Chronic Pain

Discusses chronic pain caused by problems other than cancer. Covers symptoms and how chronic pain is diagnosed. Covers conditions that can be treated, like neck pain, low back pain, and arthritis. Info on treatment with medicine and lifestyle changes.

Chronic Pain

Topic Overview

Is this topic for you?

This
topic is for people with chronic pain caused by problems other than cancer. If
you are looking for information on pain caused by cancer, see the topic
Cancer Pain.

What is chronic pain?

Pain that lasts for 3 months
or longer is called chronic. Pain is your body's way of telling you that
something is wrong. It's normal for you to have pain when you are injured or
ill. But pain that lasts for weeks, months, or years is not normal.

Chronic pain can occur anywhere in your body. It can range from being
mild and annoying to being so bad that it gets in the way of your daily
activities.

Anyone can get chronic pain. It's more common in older
adults, but it's not a normal part of aging. Older adults are more likely to
have long-term medical problems, such as
diabetes or
arthritis, which can lead to ongoing pain.

What causes chronic pain?

The cause of chronic
pain
is not always clear. It may occur because brain chemicals that usually
stop pain after you get better from an illness or injury are not working right.
Or damaged nerves can cause the pain. Chronic pain can also occur without a
known cause.

What are the symptoms?

Common symptoms of chronic
pain
include:

  • Mild to very bad pain that does not go away
    as expected.
  • Pain that is shooting, burning, aching, or
    electrical.
  • Soreness, tightness, or stiffness.

What other problems can chronic pain cause?

If you
have pain for a long time, it can make you feel very tired and may lead to
depression.

It can get in the way of your usual social
and physical activities. You may have so much pain that you can't go to work or
school.

The emotional upset may make your pain worse. And your body's defense
system (immune system) may get weak, leading to lots of
infections and illnesses.

How is chronic pain diagnosed?

Your doctor can
find out if you have chronic pain by asking about your past illnesses and your
overall health. He or she will also do a physical exam.

You may
have tests to find out if a medical problem is causing the pain. Your doctor
may check for problems with your
nervous system and may order blood tests. He or she
may also ask you questions to check your mood and mental health and to see how
well you are able to think, reason, and remember.

In most cases, test results
are normal. This can make it hard to know the exact cause of the pain. But this
doesn't mean that your pain isn't real.

How is it treated?

You can use home treatment for
mild pain or pain that you have now and then. Exercising and getting enough sleep may help reduce chronic pain.

Using
over-the-counter pain medicines such as acetaminophen,
aspirin, or ibuprofen may also help. You may want to try
complementary therapies such as massage and
yoga.

Talk to your doctor if your pain does not go away or if it
gets worse. You may need to try different treatments to find what works for
you. Medicines you take by mouth, shots of numbing medicine,
acupuncture,
nerve stimulation, and surgery are used for some types
of chronic pain.

It is important to make a clear treatment plan with your
doctor. The best plan may include combining treatments.

Living
with chronic pain can be hard.
Counseling may help you cope. It can also help you
deal with frustration, fear, anger, depression, and anxiety.

You may always have some pain. But in most cases, chronic pain
can be managed so that you can get on with your life and do your daily
activities.

Frequently Asked Questions

Learning about chronic pain:

Being diagnosed:

Getting treatment:

Ongoing concerns:

Living with chronic pain:

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Cause

The cause of
chronic pain is not clear.

When you have an injury or
illness, certain nerves send pain signals to your brain. With chronic pain,
these pain signals keep going for weeks, months, or even years after you recover.

Chronic pain can develop after a major injury or illness, such as a back injury
or
shingles, or it can happen without a known cause. It
is also possible that certain brain chemicals that usually suppress pain stop working the way they're supposed to.

Pain can affect:

  • Muscles, bones, and joints. This pain can happen from injuries or muscle strain. Health problems like osteoarthritis, rheumatoid arthritis, and fibromyalgia also can cause it.
  • Nerves and the nervous system. This type of pain happens because of pressure on nerves or damage to them from an injury or a health problem. Sometimes pain occurs when something goes wrong with the central nervous system. This can happen with diabetes, shingles, and sciatica, for example.
  • Organs. Pain in your organs occurs because of injuries, infections, or health problems such as inflammatory bowel disease, irritable bowel syndrome, pelvic pain, and stomach ulcers.

