Chronic Pain Overview

Chronic pain conditions affect about one-fifth of US adults, or 50 million people. Having a chronic pain condition, such as fibromyalgia, migraine, or low back pain, is associated with disability, missed work days, high healthcare costs, and poor health. Opioid medication, one type of prescription pain medication, has been a common treatment for chronic pain conditions but experts warn that long-term use is dangerous, leading to addiction and overdose, which can be deadly.

What is Chronic Pain?

Chronic pain differs from an injury, like a sprained ankle or when you accidentally burn your hand at the stove. Those injuries are considered an acute pain. They are painful to experience but then they resolve with proper treatment.

Chronic pain is different in that it's pain that lingers longer than three to six months. Sometimes it can last years. This pain is present even after someone has physically healed from the injury. While chronic pain is also linked to certain health conditions like cancer and arthritis, in some instances, there never was an injury or physical damage to begin with and the exact cause can't be found.

No matter if there's physical damage present or not, an individual's nervous system is still actively responding to pain signals. In other words, their experience of pain is real—and it's often debilitating and causes physical and emotional distress.

Types

Chronic pain is defined by conditions that are associated with persistent pain, such as:

Migraine: People who experience 15 or more headache or migraine days per month are considered to have chronic headaches.

Back pain: If back pain has been treated but persists for 12 weeks or longer, it's considered chronic. One-fifth of people with an injury or problem that leads to low back pain still have pain after one year.

Cancer pain: Tumors may press on surrounding organs or nerves or cause fluid accumulation. Treatments, such as chemotherapy drugs and radiation, can also lead to neuropathic pain.

Joint pain: When joint pain, or arthritis, lasts for three months and is present for most days, this is chronic pain, something that half of arthritis patients experience.

Musculoskeletal: Conditions, such as fibromyalgia, cause widespread pain around the body. Patients may also be more sensitive to pain, which enhances the discomfort.

Neurogenic pain: Nerve pain can stem from damage to peripheral nerves or the central nervous system. For example, peripheral neuropathy (damage to peripheral nerves) is a complication of diabetes, autoimmune diseases, shingles, certain infections, and other conditions.

Symptoms

Chronic pain is described as pain that persists longer than three or six months that you would have expected to go away following healing from an injury (though there is often no known acute injury or damaged that triggered the pain). But because there are so many conditions associated with chronic pain, such as fibromyalgia or vulvodynia, symptoms may be disease dependent. People may also have two pain conditions at the same time, resulting in overlapping symptoms.

In addition to the duration of chronic pain, patients also tend to report varying characteristics of pain including:

• Aching
• Burning or stinging
• Throbbing or shooting
• Tingling or pins and needles
• Electric shock
• Tightness and stiffness

Finally, because chronic pain is so disruptive to one's well-being—impacting sleep, appetite, energy levels, and mood—insomnia, fatigue, weight loss, as well as depression and anxiety are other common symptoms. Those with chronic pain may also withdraw socially.

Causes

There are many conditions that develop and cause chronic pain, and that includes migraine, arthritis, fibromyalgia, and certain autoimmune conditions.

An injury that causes damage to nerves or tissues can also cause acute pain that continues despite treatment and healing.

Changes in the nervous system may also sensitize people to pain, priming individuals to experience aches and discomfort more readily and intensely.

Diagnosis

There are no tests to diagnose someone with chronic pain, as pain is a subjective experience. However, doctors will first do a physical exam and review of your symptoms. They may decide to run tests to uncover the cause of the pain. Some tests that may be offered are imaging tests (such as MRIs) or blood tests, though doctors should take care not to over-test a patient in order to try to find the source of the pain.

During the appointment, it can often be hard for patients to talk about their pain and effectively communicate its severity. Doctors may struggle to understand as well, since pain is something that can't be felt or necessarily seen on another person. Using a pain map, such as one available through the American Chronic Pain Association, can help show the provider where it hurts, how it hurts, the intensity, and what movements make it worse, so that everyone is on the same page. This type of quantifiable scale can also be used to measure progress in treatment. In addition, be sure to express the ways that your pain is preventing you from taking part in daily activities or those that you once loved and looked forward to.

Treatment

Chronic pain is notoriously challenging to treat. What may be recommended for you will depend on your condition and the severity of your symptoms. Here are a few tools doctors can recommend:

Medication

Opioids interrupt pain processing signals and are effective treatments. However, they also have a psychological effect by making people feel good, and so these medications are extremely addicting. In some instances, opioids exacerbate pain. As a result, prescription opioids are not recommended as a first-line treatment for chronic pain. (They are also only advised for use in very short durations following acute pain.) Instead, non-opioid drugs may help patients cope with their pain, such as antidepressants or NSAIDs, aspirin, or acetaminophen.

Local electrical stimulation

These pulses of electricity target nerve endings under the skin.

Psychotherapy

Psychotherapy can also help patients accept, cope with, and feel as if they're in control of their pain, which can help it become more manageable and something that patients can feel they can live with.

Complimentary treatments

Acupuncture, yoga, tai chi, massage, and spinal manipulation may relieve and help patients manage pain. Acupuncture has been found to reduce the reliance on opioid medication.

Psychological treatments

Relaxation techniques, meditation, music, and hypnosis may also help turn down pain signals and are considered safe.

Biofeedback

This treatment involves being hooked up to a biofeedback device that teaches the patient how to control certain physiological responses of the body, such as heart rate, muscle tension, and breathing patterns.

Placebo

Some research suggests that even when patients know they are receiving a placebo treatment (an inert treatment that has no active ingredients), they still report reductions in certain types of pain.

Surgery

In some instances, surgery to nerves may be recommended for patients who don't respond to conventional treatments.

Prevention

For people who have an acute injury, such as a lower back injury or a condition, like migraine, proper treatment for the problem in the early stages can help prevent acute or occasional pain from becoming persistent and chronic (which ultimately makes it more challenging to treat). However, that is not a perfect solution, as there are many factors that go into seeking help and getting the right care. These may include medical access, genetics, other co-occurring conditions, and the use of opioids in acute injury or post-surgery, among others.

In other instances, such as with diabetes, managing the condition can help prevent possible complications that are associated with chronic pain, such as peripheral neuropathy. And still, there are many times when chronic pain conditions cannot be prevented.

To get our top stories delivered to your inbox, sign up for the Healthy Living newsletter