A new patient arrives at the healthcare facility where you work. During triage, you ask him if he’s experiencing any pain. He mentions that he’s been experiencing pain in his hands and feet. He’s hoping to get medication to help address the pain, especially since it’s affecting his day-to-day activities and the way he performs his job as a teacher.
As the triage progresses, he informs you that he’s diabetic. You ask him to describe the pain he’s experiencing, and he says that it’s shooting pains, almost like he’s being subjected to sharp, electric shocks. You ask him when he started experiencing these painful sensations, and he says that it started a few months ago.
As a nurse, you understand how crucial it is to conduct assessments that help patients get the care they need to live as healthy and pain-free as possible. Millions of people globally seek medical help for pain every year, and, in the US alone, around 50 million people are living with chronic pain according to the Centers for Disease Control and Prevention (CDC). Unfortunately, people living with chronic pain tend to endure long wait times before they get seen by an expert. A 2024 study found that 53% of adults and 82% of children based in Ontario, Manitoba, and Quebec, Canada, waited longer than a year before they were seen by a pain care specialist for their chronic pain symptoms.
With effective triage, nurses can quickly flag chronic pain signs and symptoms, match patients to the right level of care they need, and help provide patients with the resources and support necessary to manage chronic pain symptoms. In this article, we tackle chronic pain in primary care patients — its causes and types, and the most common chronic pain causes in primary care.
What is Chronic Pain?
Chronic pain is a kind of pain that can occur in any part of the body and persists for more than three months. It can be continuous or have on-and-off periods, and can negatively impact a person’s quality of life. Having chronic pain can affect one’s productivity and physical health, to the point that it can get in the way of work and everyday tasks.
People with chronic pain are also at risk of developing mental health challenges. According to the American Psychiatric Association (APA), up to 45% of people living with chronic pain experience depression. Chronic pain is also heavily linked to sleep disturbances, with more than half of those with chronic pain experiencing sleep disorders. Unfortunately, these conditions exacerbate one another — chronic pain causes poor sleep and fuels mental health disorders, while poor sleep worsens pain.
A person can develop chronic pain because of an injury, a surgical procedure, or an ongoing health condition. It’s important to note, however, that chronic pain can persist even after the health condition that caused it has been addressed.
Common Causes of Chronic Pain in Primary Care: Osteoarthritis, Diabetes, and Nerve Damage
Although there are many causes of chronic pain, the most common causes of chronic pain in primary care patients are osteoarthritis, diabetes, and nerve damage.
| Cause | Definition | Common Symptoms |
| Osteoarthritis | Osteoarthritis occurs when the protective cartilage that wraps the end parts of bones wears down. This condition, which affects 606.9 million individuals globally as of 2021, typically affects the hands, knees, hips, and spine. The damage done to the joints caused by osteoarthritis cannot be reversed, however, symptoms can still be managed. | · Joint pain especially when moving
· Stiffness especially after periods of inactivity (after sleeping) · Tenderness and inflammation (especially when touched or light pressure is applied) · Limited range of motion · Popping or crackling sound when moving · Growth of bone spurs around the affected joint |
| Diabetes | Diabetes is a condition wherein the blood glucose level exceeds normal limits because the body doesn’t produce enough insulin or the body doesn’t respond well to insulin. Because most forms of diabetes are chronic in nature, over time, it can lead to chronic pain via inflammation in the joints and muscles, as well as cause nerve damage. | · Numbness or decreased ability to feel sensations, pain, and even temperature changes
· Tingling, burning, or electric shock sensations · Sharp, shooting pains or cramps · Joints or muscles become sensitive to touch · Joint damage · Weaker muscles · Pain in the buttocks, hips, thighs, chest, or the walls of the stomach · Facial paralysis |
| Nerve damage | Nerve damage (aka peripheral neuropathy) refers to damage to nerves excluding the brain and spinal cord. Nerve damage can be caused by many things, such as autoimmune diseases, cancer treatments, accidents and injuries, and infections. Neuropathic pain is an intractable form of chronic pain. | According to the Cleveland Clinic, common sensory/movement symptoms include:
· Numbness · Muscle weakness, paralysis, and/or atrophy · Tingling, burning, or electric shock sensations · Loss of reflexes · Muscle cramps · Balance challenges |