What Is Chronic Pain?

Chronic pain is defined as any pain that lasts for three months or longer. Many different health conditions can cause this type of pain, but being assigned female at birth or being older than 65 can increase your risk of experiencing chronic pain. About 20% of American adults live with chronic pain—and more than 7% develop "high impact" chronic pain, which occurs when pain limits your ability to work, go to school, or perform daily activities.

Everyone experiences chronic pain a bit differently. Your symptoms will likely depend on the part of your body that is affected and the underlying cause of your pain. If pain is left untreated, you may experience difficulties with daily activities and changes to your mental health. Fortunately, some therapies can help you find a bit of relief. But your exact treatment plan will depend on your individual symptoms and overall health condition.

Types of Chronic Pain 

Healthcare providers break down chronic pain based on the origin or underlying process that’s causing the pain. Common types of chronic pain include:

• Neuropathic: Occurs when you have nerve damage or irritation, often due to diabetes-related complications
• Nociceptive: Causes aching, burning, or sharp pains when you have tissue damage due to injury, surgery, or dental procedures
• Musculoskeletal: Develops in the ligaments, tendons, muscles, joints, or bones anywhere in the body
• Inflammatory: Happens when you experience inflammation—your body's immune system response to infection or injury
• Psychogenic: Refers to pain that occurs due to psychological conditions, such as physical symptoms of depression or anxiety
• Mechanical: Appears when joints, vertebrae, or the surrounding tissues experience physical pressure

Symptoms of Chronic Pain

Depending on the type of chronic pain you have and its underlying cause, you can develop pain in specific parts of your body or pain that spreads to broader areas over time. Most people who experience chronic pain develop pain in their back, head, neck, arms, legs, or joints (such as your knees or wrists).

Depending on the cause of your pain, you may feel one or more of the following types of discomfort:

• Sharp or stabbing pain
• Dull aches
• Throbbing 
• Tingling
• Burning
• Stiffness
• Shooting 
• Soreness 

Secondary Effects of Chronic Pain 

Living with chronic pain can lead to several secondary effects—which are additional symptoms you might experience due to your pain. The most common secondary effects are fatigue, mood swings, insomnia, or irritability. Over two-thirds of people with chronic pain also end up developing a psychiatric condition, such as major depressive disorder or generalized anxiety disorder.

Causes

Chronic pain often occurs when your nerves become activated after an infection, injury, or tissue damage and during increased activity within the pain centers in your pain. Several health conditions and injuries can cause lasting changes to your nerves, making you more sensitive to pain. These conditions include:

• Inflammatory conditions like arthritis or psoriasis
• Muscle sprains
• Chronic conditions such as diabetes or cancer
• Bone fractures
• Fibromyalgia
• Neurological disorders like migraine
• Psychological conditions like depression or anxiety

Risk Factors

While anyone can develop chronic pain, certain factors can increase your risk of experiencing symptoms, such as:

• Being over the age of 65
• Being assigned female at birth
• Experiencing poverty
• Having a personal history of injury or a family history of chronic pain
• Smoking
• Living with obesity, high stress, or post-traumatic stress disorder (PTSD)

Diagnosis

If you're experiencing chronic pain, it's important to see your healthcare provider about your symptoms. During your appointment, you provider will ask you about your medical history, current symptoms, and medications you’re taking. In addition, they may perform the following diagnostic tests to learn more about what's causing your pain:

• Physical exam to check for problems with mobility, flexibility, stiffness, or weakness
• Neurological exam to test your reflexes, muscle strength, and sensitivity to touch
• Pain questionnaires that rate your level of discomfort and its effects on your daily life
• Psychological evaluation to screen for anxiety, depression, and other mental health conditions associated with chronic pain
• Imaging tests (such as an X-ray or MRI) to evaluate back, joint, or mechanical pain
• Blood tests to detect signs of chronic conditions such as cancer, arthritis, or diabetes  

Treatment

Your exact treatment plan for chronic pain depends on the underlying cause of your pain. Similarly, the goals of treatment will depend on the exact condition you have. For some people, the goal of treatment is to completely get rid of the pain. But for others, reducing the pain and managing the effects it has on your daily life is part of the treatment plan. A variety of treatments may be of support to you—including medications or therapies.

