Chronic Pain

Chronic pain last months or years and happens in all parts of the body. It interferes with daily life and can lead to depression and anxiety. The first step in treatment is to find and treat the cause. When that isn’t possible, the most effective approach is a combination of medications, therapies and lifestyle changes.

What is chronic pain?

Chronic pain is pain that lasts for over three months. The pain can be there all the time, or it may come and go. It can happen anywhere in your body.

Chronic pain can interfere with your daily activities, such as working, having a social life and taking care of yourself or others. It can lead to depression, anxiety and trouble sleeping, which can make your pain worse. This response creates a cycle that’s difficult to break.

What’s the difference between chronic pain and other pain?

Chronic pain differs from another type of pain called acute pain. Acute pain happens when you get hurt, such as experiencing a simple cut to your skin or a broken bone. It doesn’t last long, and it goes away after your body heals from whatever caused the pain. In contrast, chronic pain continues long after you recover from an injury or illness. Sometimes it even happens for no obvious reason.

Where do people have chronic pain?

Chronic pain can come in many different forms and appear across your body. Common types of chronic pain include:

• Arthritis, or joint pain.


• Back pain.


• Neck pain.


• Cancer pain near a tumor.


• Headaches, including migraines.


• Testicular pain (orchialgia).


• Lasting pain in scar tissue.


• Muscle pain all over (such as with fibromyalgia).


• Neurogenic pain, from damage to the nerves or other parts of the nervous system.

How common is chronic pain?

Chronic pain is a very common condition, and one of the most common reasons why someone seeks medical care. Approximately 25% of adults in the United States experience chronic pain.

SYMPTOMS AND CAUSES

What causes chronic pain?

Sometimes chronic pain has an obvious cause. You may have a long-lasting illness such as arthritis or cancer that can cause ongoing pain.

Injuries and diseases can also cause changes to your body that leave you more sensitive to pain. These changes can stay in place even after you’ve healed from the original injury or disease. Something like a sprain, a broken bone or a brief infection can leave you with chronic pain.

Some people also have chronic pain that’s not tied to an injury or physical illness. Healthcare providers call this response psychogenic pain or psychosomatic pain. It’s caused by psychological factors such as stress, anxiety and depression. Many scientists believe this connection comes from low levels of endorphins in the blood. Endorphins are natural chemicals that trigger positive feelings.

It’s possible to have several causes of pain overlap. You could have two different diseases, for example. Or you could have something like migraines and psychogenic pain together.

What does chronic pain feel like?

People with chronic pain describe their pain in many different ways, such as:

• Aching.


• Burning.


• Shooting.


• Squeezing.


• Stiffness.


• Stinging.


• Throbbing.

Chronic pain often leads to other symptoms and conditions, including:

• Anxiety.


• Depression.


• Fatigue, or feeling overly tired most of the time.


• Insomnia, or trouble falling asleep.


• Mood swings.

DIAGNOSIS AND TESTS

How is chronic pain diagnosed?

Pain is considered to be chronic if it lasts or comes and goes (recurs) for more than three months. Pain is usually a symptom, so your healthcare provider needs to determine what’s causing your pain, if possible. Pain is subjective — only the person experiencing it can identify and describe it — so it can be difficult for providers to determine the cause.

If you have long-lasting pain, see your healthcare provider. Your provider will want to know:

• Where your pain is.


• How intense it is, on a scale of 0 to 10.


• How often it occurs.


• How much it’s affecting your life and work.


• What makes it worse or better.


• Whether you have a lot of stress or anxiety in your life.


• Whether you’ve had any illnesses or surgeries.

What tests are used to diagnose chronic pain?

Your healthcare provider may physically examine your body and order tests to look for the cause of the pain. They may have you undergo the following tests:

• Blood tests.


• Electromyography to test muscle activity.


• Imaging tests, such as X-rays and MRI.


• Nerve conduction studies to see if your nerves are reacting properly.


• Reflex and balance tests.


• Spinal fluid tests.


• Urine tests.

MANAGEMENT AND TREATMENT

How is chronic pain treated?

To relieve chronic pain, healthcare providers first try to identify and treat the cause. But sometimes they can’t find the source. If so, they turn to treating, or managing, the pain.

