Chronic Pain

Cause

Sometimes it is clear what is causing your chronic pain. For example, nerve damage from diabetes or shingles can cause pain that lasts. Or if you have arthritis in your ankle, it can cause pain when you walk.

Other times, the body tissues are not being harmed or damaged, or there's been time for healing after an injury or illness. But the pain hasn't stopped. This often happens with things like headaches, low back pain, or pelvic pain. This can be confusing or frustrating.

There are a few different types of pain. You can have more than one type of pain at the same time. They include:

• Pain from tissue damage. This can happen with surgery or with injuries, such as burns, broken bones, or sprains. Sometimes it happens with an illness, like meningitis.
• Pain from nerve damage. This can happen when nerves get damaged by a health problem, such as diabetes, alcohol use disorder, or shingles. Or it can happen if something is pressing on a nerve, which sends pain signals.
• Pain from problems with the way the nerves and brain handle physical sensations. These can be things like touch, movement, or even having gas. Pain can happen if the nerves become extra sensitive or if the brain changes mild sensations into pain.

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.
• Social factors. These may include loneliness and feeling disconnected from others.
• Smoking, vaping, or using other tobacco or nicotine products.
• Drinking alcohol or using drugs.
• Long-term use of opioids.
• 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.

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 manage it.

Here are some things you can try.

• Treat your health problems early, including mental health conditions. Depression can make pain worse.
• Try to get enough sleep every night. Learn to alternate activity with rest throughout each day.
• Be as active as you can.
• Eat a variety of healthy foods.
• Try to reduce stress in your life.
• Get help for your pain early. If your doctor recommends opioids for acute pain, ask if there are safer treatments that might also work.

Symptoms

The main symptom of chronic pain is that the pain lasts over time. It may vary from day to day, but it doesn't go away and stay away. Pain may be shooting, burning, or aching. Or it may feel like an electrical shock. You may also feel sore, tight, or stiff.

Complications of chronic pain

Chronic pain can lead to other problems, such as:

• Fatigue. This is extreme tiredness.
• Problems sleeping.
• Doing less activity and needing to rest more often.
• Depression, which is common. It can make your pain worse.
• Other mood changes, such as feeling hopeless, scared, irritable, anxious, or stressed.
• Trouble focusing. This can make it hard to do certain things.
• Difficulty doing your daily activities. This may include not being able to go to work or school.

What Happens

Chronic pain may be mild to severe. It may come back from time to time over several weeks, months, or years. Or the pain may be constant. For some people chronic pain will go away completely, and for others it won't.

Your doctor can help you find treatments to manage your pain well enough so that you can do the things you want to do.

When to Call a Doctor

Call 911 or other emergency services now if:

• You or someone you know is thinking seriously about or has attempted suicide. Serious signs include these thoughts:
  • You have decided on how to kill yourself, such as with a weapon or medicines.
  • You have set a time and place to do it.
  • You think there is no other way to solve the problem or end the pain.

Where to get help 24 hours a day, 7 days a week

If you or someone you know talks about suicide, self-harm, a mental health crisis, a substance use crisis, or any other kind of emotional distress, get help right away. You can:

• Call or text the Suicide and Crisis Lifeline at 988.
• Text HOME to 741741 to access the Crisis Text Line.

Consider saving these numbers in your phone.

Go to 988lifeline.org for more information or to chat online.

Call a doctor about chronic pain if:

• Your pain has lasted more than 3 months without a clear reason.
• You are feeling sad or are losing interest in the activities or hobbies that you have enjoyed in the past. This may be a sign of 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.
• Your pain is severe or it interferes with your life.

Watchful waiting

Watchful waiting is a wait-and-see approach.

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 can control pain with exercise, massage, and pain relievers, you may not need further treatment.

