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Chronic Pain

Chronic pain is pain that lasts for at least six months, though it may last for years. An injury, disease or infection may have originally caused the pain, but chronic pain continues long after the injury or illness has gone away. In some cases there is no known cause. Psychological and environmental factors may worsen the pain.

Woman with headache

Chronic pain is sometimes called intractable pain or chronic pain syndrome, and it’s one of the most common reasons people visit their medical provider. About 50 million Americans suffer from chronic pain, according to the Centers for Disease Control and Prevention. Of those people, about 19.6 million have high-impact chronic pain.

The CDC defines chronic pain as pain that occurs every day or on most days for at least six months. High-impact chronic pain is chronic pain that limits a person’s work or life activities every day or on most days for at least six months.

Chronic pain can be disabling, but the Social Security Administration does not classify chronic pain itself as a disability. It does, however, recognize diseases and injuries that cause chronic pain as disabilities with potential compensation benefits. These include back injuries, neurological disease, lupus, cancers and inflammatory arthritis. If pain interferes with a person’s ability to work, it may also be considered as a factor.

Fortunately, patients and their medical providers can work together to treat and manage chronic pain. Treatment options include medications, non-drug treatments, psychological and behavioral treatments and mind-body treatments.

How chronic pain affects different parts of the body
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Chronic pain can affect all areas of the body and be caused by multiple conditions.
Man with pain in his arm

Types

Chronic pain is divided into two broad types: neuropathic pain and nociceptive pain. A person can experience both types of pain at the same time.

Neuropathic Pain

Neuropathic pain is pain that occurs after damage or dysfunction of the nervous system. This can happen because of a disease or injury. For example, about 30 percent of neuropathy cases result from diabetes, according to Cleveland Clinic.

Other diseases and injuries that may lead to neurologic pain include shingles, HIV infection, leprosy, stroke, broken bones, cancer and amputation.

Nociceptive Pain

Nociceptive pain comes from pain receptors in the body activated during injuries called nociceptors. Normally these receptors don’t activate unless there is an injury and then they stop when the injury is gone. Sometimes these receptors send pain signals even when the injury that triggered them is healed.

Nociceptive pain has two sub categories: visceral pain and somatic pain. Visceral pain comes from major internal organs. Most people describe this pain as achy. Even if it originates from an organ, it may affect other structures. For example, an organ in your abdomen may cause pain in the back.

Somatic pain comes from injuries to the outer body structures such as the skin, muscles, tendons, ligaments, joints and bones. Arthritis, bone pain and fibromyalgia are examples of somatic pain.

Woman with lower back pain

Causes

A disease or injury usually causes chronic pain. Sometimes, chronic pain occurs as a complication of a faulty medical device, such as a knee replacement, hip replacement or shoulder replacement. Some drugs may injure internal organs, ligaments or cause joint pain. Other times, doctors aren’t sure what the cause is.

Potential causes of chronic pain include:
  • Fibromyalgia
  • Sports injuries
  • Headaches
  • Endometriosis
  • Arthritis
  • Cancer
  • Inflammatory bowel disease
  • Surgery
  • Amputation
  • Hernia mesh or transvaginal mesh implants
  • Medications that damage internal organs
  • Muscle injuries
  • Damaged nerves
  • Fluoroquinolone antibiotics
  • Diabetes
  • Chemotherapy
  • DPP-4 inhibitor drugs for diabetes (Onglyza, Januvia, Trajenta, etc.)
  • Mental illness
Doctor showing a woman an x-ray of her spine

Risk Factors

Researchers don’t always know the exact cause of chronic pain, but people with certain risk factors have a higher chance of developing chronic pain. These factors include physical conditions, lifestyle habits and psychological factors.

Factors that impact chronic pain development include:
  • Age – chronic pain typically affects older people
  • Alcohol
  • Being a veteran
  • Being overweight or obese
  • Employment status
  • Gender – women have a higher risk
  • Genetics
  • History of surgeries
  • History of violent injury or abuse
  • Lack of sunshine and vitamin D
  • Occupation
  • Physical activity
  • Poor mental health
  • Poor nutrition
  • Prior injuries
  • Sleep disorders
  • Smoking
Woman experiencing pain while getting out of bed

Symptoms

Symptoms of chronic pain depend on what caused it and the body area affected. For example, rheumatoid arthritis pain usually attacks joints in the hands and feet on both sides of the body. A person with a bad hip replacement may feel pain in the affected hip.

Because chronic pain lasts for months or years, it takes a toll on a person’s mood and mental health.