You can have more than one kind of pain at the same time. For example, fibromyalgia can cause pain in muscles and nerves.

Symptoms

The symptoms of
chronic pain include:

  • Pain that does not go away as expected after an
    illness or injury.
  • Pain that may be described as shooting, burning, aching, or
    electrical.
  • Discomfort, soreness, tightness, or stiffness.

Pain can lead to other problems, such as:

  • Fatigue, which
    can cause impatience and a loss of motivation.
  • Sleeplessness, often
    because the pain keeps you awake during the night.
  • Withdrawal from
    activity and an increased need to rest.
  • A weakened
    immune system, leading to frequent infections or
    illness.
  • Depression,
    which is common and can make your pain worse.
  • Other mood changes,
    such as hopelessness, fear, irritability,
    anxiety, and
    stress.
  • Disability, which may include not
    being able to go to work or school or perform other daily activities.

What Happens

Whether your chronic pain develops after an injury or illness or on its own, the result is often the same: a cycle of sleeplessness, inactivity, irritability, depression, and more pain.

Chronic pain
may be mild to severe. It may come back from time to time over
several weeks, months, or years. Exercise, regular massages, and
pain-relieving medicines—such as
acetaminophen or
nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin—may be enough to manage your symptoms.

On the other hand, you may have constant chronic pain that is severe and needs more than home treatment. Without treatment,
chronic pain syndrome (changes in the body caused by long-term pain) can become disabling.

The lives of your family members, friends, or caregivers can
also be affected. The people you count on to help you may also need some
support.
Family therapy or involvement in a caregiver support
program may help.

What Increases Your Risk

Risk factors are things that increase your chances of getting sick or having a problem. Risk factors for chronic pain include:

  • Aging. Older adults are more likely to have certain health problems that can lead to chronic pain, such as arthritis, diabetes, and shingles.
  • Certain health problems. These include:
    • Existing health conditions, such as
      fibromyalgia, shingles, arthritis,
      depression or
      anxiety disorders, or phantom limb pain.
    • Past health problems, such as joint injuries or past surgeries.
    • Overall general health. You may have a
      weakened immune system, which can lead to frequent
      infections or illness.
  • Lifestyle, such as not eating healthy foods, not exercising
    regularly, smoking, or having a
    drug or alcohol problem.

Other risk factors include stress, relationship problems, or a history of physical, sexual, or emotional abuse.

When To Call a Doctor

Call a doctor about
chronic pain if:

  • Your pain has lasted more than 3 months without
    a clear reason.
  • You are feeling down or blue or are not enjoying
    the activities or hobbies that you have enjoyed in the past. You may
    have
    depression, which is common with chronic
    pain
    .
  • You can't sleep because of the pain.
  • You
    had an illness or injury that healed, but you still have pain.

Watchful waiting

Watchful waiting is a period of time during
which you and your doctor watch your symptoms without using
medical treatment.

During this period of watchful waiting, your doctor may have you try to get more sleep, work on reducing stress, and get more exercise. If you are able to control pain with exercise, massage, and pain relievers, you may not need further treatment.

But watchful waiting is not appropriate if your pain is severe or if it
interferes with your life. If you delay treatment, the pain may get
worse.

Who to see

If you have mild to moderate pain that keeps coming back and that
you can't manage at home on your own, you may need to see one of the following health
professionals:

  • Family doctor
  • Internist, a doctor who specializes in the care of adults
  • Nurse practitioner, a nurse who has advanced training
  • Physician assistant, a health professional who practices medicine under a doctor's supervision
  • Osteopathic physician, a doctor who uses medicine, surgery, and other kinds of treatment but may also use manipulation or manual treatment

If your chronic pain is moderate to severe and is constant,
or if treatment does not control the pain, you may need to see a specialist, such as one or more of the
following:

  • Pain management specialist, a doctor who specializes in treating chronic pain
  • Physiatrist, a doctor who specializes in physical medicine and rehabilitation
  • Physical therapist, someone who evaluates physical problems and injuries and then provides education and treatment
  • Neurologist, a doctor who specializes in treating the brain, spinal cord, and nervous system
  • Anesthesiologist, a doctor who specializes in using pain-blocking techniques and medicines
  • Psychiatrist,
    psychologist, or licensed mental health counselor
    , all of whom specialize in treating mental health and behavior issues
  • Orthopedic surgeon, a doctor who specializes in bone, muscle, and joint surgery
  • Rheumatologist, a doctor who specializes in treating autoimmune diseases and problems in the joints
  • Chiropractor, someone who specializes in treating problems that affect the alignment of muscles and bones