Who to see

If you have 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 care providers:

• Family medicine physician
• Internist
• Nurse practitioner
• Physician assistant
• Osteopathic physician

Depending on what treatments your doctor recommends and how well your pain is managed, you may need to see one or more of the following specialists:

• Pain management specialist
• Physiatrist
• Physical therapist
• Neurologist
• Anesthesiologist
• Psychiatrist, psychologist, or licensed mental health counselor
• Orthopedic surgeon
• Rheumatologist
• Chiropractor

Often more than one health care provider will treat your chronic pain. For example, a family medicine 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.

Exams and Tests

Your doctor will take a detailed medical history. The doctor will ask you questions about your overall health and past illnesses, surgeries, or injuries.

Your doctor will also ask you questions about your pain, such as:

• When did your pain start?
• How long does your pain last?
• What makes your pain better or worse?

Your doctor may also want to know if your pain disrupts your daily activities, sleep, or mood.

You also may be asked to keep a pain journal.

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 can lead to chronic pain, such as nervous system problems.

Tests

One or more of these tests may help your doctor rule out health problems that can cause chronic pain. These tests may also help your doctor find the cause of your pain. They include:

Blood tests or other lab tests. A small sample of your blood is taken. It's then checked to see if you have an infection or other condition that could be causing your pain.

Imaging tests. X-rays or other imaging tests (such as CT scans, MRIs, or ultrasounds) take pictures of the inside structures of your body to look for disease and injury.

Nerve tests. Electromyogram (EMG) nerve conduction studies and other nerve tests measure muscle and nerve function to find out if your chronic pain is related to muscle or nerve problems.

Diagnostic nerve blocks. One example of these types of nerve blocks is an injection of a local anesthetic near a nerve to find out if that nerve is causing the pain.

Treatment Overview

Treating chronic pain can be challenging. You may need to try several types of treatment or combine treatments before you find what works for you. Treatment can help you manage your pain well enough so that you can do the things that are important to you.

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

Be sure to seek treatment early. It may help prevent the pain from getting worse.

There are many treatments you can try to manage your pain. Often people think of taking strong prescription pain medicines to treat pain, such as opioids. But there are non-medicine treatments that can work better and are safer. They may include:

• Physical treatments. These can be things like physical therapy, massage, or heat or cold.
• Behavioral health treatments. These are things like cognitive behavioral therapy (CBT) or mindfulness-based stress reduction (MBSR).
• Mind-body treatments. These may include relaxation exercises or yoga.

Your doctor may suggest other treatments, such as:

• Other medicines. These may include anticonvulsants or certain antidepressants that can help with chronic pain. Sometimes medicines you put on your skin may be used.
• Injections. Shots like a nerve block or a joint injection may be tried.
• Surgery. For example, intrathecal drug delivery or spinal cord stimulation may be helpful.

If your chronic pain isn't managed well enough after working with your doctor, you may want to see a pain management specialist.

Self-Care

You can care for yourself when you have chronic pain. Here are some things to try.

• Get enough sleep.
  • Set a bedtime and a wake-up time—and try to keep that schedule, even on weekends. This helps your body get used to a regular sleep time.
  • Avoid taking naps, especially in the evening.
  • Avoid drinking caffeine after 3 p.m. This includes coffee, tea, cola drinks, and chocolate.
• Get help for health conditions.
  • See your doctor regularly for any health problems you have. If you have changes in your health, see your doctor as soon as you can. Take prescription medicines as directed.
• Take care of your mental health.
  • Depression is common in people with chronic pain. And it can make pain worse. If you think you may be depressed, tell your doctor. They can help you find treatment.
• Stay active.
  • Talk to your doctor before you begin an exercise program. Start slowly and increase your efforts bit by bit.
  • Get regular aerobic exercise—such as swimming, stationary cycling, and walking—to build your strength and health. Water exercise may help with pain that gets worse during weight-bearing activities, such as walking.
  • 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.
  • If your joints are stiff, try taking a warm bath or shower first to loosen up. Also, do some stretching exercises each day.
• Practice healthy habits.
  • Try to eat a variety of healthy foods. Good nutrition will help you stay healthy and strong.
  • If you smoke, try to quit. If you can't quit, cut back as much as you can. Smoking may affect your level of pain.
  • Reduce stress. Try relaxation therapy such as breathing exercises or meditation.
• Use 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.