Symptoms include:
  • Pain that can feel like: burning, dull, stabbing, an electric shock, tingling, “pins and needles,” throbbing or stinging
  • Trouble sleeping
  • Depression
  • Anxiety
  • Low self-esteem
  • Anger
  • Fatigue
  • Mood changes
  • Loss of appetite
  • Weight loss
  • Decreased sex drive
  • Fear of injury
Man experiencing a painful headache

Acute Pain vs. Chronic Pain

While acute pain can be mild or severe and may last weeks or months, chronic pain lasts for more than six months and may last for years.

Acute pain is “sharp” and typically goes away after the injury or disease heals. For example, acute pain is the pain you may get from a cut or during childbirth. Once the body heals, the pain goes away.

Chronic pain continues even after an injury is healed. Certain chronic diseases with no cure such as arthritis and fibromyalgia cause chronic pain.

Man with back pain sitting at his desk

Can Chronic Pain Kill You?

Chronic pain itself isn’t fatal, but a person may die from complications of chronic pain — especially if the pain is poorly controlled.

For example, severe pain puts stress on the body. The body releases chemicals to contain the stress. These chemicals cause an increase in heart rate and blood pressure. The strain on the heart can lead to heart attacks.

Adrenal insufficiency is another cause of sudden death in chronic pain patients. Episodes of severe pain cause adrenal hormones to drop which may lead to cardiac arrhythmia and death.

People who have chronic pain may be treated with opioid painkillers. Sometimes, a person may die from an overdose.

Doctor discussing chronic pain with man that has headache

Treatment

There is no one treatment or cure for chronic pain. If a disease or injury is causing pain, medical providers will first treat that problem. Most pain management doctors recommend a treatment plan that doesn’t rely solely on medications.

Learning ways to cope with pain, making lifestyle changes and improving mental health are non-pharmaceutical ways to treat chronic pain.

Medications

Medications are the most common way to treat pain. Depending on the type of pain, different medications may be more effective.

Medications to treat pain include:
  • Acetaminophen
  • Anticonvulsants (anti-epileptics) such as gabapentin
  • Antidepressants such as the SNRI Cymbalta (duloxetine), tricyclic antidepressants and SSRIs
  • Antirheumatics/immunological agents
  • Botulinum toxins
  • Corticosteroids
  • Muscle relaxants
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Opioids
  • Sedatives for sleep problems
  • Topical pain relievers

Non-pharmaceutical Treatments

In addition to medication, medical providers may recommend lifestyle changes and other modalities to treat chronic pain.

Non-drug treatments include:
  • Acupuncture
  • Cold and heat application
  • Deep brain stimulation
  • Exercise
  • Healthy diet with adequate nutrition
  • Massage
  • Spinal cord stimulation

Mind-Body Treatments

Emotions and the mind play a role in how a person experiences pain. For example stress, fear and depression can make the pain feel worse.

Likewise, people with chronic pain have a greater chance of developing mental health problems. People with chronic pain are four times more likely to have depression or anxiety than those without chronic pain, according to Mental Health America.

Mind-body treatments can be effective additions to a pain management plan.

Mind-body therapies include:
  • Aromatherapy
  • Art therapy
  • Meditation
  • Mindfulness training
  • Music therapy
  • Pet therapy
  • Relaxation techniques

Behavioral and Psychological Treatments

Behavioral and psychological treatments focus on improving a person’s coping skills and teach them how to manage their pain. Therapy can help improve mental health which may improve pain.

General Counseling

General counseling sessions focus on helping people manage and reduce depression, stress and anxiety.

Fear-avoidance Training

People with chronic pain may develop a fear of activity and movement because they fear pain or getting hurt again. This therapy focuses on helping people do activities they stopped doing because of pain, and it teaches them techniques for managing pain.

Cognitive Behavioral Therapy (CBT)

CBT teaches patients to rethink their thought process when it comes to pain. It also teaches relaxation techniques. CBT helps a person gain more control over feelings of pain.

Please seek the advice of a medical professional before making health care decisions.

Michelle Llamas, Senior Content Writer
Written By Michelle Llamas Senior Writer

Michelle Llamas has been writing articles and producing podcasts about drugs, medical devices and the FDA for seven years. She specializes in fluoroquinolone antibiotics and products that affect women’s health such as Essure birth control, transvaginal mesh and talcum powder. Michelle collaborates with experts, including board-certified doctors, patients and advocates, to provide trusted health information to the public. Some of her qualifications include:

  • American Medical Writers Association (AMWA) Engage Committee and Membership Committee member
  • Centers for Disease Control and Prevention (CDC) Health Literacy certificates
  • Original works published or cited in The Lancet, British Journal of Clinical Pharmacology and the Journal for Palliative Medicine
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11 Cited Research Articles

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