Often more than one specialist will treat your chronic
pain
. For example, a primary physician may manage your medicines, and a
physical therapist may help you restore function through exercise or other
treatments. A professional counselor may help you with coping and depression. Someone else may help you with acupuncture or
yoga.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

Your doctor will take a detailed medical history, asking you questions about your overall health; past illnesses, surgeries, or injuries; and your pain. He or she may ask you to start keeping a pain diary ( What is a PDF document? ).

Physical exam

In your physical exam, your doctor will look for areas that are tender, weak, or numb. The doctor will also check for health problems that contribute to chronic pain, such as:

  • Nervous system problems. You may be asked to do
    a few physical tasks, such as walking up and down a hall or getting up from a
    chair. By checking your reflexes and your ability to feel light touch, your doctor can look for a nerve problem. The doctor may also ask
    you to repeat a series of numbers or to answer simple questions about dates,
    places, and current events.
  • Mental health problems. A mental health assessment involves asking you questions to help your doctor find out whether such conditions as
    depression,
    insomnia, or
    stress are contributing to or happening as a result of
    your chronic pain. These conditions often occur with chronic pain. You may also
    be asked about your use of alcohol and drugs. Answering these questions fully
    and honestly may help your doctor and you identify the sources of your chronic
    pain
    .

Tests

One or more of these tests may help your doctor rule out health problems that can cause chronic pain.

  • Blood tests or
    other lab tests: A small sample of your blood is taken and then
    checked to see if you have an infection or other condition that could be
    causing your pain.
  • X-rays or other imaging tests (such as
    CT scans,
    MRIs, or
    ultrasounds): These tests take pictures of the inside
    structures of your body to look for disease and injury.
  • Electromyogram (EMG) and nerve conduction studies or
    other nerve tests: These tests measure muscle and nerve function to find out
    whether your chronic pain is related to muscle or nerve problems.
  • Angiogram or other studies of your blood vessels:
    This test injects a dye and inserts a small tube into your arteries to trace
    the movement of blood within your body.
  • Diagnostic
    nerve blocks: One example is an injection of a
    local anesthetic into or around a nerve to identify
    whether that nerve is causing the pain.

Treatment Overview

Treating
chronic pain can be challenging. And it may take several types or combinations of
treatments before you find relief.

Be sure to seek treatment if your pain lasts longer than 2
to 3 months. Early treatment may prevent the pain from getting worse.

The goals of treatment are to
reduce
your pain and increase your ability to function.
This includes improving your sleep and your coping skills and reducing
stress so you can return to your regular activities.

It's important to build a clear
treatment plan with your doctor. Part of this plan
includes identifying ways for you to manage your pain. Only you know the
severity of your pain and how it affects your life. Be
sure to ask your doctor if you are not clear about what steps you can take when
pain occurs or gets worse.

Chronic pain treatments

You
may be able to control your pain at home by using pain relievers and practicing healthy habits. For more information, see Home Treatment.

When home treatment isn't enough, other treatments may include:

  • Pain medicines or medicines to treat problems that are linked to chronic pain. For more information, see Medications.
  • Treatments such as counseling, physical therapy, and complementary therapies. For more information, see Other Treatment.
  • Surgery, such as intrathecal drug delivery and spinal cord stimulation. For more information, see Surgery.

If your
chronic pain is not relieved after you have tried
numerous treatments, you may want to think about going to a
pain management clinic. Treatment is provided by a team of doctors who work
together to address all the things that may cause your chronic pain.

Prevention

Chronic pain
can't always be prevented. But staying in good physical and mental
health may be the best way to prevent it or help you cope with it.

  • Treat your health problems early.
  • Get enough sleep every night. Learn to alternate activity with rest throughout each day.
  • Exercise.
  • Eat a
    balanced diet.
  • Try to reduce
    stress in your life.

