Chronic pain — a definition
		Angina pain — causes and symptoms
		Chronic pain is physical — and emotional
		Angina treatments help — but may not halt — the pain
		Managing your angina pain or discomfort

1. Angina pain and discomfort are rarely considered "chronic pain," but for many of the almost 7 million Americans who have repeated attacks, chronic pain that comes and goes can be a persistent part of life.



2. Chronic pain and the limitations it creates can trap patients with angina in a downward spiral of symptoms, including depression, anxiety, sexual problems, and more frequent angina attacks.



3. Angina medications may not always stop painful attacks, which tend to average two per week. The greater the number of attacks, the less a patient's feeling of well-being.



4. A startling 82% of patients with angina downsize their lifestyles by avoiding tasks that require exertion. They also sleep and rest more to avoid attacks of pain and discomfort.

Chronic pain — a definition

According to the International Association for the Study of Pain (IASP), ongoing pain that lasts beyond the usual recovery time for illness or injury is called chronic pain.¹ Such pain may be continuous, or it may come and go. Chronic pain is commonly associated with conditions like arthritis or migraines. However, both the IASP and the American Academy of Pain Medicine recognize that chest pain associated with coronary artery disease (CAD) — also known as angina pectoris — is another type of chronic pain.^1-2 Read more in Coronary Artery Disease.

Chronic angina pain or discomfort are rarely discussed as types of chronic pain. But for many of the almost 7 million people in the United States who have repeated attacks of angina, chronic pain that comes and goes is a persistent part of their lives. Angina pain occurs only during an attack, but these attacks can strike frequently, as often as a few times each week or more.

The physical and emotional impact of anticipating and dealing with such discomfort can be enormous. Chronic pain and the limitations it creates can trap patients with angina in a downward spiral of symptoms, including depression, anxiety, increased angina frequency, sexual problems, and possibly other ailments. What's more, chronic pain not only diminishes quality of life for the patient and family members alike, but can threaten a household's economic security, too, resulting in sick time, reduced productivity, and increased medical costs.

Medications may not always prevent or end painful or uncomfortable angina attacks. One study of more than 5,000 men and women with angina, who averaged 69 years of age, showed that each person typically had two angina attacks per week, even though the majority received treatment. About 90% reported angina pain during physical exertion; 47% had pain while resting; and 35% had pain during periods of mental stress. Not surprisingly, the study showed that the greater the number of angina attacks, the less the overall feeling of well-being.³

Angina pain — causes and symptoms

Angina strikes when the heart fails to get enough of the oxygen-rich blood it needs to keep pumping at top form. The problem usually stems from CAD. The coronary arteries that carry blood to the heart become narrowed by plaques—made up of cholesterol and other substances—on the inner lining of the vessels, restricting blood flow. As a result, less oxygen reaches the heart, and angina pain or discomfort results.

Angina attacks can be triggered by emotional stress, exercise, routine physical activity, extreme cold or heat, cigarette smoking, air pollution, or heavy meals—all of which can place extra demands on the heart.

Patients describe chronic angina pain differently. Typically, they feel symptoms in their chest. Some liken the pain to a vise squeezing their chest, while others say it feels like a crushing, burning, heavy, or strangling sensation in the chest. Some patients say they also feel symptoms radiating into the teeth, jaw, neck, back, shoulder, or arm. Some report breathing problems, nausea, or numbness. Angina pain and discomfort can range from mild to severe. Women may also be less likely than men to suffer the well-known chest symptoms of chronic angina that cause them to suddenly clutch their chest during an attack. Learn more in Women and Heart Disease.

Chronic pain is physical — and emotional

While angina can cause strong pain, the heart muscle isn't usually damaged during an angina attack. During a heart attack, however, the flow of oxygen-rich blood may be so restricted that part of the heart muscle dies. The pain of a heart attack is usually greater, lasts longer, and doesn't go away with rest or short-acting nitroglycerin, as angina pain does.

Pain from an angina attack typically doesn't last long; the average episode goes on for three to five minutes—but of course, that's a long time, even for mild discomfort. Never ignore pain that continues after resting or after taking short-acting nitroglycerin as directed by your doctor—call 911 or go to an emergency room right away.

Angina causes not only physical pain, but emotional pain as well. Patients know what it's like to feel frightened during an angina attack, but even after the attack passes, a person may live in fear and dread of the next painful attack. Patients can feel depressed if they must avoid picking up grandchildren or playing with them for fear of triggering an angina attack, or if they must constantly rely on others for help because pain limits their ability to do basic tasks. That's why a startling 82% of patients with angina downsize their lifestyles by avoiding tasks that require exertion. They also sleep and rest more to avoid attacks of pain and discomfort.⁴

Women may be more likely to feel hampered by angina, as suggested by one recent study of 128 patients surveyed in an outpatient cardiology clinic. Overall, both men and women described their pain in similar terms. However, women reported that their angina caused them greater physical limitation.⁵

Angina treatments help — but may not halt — the pain

Current angina therapy is used to treat angina pain and discomfort by helping the heart to receive more oxygen-rich blood. Medications to treat angina pain typically begin with short-acting nitroglycerin tablets that are placed under the tongue to stop an attack. Short-acting nitroglycerin also comes as a mouth spray.

For long-term treatment, a doctor may prescribe beta-blockers, calcium channel blockers, long-acting nitroglycerin, or, for most patients, a combination. These drugs help prevent angina pain either by improving blood flow to the heart or by decreasing the heart's workload, especially during times of emotional stress or physical exertion. Learn more in Angina Medications.

Unfortunately, these drugs may cause side effects in some people, ranging from tiredness and cold hands and feet to headaches and sexual problems—and sometimes medications may not always help prevent angina attacks. This may be related to how regularly you take your medications, or how severe your CAD is.

Managing your angina pain or discomfort

If you continue to struggle with angina pain, be sure to discuss your symptoms with your doctor. Don't just assume that nothing more can be done. Work together with your physician to find out whether a different medication and lifestyle changes (such as healthful eating, stress management, or smoking cessation) can help you.

Surgery might be an option as well. Procedures that increase blood flow to the heart by opening or bypassing clogged coronary vessels may give you relief. See Surgery and Related Therapies for descriptions of common procedures such as percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG). Surgery, however, is not always the answer; procedures are invasive and unfortunately, angina pain may recur over time in some patients. If your doctor mentions these surgeries as options for you, be sure that you have discussed all the pros and cons.

Bear in mind that while current medications and procedures may have some disadvantages, researchers are developing new strategies that might hold promise for better treatment of angina pain in the future. Learn more in Potential Therapies.

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Sources

1. International Association for the Study of Pain. Definition of Chronic Pain. 2004. http://www.efic.org/about_pain.htm#costs, Accessed July 27, 2004.
   
   
2. American Academy of Pain Medicine. FAQs About Pain. 2004. http://www.painmed.org/faqs/pain_faqs.html, Accessed July 27, 2004.
   
   
3. Pepine, Carl, et al. "Characteristics of a Contemporary Population with Angina Pectoris," American Journal of Cardiology, 1994, Vol. 74. 226-231. PubMed.
   
   
4. Chestnut, L.G., et al. "Measuring Heart Patients' Willingness to Pay for Changes in Angina Symptoms." Journal of Medical Decision Making, 1996, Vol. 16. 65-77. PubMed.
   
   
5. Kimble, L.P. et al. "Gender Differences in Pain Characteristics of Chronic Stable Angina and Perceived Physical Limitation in Patients with Coronary Artery Disease." Pain. 2003 January; 101(1-2):45-53. PubMed.