronic pain syndrome include:
- Feelings of stress and helplessness
- Clinical anxiety
- Intrusive thoughts
- Clinically diagnosed depression
- Persistent feelings of isolation and hopelessness
Clearing: What is the difference between a symptom and a syndrome?
Dr. Hascalovici: To begin understanding chronic pain, it’s important to draw distinctions between chronic pain the disease symptom and chronic pain the syndrome. There can be some confusion.
Broadly speaking, a disease usually has a defining cause, distinguishing symptoms and treatments.
A syndrome, on the other hand, is a group of symptoms that might not always have a definite cause.
Let’s start with a few definitions from Webster’s Dictionary.
- A disease is a condition of living plants and animals that impairs normal functioning and typically manifests distinguishing signs and symptoms.
- Symptoms are any subjective evidence of disease and broadly as something that indicates the presence of bodily disorder.
- A syndrome is an abnormal bundle of symptoms occurring together that usually form an identifiable pattern.
Clearing: How can you tell if your chronic pain is a symptom or a syndrome?
Dr. Hascalovici: Chronic pain as a symptom is your body's normal reaction to an injury or illness; it’s a warning that something is wrong. When your body heals, you usually stop hurting. The symptom is the physical subjective experience of the pain itself. The ‘it hurts,’ ‘it pains’ and ‘this ails.’
Doctors call the time period you have spent experiencing the symptom the ‘chronicity.’ Most medical experts define pain with a chronicity greater than three months as ‘chronic.’
Chronic pain syndrome extends beyond the warning sign that something is wrong. It's when the symptoms last for months, or even years, after the body heals and can occur without an identifiable trigger. It’s when the symptom starts affecting both your physical and mental health and is associated with depression, anxiety, social isolation and interference with daily activities.
These mental health symptoms are connected to the primary symptom of your pain. When you have chronic pain syndrome, your pain becomes the center of attention and the determining factor regarding your disabilities and abilities.
How is mental health part of chronic pain?
Clearing: Can having a mental health condition make chronic pain symptoms worse?
Dr. Hascalovici: We know two truths about pain as a symptom. First, this pain can affect your mental health. Second, mental health issues can amplify your pain perception.
The environment can affect physiological changes in the body. Think back to the last scary movie you were watching or the last time you felt frightened. What made your heart start racing, your hands shaky and your palms sweaty? An external stimulus caused a chemical change in your body. In this case, the physiological manifestation was your racing heart, shaky and sweaty hands.
I've treated countless patients with chronic pain who suffer from concurrent behavioral health problems. In fact, chronic pain sufferers are three times more likely to develop depression and anxiety and two times more likely to commit suicide compared to non chronic pain suffers.
The biopsychosocial model of chronic pain, proposed by George Engel, stresses the importance of recognizing and treating chronic pain beyond the biomedical. It’s a good idea for patients have chronic pain to be screened for depression and anxiety, or at least referred to the appropriate providers. Interestingly, some of the most effective medications for certain chronic pain syndromes are antidepressants, which help treat depression, and anxiolytics, which help treat anxiety.
Clearing: Do chronic pain “symptoms” cause the mental and emotional characteristics of chronic pain “the syndrome,” or is it the other way around?
Dr. Hascalovici: For doctors working to treat chronic pain (and the patients who live with these health conditions), this question becomes a sort of chicken vs. egg scenario. Did the symptom give rise to the mental and emotional characteristics of the syndrome, or did the mental and emotional characteristics of the syndrome give rise to pain the symptom?
A hyphenated variation of the word disease is dis-ease and is a term utilized by lifestyle medicine practitioners and wellness coaches/communities to encourage and place emphasis on the natural state of ‘ease.’
This distinction between disease and dis-ease is particularly meaningful as it relates to pain as a symptom, chronic pain as the syndrome and pain relief as a whole. When mental health conditions are giving rise to symptoms of pain, treating those conditions becomes the primary target of our symptom management strategy. However, in cases where pain symptoms predate mental health symptoms, it’s critical to prioritize the biological issues first.
‘Disease’ suggests negativity and demise, whereas ‘dis-ease’ suggests balance and equilibrium that can be restored. Our thoughts shape the way we feel and experience reality. That’s why our thoughts influence the way we experience chronic pain.
By understanding the nature of chronic pain, we can appreciate the need for a major paradigm shift in the way we view the symptoms and treat the syndrome. Chronic pain syndrome is a state of dis-ease rather than disease. This is where the pain relief journey should begin.
How should chronic pain symptoms and syndrome be treated?
Clearing: Is it more important to treat the symptoms or the syndrome?
Dr. Hascalovici: Chronic pain symptoms and chronic pain syndrome both need to be treated, although methods of treatment may vary.
If you have chronic back pain from an old muscle strain or arthritis, the treatment may be a bit more straightforward. Prescription-strength topicals, home exercise, physical therapy and a nutraceutical to help support bone, joint and nerve health may be all it takes to manage your symptoms.
Once your pain symptoms are being treated, you may find that you’re able to enjoy some old activities again. From a strictly physical perspective, treating chronic pain symptoms means you will be able to keep up with the daily rhythms of your life more easily.
However, if your chronic back pain has escalated to the point where you have chronic pain syndrome, it won’t be enough to simply treat and manage pain. Restoring movement and managing discomfort will have a life-changing impact, but those factors alone won’t resolve the longer-term impact that chronic pain has had on your mental health and social experiences.
For example, maybe you used to enjoy ballroom dancing with your partner, but you stopped going to social dances because your chronic pain made it impossible. That means you lost a critical aspect of your social life, and maybe even a friend. Treating the pain might mean that you can dance again from a medical standpoint, but it doesn’t mean you won’t feel anxious about going out dancing, or that you’ll even want to go out and give it another try.
That’s why treating chronic pain as a syndrome typically means seeking help from care providers from other disciplines, such as mental health counselors or social workers. In severe cases a psychiatrist who can prescribe medication may also be needed. Once your care is being managed by a team of professionals who are on your side, only then can we confidently say that we are treating chronic pain the 'syndrome.’
Clearing: How does Clearing help treat chronic pain?
Dr. Hascalovici: Clearing is the first digital healthcare platform that brings chronic pain relief to the millions of Americans who need it most. For too long, finding relief from chronic pain has been frustrating and impersonal. That’s why I started Clearing. My hope is that everyone can access America’s leading pain relief clinicians and affordable, personalized and opioid-free care, all from the comfort of your home.
At Clearing, we’re here to bring you custom chronic pain relief for your kind of pain. Depending on your situation, this could include a personalized exercise program, custom compounded pain cream, CBD cream, nutraceuticals, health coaching and access to leading pain specialists.
Dr. Jacob Hascalovici MD, PhD is a neuroscientist and neurologist specializing in chronic pain management, and the Co-founder and Chief Medical Officer at Clearing.
This article is for informational purposes only and does not constitute professional medical advice. Always seek the advice of your healthcare professional with any questions or concerns you may have regarding your individual needs and medical conditions.