Healthcare providers treat chronic pain in many different ways. The approach depends on many factors, including:

• The type of pain you have.


• The cause of your pain, if known.


• Your age and overall health.

The best treatment plans use a variety of strategies, including medications, lifestyle changes and therapies.

If you have chronic pain and depression and/or anxiety, it’s important to seek treatment for your mental health condition(s) as well. Having depression or anxiety can make your chronic pain worse. For example, if you have depression, the fatigue, sleep changes and decreased activity it may cause can make your chronic pain worse.

What medications can treat chronic pain?

Your healthcare provider may recommend certain medications to relieve chronic pain, including:

• Anticonvulsants (medications that prevent seizures) for nerve pain.


• Antidepressants such as tricyclic antidepressants.


• Corticosteroid.


• Muscle relaxers.


• Nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen.


• Topical products (applied to the skin) that contain pain relievers or ingredients that create soothing heat or cold.


• Opioids (narcotics). Opioids can be addictive, and you can build up a tolerance to them over time. Because of this, healthcare providers usually try other pain treatment options before prescribing opioids.


• Sedatives to help with anxiety or insomnia.


• Medical marijuana.

Other medical treatments your healthcare provider may have you try include:

• Transcutaneous electrical nerve stimulation (TENS): This procedure delivers small shocks through patches on your skin. The electrical impulses can relieve pain.


• Nerve blocks: For this treatment, your healthcare provider injects an anesthetic near the site of your pain to reduce feeling in the area. Nerve blocks can also sometimes provide diagnostic information and locate the source of your pain.


• Epidural steroid injections: This procedure is an injection of anti-inflammatory medicine — a steroid or corticosteroid — into the space around your spinal nerves known as the epidural space to treat chronic pain caused by irritation and inflammation of spinal nerve roots.

Are there side effects or complications of medical treatment for chronic pain?

Every medication has a potential for side effects — some are more serious than others. Be sure to discuss the possible side effects of your chronic pain medications with your healthcare provider.

Complications from medical treatments for chronic pain can include:

• Acute liver failure from acetaminophen treatment.


• Opioid addiction and/or overdose.


• Mood changes, confusion and respiratory issues from nerve pain medications.


• Spinal cord damage or infection from spinal cord stimulators.

Can lifestyle changes help with chronic pain?

Four major lifestyle factors can affect your chronic pain and help minimize it. Healthcare providers sometimes call them the four pillars of chronic pain. They include:

• Stress: Stress can play a major role in chronic pain, so it’s important to try to reduce your stress as much as possible. Everyone has different techniques for managing their stress, but some techniques include meditation, mindfulness and deep breathing. Try different options until you find what works best for you.


• Exercise: Participating in low-intensity exercises, such as walking or light swimming, for 30 minutes every day may help reduce your pain. Exercise can also be a stress reliever for some people, which is important to manage when you have chronic pain.


• Diet: It’s important to eat a healthy diet to boost your overall health. Your healthcare provider may suggest trying an anti-inflammatory diet by eliminating foods that cause inflammation, such as red meat and refined carbohydrates.


• Sleep: Getting enough quality sleep is important for your overall health. A lack of sleep can cause you to gain weight, which could make your chronic pain worse. Getting quality sleep is also important for stress management.

Be sure to discuss these four lifestyle pillars with your healthcare provider to determine how each applies to your type of chronic pain and how you can incorporate changes into your day-to-day life.

Can therapy help with chronic pain?

Certain therapies may help you manage chronic pain, including:

• Cognitive-behavioral therapy (CBT): This counseling method helps you think differently about pain and teaches you ways to cope.


• Counseling: Talk therapy can help you manage chronic pain, especially psychogenic pain.


• Occupational therapy: Occupational therapy teaches you how to do everyday tasks differently to lessen pain or avoid injury.


• Physical therapy: Physical therapy involves exercises that stretch and strengthen your body, which can help reduce your pain.

What alternative treatments are available for chronic pain?

Alternative treatments that have been shown to relieve chronic pain over time include:

• Acupuncture, which uses small needs placed in the body.


• Aromatherapy, which uses aromatic plants and essential oils.