Home Treatment

Get enough sleep

If you are tired
during the day and have trouble sleeping, try to:

  • Set a bedtime and a wake-up time—and stay
    with these times, even on weekends. This helps your body get used to a regular
    sleep time.
  • Get some exercise during the day.
  • Avoid
    taking naps, especially in the evening.
  • Avoid drinking or eating
    caffeine after 3 p.m. This includes coffee, tea, cola drinks, and
    chocolate.

Deal with problems right away

Treat medical conditions and mental health
concerns early, before they get worse and become harder to treat.

Untreated
health conditions (such as
shingles) or mental health problems (such as
depression or
anxiety) can make chronic pain harder to
treat.

Stay active

Get regular aerobic exercise—such as swimming,
stationary cycling, and walking—to build your strength and health.

Water
exercise
may be especially helpful in reducing pain that gets worse during
weight-bearing activities, such as walking.

Talk to your doctor before you
begin an exercise program. Start slowly and increase your efforts bit by bit.
If your joints are stiff, try taking a warm bath or shower first to loosen up.
Also, do some stretching exercises each day.

Schedule your day so
that you are most active when you have the most energy. Learn to move in ways
that are less likely to make your pain worse.

Practice healthy habits

  • Eat a
    balanced diet. Good nutrition will help you stay
    healthy and strong. For more information on good nutrition, see the topic Healthy Eating.
  • Stop smoking. Smoking may affect your level of
    pain and may reduce how well your chronic pain treatment
    works.
    For more information, see the topic Quitting Smoking.
  • Reduce
    stress. Try a relaxation therapy such as
    breathing exercises or
    meditation.
    For more information, see the topic
    Stress Management.

Think about tools that may help

Assistive devices, such as walking canes or doorknob extenders, may help you do your daily activities. These devices can help you to be more mobile
and independent.

Try self-massage

With self-massage you can help relax your own back muscles using a tennis ball.

Caregivers need care too

If you are a caregiver for a person who has chronic pain,
your own stress and worry can also cause you to have symptoms of depression,
vague body pains, digestive disorders, or headaches.

Experts say that it is
important to take care of yourself, too, and not to feel guilty about it. For
more information, see the topic
Caregiver Tips.

Medications

Medicines can often help control
chronic pain. In some
cases, it may take several weeks for the medicine to work.

Medicine may work best when it's used along with other types of treatment, such as physical therapy and
counseling, to address the different causes of chronic pain.

Sometimes a medicine loses some or all of its ability to work
when it is used daily over a long period of time. This is because your body develops a
tolerance to it. If this happens, you may need to take more of the medicine, change medicines, or add another medicine. Your doctor can work with you to do this.

Pills for pain

You will likely start with medicines that cause the fewest
side effects (such as
acetaminophen). The dose will be
increased or the medicines will be changed as needed. Be safe with medicines. Read and follow all instructions on the label.

Medicines you put on your skin

A variety of creams, gels, sprays, and patches may be used to relieve chronic pain, including:

  • Topical analgesics. These are pain relievers that are applied directly to
    the skin, such as EMLA cream or a lidocaine patch
    (Lidoderm). Some creams or gels can be made at the pharmacy according to your doctor's directions. Some may contain capsaicin, a naturally occurring
    substance found in chili peppers.
  • Cooling spray. This involves using a cooling
    spray (such as Biofreeze) directly on the skin. This may be repeated several
    times.

Injections

Injected medicines—shots—may be used to treat chronic pain, including:

  • Epidural steroid
    injections
    (injecting steroids around the spine). Although these injections
    have been used for many years and may provide relief for
    low back or neck pain caused by disc disease or
    pinched nerves, they may not work for everyone.
  • Joint block injections. A corticosteroid is injected into the painful joint or joints.
  • Nerve block injections. An anesthetic
    is injected into the affected nerve to relieve pain. The anesthetic may relieve
    pain for several days, but the pain often returns. Although nerve blocks do not
    normally cure chronic pain, they may allow you to begin physical therapy and
    improve your
    range of motion.
  • Trigger point
    injections.
    These may relieve pain by injecting a local anesthetic into trigger
    points (or specific tender areas) linked to chronic myofascial pain or
    fibromyalgia. These injections do not relieve chronic pain
    in everyone.

Surgery

Surgery for chronic pain isn't common. It's usually considered only
after other treatments have failed or if it is considered medically necessary.

Surgery may provide pain relief, but it also may permanently
damage your ability to perceive other sensations, such as light touch and
temperature changes. It can also cause a different pain to occur.

