Chronic Pain

What is chronic pain?

Chronic pain is pain that lasts for over three months. You may feel the pain all the time or it may come and go. It can happen anywhere in your body and has countless causes.

Chronic pain is a very common condition and one of the most common reasons why people seek medical care. In 2021, about 20.9% of U.S. adults (51.6 million people) experienced chronic pain, according to a study from the U.S. Centers for Disease Control and Prevention (CDC).

Pain is your body’s way of telling you that something’s wrong, like an alarm. But when that alarm continues to go off for months or years, it can drown out many aspects of life that bring you joy. And it can take quite a toll on your physical, mental and emotional health. Because of this, it’s essential to seek help for chronic pain. Together, you and your healthcare provider can develop a plan to help dampen chronic pain.

Common types of chronic pain

Chronic pain can come in many different forms and occur across your body. It’s the main symptom of a wide range of injuries, infections and diseases. Common types of chronic pain include:

• Arthritis or joint pain, like knee pain.
• Back pain, especially lower back pain.
• Cancer pain.
• Fibromyalgia.
• Headaches, including migraines.
• Neck pain.
• Neuropathic (nerve) pain.

What does chronic pain feel like?

Chronic pain symptoms vary from person to person. But the defining characteristic of chronic pain is that it lasts for more than three months. You may describe the pain as:

• Aching.
• Burning.
• Shooting.
• Squeezing.
• Stiffness.
• Stinging.
• Throbbing.

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

• Generalized anxiety disorder.
• Major depressive disorder.
• Fatigue, or feeling overly tired most of the time.
• Insomnia, or trouble falling asleep.
• Irritability or mood swings.

It’s important to see a healthcare provider if pain is interfering with your daily life.

What causes chronic pain?

Chronic pain is often very complex. Sometimes, it has an obvious cause — you may have a long-lasting condition like cancer or arthritis that leads to pain. Other times, it’s more difficult to find the underlying cause — or there may be several factors contributing to pain.

General types, or causes, of pain include:

• Neuropathic pain: This is nerve pain that can happen if your nervous system malfunctions or gets damaged. Examples include peripheral neuropathy, pinched nerves and trigeminal neuralgia.
• Musculoskeletal pain: This is pain that affects your bones, joints, ligaments, muscles and/or tendons. Musculoskeletal pain often results from injuries (like joint dislocation) or “wear and tear” over time (like tendonitis).
• Visceral pain: This type of pain stems from your organs, like your heart, lungs, bladder, reproductive organs and the organs in your digestive system. Visceral hypersensitivity may make it more likely that you have chronic visceral pain.
• Inflammatory pain: This type of pain happens in response to tissue damage and inflammation. Chronic conditions or short-term illnesses may cause this type of pain. For example, you may have an autoimmune condition like rheumatoid arthritis or lupus that causes chronic inflammation and pain. An infection like shingles can cause postherpetic neuralgia.
• Central sensitization: This type of pain results from changes that occur in your central nervous system. Over time, the changes make you more sensitive to pain and other sensations. Central sensitization can occur with any type of pain and can lead to other symptoms like sensitivity to lights, noises and emotions.

Some people also have chronic pain that’s not tied to a direct physical cause. This doesn’t mean that your pain isn’t real. Oftentimes, this type of pain (psychogenic pain) is related to changes in your nervous system and other understandable emotional and psychological factors.

It’s possible to have several causes of pain overlap. You could have fibromyalgia in addition to back pain from degenerative disk disease, for example.

What are the risk factors for chronic pain?

As many conditions or injuries can cause chronic pain, there are several risk factors for it. In general, some risk factors include:

• Genetics: Some chronic pain causes, like migraines and rheumatoid arthritis, run in biological families (are genetic).
• Aging: As you age, your risk for developing chronic pain increases, especially “wear and tear” causes of chronic musculoskeletal pain.
• Previous injury: If you’ve had a traumatic injury, you’re more likely to develop chronic pain.
• Having a manual labor job: If you have a physically strenuous job, you’re at greater risk for developing chronic pain.
• Frequent or severe stress: Studies show that chronic pain is connected to both frequent stress and post-traumatic stress disorder.
• Smoking: People who smoke are nearly three times as likely to get lower back pain. And smoking may increase pain sensitivity in general.
• Obesity: Having obesity can worsen certain health conditions that cause pain, like arthritis, as there’s extra pressure on your joints.

How is chronic pain diagnosed?

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

If you have long-lasting pain, see a provider. They’ll 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 affects 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 or have chronic conditions.

Your provider may do a physical exam and recommend tests to look for the cause of the pain, like:

• Blood and urine tests.
• EMG (electromyography) to test muscle activity.
• Imaging tests, like X-rays and MRI.
• Nerve conduction studies to see if your nerves react properly.
• Reflex and balance tests.
• Spinal fluid tests.

What is the treatment for chronic pain?

Your healthcare provider may recommend one approach or a combination of several chronic pain management techniques. It may involve treating the underlying cause of chronic pain and/or managing pain as a symptom. Research shows that a combination of therapies results in a more significant reduction in pain than relying solely on single treatments.

How well a particular treatment works varies from person to person — even for the same cause of chronic pain. Providers typically start with minimally invasive or conservative pain management therapies before trying riskier ones. But there’s no single “right” approach for pain management for all people.

Approaches to chronic pain management include:

• Lifestyle changes, like weight management, stress management and physical activity.
• Physical therapy and occupational therapy.
• Psychological therapies for pain, which can include cognitive behavioral therapy, group therapy acceptance and commitment therapy, mindfulness therapy and more.
• Complementary medicine therapies, like massage therapy, biofeedback and meditation.
• Medical procedures and devices, like surgery, TENS, steroid injections and botulinum toxin (Botox®) injections.
• Medications, like NSAIDs, muscle relaxers and opioids.
• Clinical trials.

Depending on the cause of your pain and your unique characteristics, it may take time — and several different therapies — before you find the right approach that works for you. Your pain management plan is more likely to be effective if you work closely with your provider or team and adjust the plan as your needs change. It’s also important to discuss the benefits and possible risks and side effects of each treatment.

Does chronic pain ever go away?

Currently, there’s 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 their pain.

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 reduce a person’s pain score by about 30%. Treatments also have a significant impact on your quality of life and can lessen the stress associated with having a chronic pain condition.

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

What are the complications of this condition?

Unmanaged or undermanaged chronic pain can impact your quality of life and your ability to function day to day. This can affect your ability to take care of yourself, work and maintain relationships. It can also worsen chronic conditions.

Living with chronic pain also increases your risk of:

• Depression and/or generalized anxiety disorder. One study reported that about 67% of people with chronic pain have a comorbid mental health condition.
• Suicide. Studies show that the lifetime prevalence of suicide attempts among people with chronic pain ranges from 5% to 14%. Approximately 20% of people with chronic pain experience suicidal ideation.
• Substance use and substance use disorder.
• Alzheimer’s disease and related dementias.

It’s essential to seek medical care if you’re experiencing chronic pain or any of these complications. While it may take a while to find the right combination of therapies that work for you, it’s worth undertaking.

If you or a loved one are thinking about suicide, dial 988 on your phone to reach the Suicide and Crisis Lifeline. Someone is available to help you 24/7.

When should I see my healthcare provider?

See your healthcare provider if:

• Pain worsens or comes back after treatment.
• You have unpleasant side effects of pain management therapies.
• You feel anxious or depressed.
• You’re having trouble sleeping because of pain.
• Pain is keeping you from enjoying your usual activities.

What questions should I ask my healthcare provider?

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 not, 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?