• Biofeedback, which teaches you how to tweak the way your body works, influencing such things as heart rate, breathing and muscle tension.


• Hypnotherapy, or hypnosis.


• Mindfulness training, which teaches you how to calm yourself.


• Music, art or pet therapy.


• Reiki or Healing Touch™, with a therapist using touch to change energy fields in your body.


• Relaxation techniques, such as massage, meditation and guided imagery.

Is there a cure for chronic pain?

Currently, there is no cure for chronic pain, other than to identify and treat its cause. For example, treating arthritis can sometimes stop joint pain.

Many people with chronic pain don’t know its cause and can’t find a cure. They use a combination of medications, therapies and lifestyle changes to lessen pain.

PREVENTION

What are the risk factors for chronic pain?

Since many conditions or injuries can cause chronic pain, there are several risk factors for experiencing it. Some risk factors include:

• Your genetics: Some chronic pain causes, like migraines, run in the family (are genetic).


• Having obesity: Having obesity can worsen certain health conditions that cause pain, such as arthritis since there’s extra pressure on your joints.


• Your age: Older people are more likely to experience chronic pain from arthritis and neuropathy.


• Having a previous injury: If you’ve had a traumatic injury, you’re more likely to develop chronic pain in the future.


• Having a labor-intensive job: If you have a physically strenuous job, you’re at greater risk for developing chronic pain.


• Experiencing stress: Studies have shown that chronic pain is connected to both frequent stress and post-traumatic stress disorder.


• Smoking: If you smoke, you’re at greater risk for developing medical conditions that lead to a need for chronic pain treatment.

Can chronic pain be prevented?

Unfortunately, nothing has been proven to prevent chronic pain in general. You may be able to prevent certain conditions that lead to chronic pain. For example, you can quit smoking to lower your risk of lung cancer.

OUTLOOK / PROGNOSIS

What is the prognosis (outlook) for people with chronic pain?

Chronic pain usually doesn’t go away, but you can manage it with a combination of strategies that work for you. Current chronic pain treatments can reduce a person’s pain score by about 30%.

Researchers continue to study pain disorders. Advances in neuroscience and a better understanding of the human body should lead to more effective treatments.

If you have chronic pain and depression and/or anxiety, it’s important to seek treatment for your mental health. Untreated depression and anxiety can make your pain worse and further lower your quality of life.

What are the complications of chronic pain?

Complications of chronic pain can include:

• Decreased quality of life.


• Depression.


• Anxiety.


• Substance abuse disorders.


• Worsening of existing chronic disease.


• An increased risk of suicidal ideation and/or suicide.

The complications of chronic pain are serious. Because of this, it’s essential to seek medical care if you’re experiencing chronic pain. There are many options for pain treatment and management. While it may take a while to find the right combination of therapies that work for you, it’s worth undertaking.

If you’re experiencing thoughts of suicide, contact the Suicide and Crisis Lifeline at 988. Someone will be available to talk with you 24 hours a day.

LIVING WITH

How can I cope with chronic pain?

Besides taking medications, getting therapy and making lifestyle changes, take good care of yourself. The following actions can help you cope with your chronic pain and improve your overall health:

• Avoid smoking.


• Don’t try to do too much. Create a daily schedule that includes a few priorities and time for rest and self-care.


• Eat a healthy diet.


• Exercise regularly.


• Get enough sleep.


• Manage your stress.


• Join a support group for chronic pain to learn from other people with similar conditions.


• Limit alcohol, which can cause more problems with sleep and pain.


• Try to think positively.

What questions should I ask my doctor?

If you have chronic pain, it may be helpful to ask your healthcare provider the following questions:

• What’s causing my pain?


• Will it go away? If no, why not?


• What kinds of medications can I take? What are their side effects?


• Should I try physical or psychological therapy?


• Is it safe to exercise?


• What else can I do to relieve my chronic pain?


• Should I call you if it gets worse?

A note from Cleveland Clinic

Chronic pain lasts months or years and can interfere with your ability to work, enjoy activities and take care of yourself or others. If you have chronic pain, please talk to a healthcare provider or pain specialist. There are ways to manage your pain to help you toward a more comfortable life.