Implanted pain control systems

Implanted pain control systems involve inserting devices under your skin or elsewhere in your body. The devices use medicine, electric current, heat, or chemicals to numb or block pain.

Decompression

Decompression is a type of surgery used for nerve pain, such as from trigeminal neuralgia. The doctor cuts open your skin and then tries to move away blood vessels or other body structures that are pressing on nerves and causing pain.

Other Treatment

Manual therapy

For back pain, physical therapy, osteopathic care, or chiropractic care usually includes spinal manipulation, which is a kind of manual therapy. It involves working on the head, shoulders, neck, back, or hips. It can range from massage and slow pressing to a quick thrust. Your care provider may also use hot
and cold therapy to relieve pain.

You may also learn
stretching and
range-of-motion exercises to maintain strength,
flexibility, and mobility.

TENS

Transcutaneous electrical nerve stimulation (TENS) applies brief pulses of electricity to nerve endings in the
skin to relieve chronic pain.

Counseling

It's common to respond to chronic
pain
with feelings of frustration, depression,
anxiety, fear, and even anger. These feelings can make
it harder to manage chronic pain, especially if you use alcohol or drugs to
deal with your symptoms.

A counselor may use
treatments such as
cognitive-behavioral therapy to help you cope with
your pain.

Chronic Pain: Using Healthy Thinking

Support groups

A support group is made up of people with similar experiences
who can understand your feelings and provide comfort. They can keep
you from feeling isolated and alone.

Being around others who share your problem
can help you and your family learn how to accept and manage chronic pain.

To
find a group near you, contact the American Chronic Pain Association at
1-800-533-3231 or online at www.theacpa.org.

Complementary therapies

Complementary therapies may help you feel better by reducing your pain or stress. These therapies include:

If you decide to try one or more
of these complementary therapies to treat your chronic pain, find a health
professional who has special training and, whenever possible, certification in
the particular therapy.

You may get a referral from someone you trust such as
your doctor, family, or friends. Make sure all of your health professionals
know every type of treatment you are using to reduce chronic pain.

Other Places To Get Help

Organizations

National Institute of Neurological Disorders and Stroke (U.S.)
www.ninds.nih.gov

American Chronic Pain Association
www.theacpa.org

References

Other Works Consulted

  • American Society of Anesthesiologists (2010). Practice guidelines for chronic pain management. Anesthesiology, 112(4): 810–833.
  • Brodie EE, et al. (2007). Analgesia through the looking-glass? A randomized controlled trial investigating the effect of viewing a 'virtual' limb upon phantom limb pain, sensation and movement. European Journal of Pain, 11(4): 428–436.
  • Dubinsky RM, et al. (2010). Assessment: Efficacy of transcutaneous electric nerve stimulation in the treatment of pain in neurologic disorders (an evidence-based review): Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology, 74(1): 173–176.
  • National Institute for Health and Clinical Excellence (NICE) (2008). Spinal cord stimulation for chronic pain of neuropathic or ischaemic origin. London: National Institute for Health and Clinical Excellence (NICE). Available online: ://guidance.nice.org.uk/TA159.
  • National Pharmaceutical Council (NPC), Joint Commission on Accreditation of Healthcare Organizations (JCAHO) (2001, with 2005 update). Pain: Current understanding of assessment, management, and treatments. Available online: ://www.npcnow.org/App_Themes/Public/pdf/Issues/pub_related_research/pub_quality_care/Pain-Current-Understanding-of-Assessment-Management-and-Treatments.pdf.
  • Woolf CJ (2004). Pain: Moving from symptom control toward mechanism-specific pharmacologic management. Annals of Internal Medicine, 140: 441–451.
  • Ziconotide (Prialt) for chronic pain (2005). Medical Letter on Drugs and Therapeutics, 47(1223/1224): 103–104.

Credits

ByHealthwise StaffPrimary Medical Reviewer Anne C. Poinier, MD - Internal Medicine E. Gregory Thompson, MD - Internal Medicine Adam Husney, MD - Family Medicine Martin J. Gabica, MD - Family Medicine Kathleen Romito, MD - Family Medicine Specialist Medical Reviewer Nancy Greenwald, MD - Physical Medicine and Rehabilitation

Current as ofOctober 9, 2017