Medicines

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

Medicines are usually used along with other types of treatment, such as physical therapy and counseling, to address the different causes of chronic pain.

Medicines can help with pain. Which medicines will work for you depends on things like the type of pain you have and what health problems you have. The goal is to manage your pain as safely as possible. Be safe with medicines. Read and follow all instructions on the label.

Pills

Pills for pain include:

• Acetaminophen (Tylenol).
• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve).
• Antidepressants, such as amitriptyline or duloxetine.
• Corticosteroids, such as prednisone.
• Anticonvulsants, such as gabapentin and pregabalin.
• Opioid pain relievers, such as hydrocodone (Norco).

Medicines you put on your skin

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

• Topical analgesics. These are pain relievers that you apply directly to the skin. Examples include some forms of nonsterodial anti-inflammatory drugs and lidocaine. Some may contain capsaicin.
• Cooling spray. One example is Biofreeze. You spray it directly on the skin. This may be repeated several times.

Injections

Injected medicines—shots—may be used to treat chronic pain. These include:

• Epidural steroid injections. Steroids are injected around the spine.
• Joint injections. A corticosteroid is injected into the painful joint or joints.

Surgery

Surgery for chronic pain isn't common. It's usually an option only after other treatments have not worked or if your doctor thinks it's medically necessary.

Surgery may provide pain relief. But it also may make you less able to feel other sensations, such as light touch and temperature changes. It can also cause a different pain to occur.

Implanted pain control systems involve inserting devices under your skin or elsewhere in your body. For example, intrathecal drug delivery sends medicine to the area of your pain.

Other procedures include:

• Electrical nerve stimulation. It uses electric current to interrupt pain signals.
• Nerve ablation. It destroys or removes the nerves that are sending pain signals.
• Decompression. This is a type of surgery used for nerve pain, such as from trigeminal neuralgia. The doctor tries to move away blood vessels or other body structures that are pressing on nerves and causing pain.

Other Treatment

Physical treatments can be an important part of managing chronic pain. You may find that combining more than one treatment helps the most.

These treatments can include:

• Heat or cold. This can help arthritis, sore muscles, and other aches.
• Hydrotherapy. It uses flowing water to relax muscles.
• Massage. Massage involves rubbing the soft tissues of the body. It eases tension and pain.
• Transcutaneous electrical nerve stimulation (TENS). This treatment uses a gentle electric current applied to the skin.
• Acupuncture. This is a form of traditional Chinese medicine. It uses very thin needles inserted into certain points of the body.
• Physical therapy. This treatment uses stretches and exercises to reduce pain and help you move better.

If you get physical therapy, make sure to do any home exercises or stretching your therapist has prescribed. Stay as active as you can. Try to get some physical activity every day.

Complementary treatments

You can manage chronic pain by using things other than medicines or physical treatments. For example, you can keep track of your pain in a pain journal. It can help you understand how the things you do affect your pain.

Reducing stress and tension can reduce pain. And being more aware of your thought patterns can be helpful. In some cases, shifting how you think about pain can affect how you feel.

Here are some options to think about:

• Breathing exercises and meditation. These can help you focus your attention, relax, and get rid of tension.
• Guided imagery. This is a series of thoughts and images that can focus your attention away from your pain.
• Hypnosis. It's a state of focused concentration that makes you less aware of what is around you.
• Cognitive behavioral therapy. This type of counseling helps you change your thought patterns.
• Yoga. Stretching and exercises can reduce stress and make your body more flexible.

If what you're doing to manage your pain isn't working, or if you're feeling depressed, talk to your doctor. The doctor can help you change your pain management plan and find resources for emotional support.