Much about chronic pain remains a mystery—but there are research-backed remedies that can help. Here’s why doctors are hopeful about the diagnosis.

By Maggie Puniewska
March 16, 2020
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There isn’t one way to describe chronic pain. Some people compare it to lightning bolts; others say their bodies feel heavy, like concrete. The pain can be an everyday reality, or only flare up a few times a week. It may be sharp or dull, burning, stabbing, prickling, or tingling.

“For many patients, it flips their lives upside down,” says Jack Lam, MD, a physician at the Rex Pain Management Center in Raleigh, North Carolina. Though they may look fine on the outside, they could be in agony, he adds.

Pain is considered chronic when it lasts longer than three months or persists beyond the expected healing time for a particular injury. It can affect any part of the body and may entail more than just physical discomfort. This complex condition can sap a person’s energy; make it difficult to get a good night’s sleep; and lead to mental health issues, like anxiety or depression.

It’s also probably more widespread than you think: According to the CDC, roughly one in five Americans has chronic pain. The most common types include migraines, low back pain, nerve pain, and joint pain.

Where It Begins

Certain medical conditions—such as endometriosis and Lyme disease—can cause chronic pain. But it typically starts with postsurgical pain or an injury. “It’s not clear why some people get it and others do not,” says Beth Darnall, PhD, an associate professor in the Department of Anesthesiology, Perioperative and Pain Medicine at the Stanford University School of Medicine.

One theory is that the brain develops an “imprint” of the neurological pathway of the original pain, says Sharvani Durbhakula, MD, a physician at the Johns Hopkins Hospital Blaustein Pain Treatment Center in East Baltimore. As a result, the brain continues to transmit pain signals even after the physical damage to the body has healed.

Persistent aches can also set up a vicious cycle. The longer some people experience pain, the more they focus on it, and the more stressed they become. We know that both attention and stress hike up pain processing in the brain, says Darnall.

Indeed, one 2017 study from the University of Hiroshima in Japan suggested that repeatedly thinking about pain—or worrying about when it will strike next—may amplifies the perception of those aches. But make no mistake, chronic pain is not purely psychological: “It’s important for people to know that all pain is real. Pain has a medical basis,” says Darnall. “It’s not all in your head.”

Ease the Ache

Another misconception about the condition is that it’s not treatable. “People think chronic means unsolvable,” says Darnall, and that’s not the case.

Your primary care provider might suggest starting with physical therapy or an over-the-counter medicine. (It can be tempting to self-medicate, says Dr. Lam, but an MD can point you to a drug that’s most effective for your type of pain.) If those initial treatments don’t work, it’s a good idea to see a doctor who specializes in pain management. Try to find a physician who has experience with your specific issue, says Darnall—and someone who will take a holistic approach that goes beyond the medical underpinnings of your pain.

Specialists use a variety of therapies to ease persistent pain, from meds such as anti-inflammatories and antidepressants to steroid injections and surgical procedures. In some cases, a spinal cord stimulator may be helpful. This implanted device emits tiny electrical pulses that mask pain signals traveling to the brain; you feel a gentle tingling or fluttering sensation instead. Research suggests some complementary practices, including mindfulness meditation, can offer relief too. (Check out the latest findings on promising methods at right).

After exploring many other options, your doc may recommend trying an opioid. Because these powerful drugs can be so addictive, she should help you carefully weigh the risks and benefits. If you decide to fill the script, you’ll have regular follow-ups so she can evaluate its effects.

Boost Your Reserves

Does your pain mess with your sleep? It turns out restless nights are a double whammy: The quality of your sleep is one of the most important predictors of pain intensity the next day. So if you’re struggling to get enough shut-eye, be sure to tell your physician. She may suggest techniques to help you relax or change the timing of your medication to give you the most relief at bedtime.

Some people with chronic pain report that CBD helps them get to sleep, and also eases anxiety and dampens pain sensations—but this phytochemical derived from the cannabis plant hasn’t been well studied yet in humans. It’s thought to work by quieting nerves that are overfiring, says Dr. Lam.

If you’re looking for a more tried-and-true method for managing the everyday realities of chronic pain, consider cognitive behavioral therapy, or CBT. There is a vast body of research behind this form of talk therapy, which teaches techniques to control pain-related distress. “Over time, these skills help to calm the central nervous system and decrease pain signals in the brain,” says Darnall. Her research has also shown that CBT can make medical treatments more effective.

With a multipronged approach, most chronic-pain patients are able to find relief, she says. “Whether you’ve had pain for months or decades, there are things you can do on a daily basis to reduce both the intensity and the impact of the pain.”

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