Medications 

Your provider may prescribe one of the following classes of medications to help you ease pain symptoms:

• Non-steroidal anti-inflammatory drugs (NSAIDs): Motrin (ibuprofen) or Aleve (naproxen) to treat swelling and pain
• Opioids: Ultram (tramadol) and Vicodin (hydrocodone) for severe pain for short-term cases (such as after major surgery or injury)
• Anticonvulsants: Horizant (gabapentin) or Lyrica (pregabalin) which traditionally treat seizures but can also minimize chronic pain
• Antidepressants: Elavil (amitriptyline) or Effexor (venlafaxine) to reduce the emotional effects of chronic pain
• Topical analgesics: Pain medication creams such as Voltaren (diclofenac) or Lidoderm (lidocaine) that you can apply directly to inflamed or swollen skin
• Muscle relaxers: Soma (carisoprodol) or Fexmid (flexeril) to reduce muscle pain or spasms
• Anti-anxiety medications: Xanax (alprazolam) or Klonopin (clonazepam) to help reduce anxiety associated with chronic pain   

Transcutaneous Nerve Stimulation (TENS)

If your chronic pain is severe or resistant to medication, your provider may recommend transcutaneous nerve stimulation (TENS). This treatment involves using a device that transmits electrical signals through the skin over affected areas of your body that are experiencing pain. Studies show that TENS may help reduce pain symptoms.

Injections 

For chronic back pain or joint pain, nerve block injections or epidural steroid injections may help. For nerve block injections, your provider injects an anesthetic near the affected area. For epidural injections, your provider can inject corticosteroids around the affected joints or back areas to reduce inflammation.

Physical or Occupational Therapy

Some people find physical therapy and occupational therapy effective, especially when they're paired with other treatments or medications. A physical therapist can help you learn and perform exercises that help improve strength, mobility, and flexibility to reduce chronic pain. An occupational therapist can teach you strategies to make daily tasks (such as cooking or putting clothes) on more feasible with chronic pain. Both healthcare providers can recommend any assistive devices that may help you live well with pain.  

Psychotherapy

If your chronic pain is due to psychogenic causes, sessions with a mental health professional such as a psychiatrist or psychologist may help ease physical and emotional symptoms of pain. Research shows that forms of talk therapy, such as cognitive-behavioral therapy, can help you reframe how you think about pain and develop strategies to reduce the emotional effects of chronic pain.

Complementary or Alternative Approaches 

Many alternative or complementary therapies may also help ease chronic pain. These include:

• Massages
• Tai chi
• Acupuncture
• Supplements such as vitamin D, omega-3 fatty acids, magnesium, and riboflavin
• Herbal remedies like cayenne, white willow bark, and arnica
• Cannabis or medical marijuana, for people living in states where medical use is legalized

Keep in mind: before you start a complementary approach, it's essential to talk to your healthcare provider to learn if these therapies, herbal remedies, and supplements are safe for you. Do not take or use any alternative treatments unless you have your provider's approval to do so.

How to Prevent Chronic Pain 

It's not always possible to prevent chronic pain (especially if your pain is due to an autoimmune condition or accident). However, you can lower your risk of developing a condition that causes chronic pain and reduce your pain from worsening. Some prevention strategies you can try include:

• Managing stress through meditation, yoga, journaling, or doing hobbies you enjoy
• Participating in gentle exercise or movement, such as walking or swimming
  
• Eating nutritious foods such as fresh fruits and vegetables, proteins, and whole grains
• Getting enough sleep at night
• Quitting smoking

Related Conditions 

Without treatment, chronic pain can also increase your risk of other related conditions, such as:

• Depression: Studies have found that up to 85% of people with chronic pain have depression, which causes a depressed mood and lack of interest in daily activities, among other symptoms.
• Anxiety disorders: Chronic pain can also lead to anxiety disorders, which cause persistent and debilitating worry that affects your regular activities. Anxiety is about five times more likely in people with chronic pain compared to those without.
• Substance use disorder: Up to 10% of people with chronic pain develop substance use disorder, which is the excessive use of alcohol and other drugs. 
• Suicide: People with severe chronic pain may also be at a higher risk of developing thoughts of suicide and self-harm.

Living Well With Chronic Pain

Chronic pain can have severe and lasting effects on your quality of life—especially if you leave your pain untreated. Over time, people with chronic pain score consistently worse on measures of quality of life and functional ability. It’s a standing issue—and estimates show that current treatments can only reduce pain by an average of 30%.

Living with chronic pain also means learning how to cope with the physical and emotional changes to your overall health. However, being proactive can help you live well with your condition. Consider the following approaches to take care of your overall well-being:

• Opening up to family and friends about your condition and asking for support when you need
• Trying out individual or group therapy
• Logging symptoms, medications, and side effects in a journal to keep track of your progress
• Finding social media communities and online forums to connect with others with chronic pain