Chronic Pain

What is chronic pain?

Chronic pain is pain that lasts for more than 3 months. It is pain that lasts longer than the usual recovery period after an illness, accident, or surgery. Or it is pain that occurs along with an ongoing (chronic) health condition, such as arthritis. 

Chronic pain may come and go. Or it may be constant. It may affect people to the point that they can't work, eat properly, take part in physical activity, or enjoy life.

Chronic pain is a major health condition that can and should be treated.

What causes chronic pain?

Pain starts in nerve cells beneath the skin and in organs throughout the body. When you are sick, injured, or have other types of problems, these nerve cells send messages along nerve pathways to the spinal cord. This then carries the message to the brain.  

There are many causes of chronic pain. It may have started from an illness or injury. You may have recovered from that, but pain remained. Or there may be an ongoing cause of pain, such as arthritis or cancer. Many people suffer chronic pain without having a past injury or illness.

Many conditions can cause chronic pain. Some of the more common include:

• Previous surgery

• An old injury

• Infection

• Diseases, such as diabetes

• Nerve damage

• Back injury

• Arthritis

• Migraine or other headaches

• Fibromyalgia

• Cancer

Depression and stress can make chronic pain symptoms worse. In some cases, a cause for the pain can't be found. 

Who is at risk for chronic pain?

You are at higher risk of developing chronic pain if any of these are true:

• Long-term opioid use

• Older age

• Genetics

• Negative emotions and expectations, such as fear and worries about the impact of pain on one's life

• Social problems

• Past pain-related treatment that wasn't successful

• Mental and behavioral health conditions

A family history of chronic pain can also increase your risk of developing some health problems linked with chronic pain. These include frequent headaches, inflammatory diseases, and fibromyalgia.

What are the symptoms of chronic pain?

Chronic pain symptoms may include:

• Mild to severe pain that does not go away as expected

• Pain that may be described as shooting, burning, aching, or electrical

• Mild pain, soreness, tightness, or stiffness

Chronic pain can affect almost all parts of your life. Your sleep, mood, activity, and energy level can all be disrupted by pain. Being tired, depressed, and out of shape can make the pain worse and harder to cope with. 

Pain can become such a problem that it interferes with your life's work and normal activities. You may then go through what is called a "pain cycle." You may become focused on the pain, which makes you depressed and irritable. This often leads to problems with sleeping (insomnia) and to extreme tiredness (fatigue). That leads to more irritability, depression, and pain. This is the pain cycle. The urge to stop the pain can make some people dependent on medicines. It may cause others to have repeated surgeries or try questionable treatments. This can often be as hard on the family as it is on the person who has the pain. 

How is chronic pain diagnosed?

Your healthcare provider will review your health history, do a physical exam, and evaluate your pain. You will be asked some basic questions about your pain, such as:

• Where is your pain?

• How long have you had it?

• Have you had pain like this before?

• Does it limit your daily activities? How?

• On a scale of 1 to 10, how bad is your pain?

• Is it constant or does it come and go?

• Is it set off by certain activities?

• Can you do anything to make it better?

• What other conditions do you have or have you recently gotten over?

• What medicines do you take, including those for your pain?

• What are your goals for treating your pain?

• Is pain affecting your mood or causing anxiety or depression?

Depending on your answers to the questions and the results of a physical exam, you may have one or more diagnostic tests to help your provider find the cause of your pain. These tests include:

• X-rays. These can show bone problems, such as breaks (fractures) or arthritis.

• MRI. This test shows soft tissues and organs. An MRI also can show pinched or compressed nerves.

• CT scan. This test shows soft tissues and internal organs. It can be used to spot many cancers.

• Nerve conduction tests. These help providers identify abnormalities of both nerves and muscles. A small electrical shock is given to a nerve, and the electrical signal that travels down the nerve is measured.

• Blood tests. These can give clues about what is causing the pain. They can show signs of inflammation, infection, or abnormalities in how an organ is functioning.

How is chronic pain treated?

Treatment can help reduce chronic pain. In many cases, pain can become less severe, occur less often, and interfere less with your daily life. Chronic pain is often treated with a combination of medicines, therapies, and lifestyle changes. Work closely with your healthcare provider to find a treatment plan that works best for you.

Ask your healthcare provider for a referral to a pain management specialty center. These can provide the most recent and proven pain management strategies, along with emotional support and comprehensive services. 

Several different types of medicines may be prescribed for chronic pain. Work with your healthcare provider to create a medicine plan that helps manage your pain. Medicines may include:

• Over-the-counter (OTC) medicines. These may include nonsteroidal anti-inflammatory drugs, aspirin, ibuprofen, or acetaminophen.

• Injections. These include steroid injections.

• Prescription pain medicines. These include opioids, which may be needed for stronger pain relief than OTC medicines. But these medicines are used only for more severe types of pain. These medicines can be abused. They may also have unpleasant and possibly very dangerous side effects.

• Prescription antidepressants. These medicines can help by increasing the supply of the naturally produced neurotransmitters, serotonin and norepinephrine. Serotonin is an important part of a pain-controlling pathway in the brain.

Other types of treatment include: 

• Physical therapy. This involves different treatments, such as exercises and stretching. These can help reduce certain types of chronic pain.

• Occupational therapy. This teaches you how to do routine tasks of daily living in ways that can help reduce your pain.

• Heat and cold treatments. These can reduce stiffness and pain, especially with joint problems, such as arthritis.

• Local electrical stimulation. Short pulses of electricity on nerve endings under the skin give pain relief.

• Other therapies. Meditation, yoga, biofeedback, massage, and acupuncture can also help manage chronic pain.

Counseling can help you cope better with stress and pain. Emotional and psychological support for pain may include:

• Psychotherapy and group therapy

• Stress management

• Relaxation training

• Meditation

• Hypnosis

Lifestyle behaviors can help reduce chronic pain. These include:

• Eating healthy

• Starting an exercise routine

• Getting enough sleep

• Stopping smoking and limiting alcohol use

• Losing excess weight

Surgery may be considered for chronic pain. Surgery can bring release from pain. But it may also destroy other sensations as well. Or it can cause new pain. Relief may not be permanent, and pain may return. Discuss surgical choices with your healthcare provider.

When should I call my healthcare provider?

Call your healthcare provider if:

• Your pain symptoms get worse or you develop new pain

• You suspect you may be having a reaction to medicine prescribed by your provider

Key points about chronic pain 

• Chronic pain is pain that lasts for more than 3 months.

• Chronic pain may come and go. Or it may be constant.

• It may have started from a past illness or injury. Or there may be an ongoing cause of pain, such as arthritis or cancer.

• It may affect people to the point that they can't work, eat correctly, take part in physical activity, or enjoy life.

• Chronic pain is often treated with a combination of medicines, therapies, and lifestyle changes.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your healthcare provider if you have questions, especially after office hours or on weekends and holidays.