What is chronic pain?

Chronic pain is pain that lasts a long time (months or even years) and may or may not have a clear cause. It is different from acute pain, which usually does have a clear cause—like an injury or illness—and gets better over time. Chronic pain:

• Lasts over time but may vary from day to day.
• Does not go away despite efforts to end it.
• May disrupt your sleep and lead to fatigue.
• May cause depression or anxiety.
• May make your muscles tense, causing more pain.
• Can disrupt your work, hobbies, home life, and relationships with friends and family.

Chronic pain is a very real condition. It is not just in your head. Treatment can help and usually includes several methods used together, such as medicines, physical therapy, exercise, and other treatments. Learning how to relax and changing negative thought patterns can also help you cope.

Chronic pain is complex. Taking an active role in your treatment will help you better manage your pain. Tell your doctor if you have trouble dealing with your pain. You may have to try several things before you find what works best for you.

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.

When you have chronic pain, you may avoid activity because you worry about making your pain worse or injuring yourself again. Often being inactive leads to more pain. And it can make it harder to do your daily activities. This can increase your worries even more. But being more active may help with your pain.

Chronic pain can also lead to symptoms of depression and problems sleeping. And depression can make chronic pain worse and harder to treat. Treatment can help you manage other conditions that often come with chronic pain.

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.

Common symptoms of chronic pain include mild to very bad pain that does not go away as expected after an illness or injury. It may be shooting, burning, or aching. Or it may feel like an electrical shock. You may also feel sore, tight, or stiff.

It's important to make a treatment plan with your doctor. It may take several types or combinations of treatments before you find relief.

There are many treatments you can try to manage your pain. Often people think of taking medicine to treat pain. But there are many non-medicine treatments that may be just as helpful.

Treatment options may include:

• Physical treatments. These can be things like physical therapy or massage.
• Behavioral health treatments. These are things like cognitive-behavioral therapy.
• Over-the-counter pain medicines. These include acetaminophen and ibuprofen.
• Other medicines. These are medicines like 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 may be tried.
• Surgery. For example, spinal cord stimulation may be helpful.
• Going to a pain management clinic.

Here is an example of a pain management plan. You can work with your doctor to complete it.

My Goals

Example: "Control pain long enough to walk the dog each day" or "Reduce or stop taking pain medicines by the end of summer."

1. ________________________________________________
2. ________________________________________________
3. ________________________________________________
4. ________________________________________________

My Non-Medicine Strategies

Example: "Complete my physical therapy exercises each day" or "Do yoga twice a week."

1. ________________________________________________
2. ________________________________________________
3. ________________________________________________

My Medicines That Help With Pain

Include prescription and over-the-counter medicines.

1. Medicine: ______________________
   • How much to take: ______________________________
   • How often to take it: ______________________________
   • Other instructions: ______________________________
2. Medicine: ______________________
   • How much to take: ______________________________
   • How often to take it: ______________________________
   • Other instructions: ______________________________

My Next Steps

If I'm not meeting my goals, my doctor recommends:

• ________________________________________________
• ________________________________________________
• ________________________________________________

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.

Here are some things you can try.

• Treat your health problems early, including mental health conditions. Depression can make pain worse.
• 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.
• Get help for your pain early. If your doctor prescribes opioids for acute pain, take them for the shortest amount of time possible.

Your doctor will ask you about your past illnesses and your overall health. You will also be asked about your pain, including if it disrupts your daily activities, sleep, or mood. Your doctor will also do a physical exam. You may need tests, such as imaging tests or tests to check your nervous system.

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. Your body forms 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. Pills for pain include:

• Acetaminophen, such as Tylenol.
• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (for example, Advil), and naproxen (for example, Aleve).
• Antidepressants, such as amitriptyline or duloxetine.
• Corticosteroids, such as prednisone.
• Anticonvulsants, such as gabapentin and pregabalin.

In some cases, an opioid pain medicine may be tried.

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.

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 medicine physician
• Internist
• Nurse practitioner
• Physician assistant
• 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
• Physiatrist
• Physical therapist
• Neurologist
• Anesthesiologist
• Psychiatrist, psychologist, or licensed mental health counselor
• Orthopedic surgeon
• Rheumatologist
• Chiropractor

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.

• Pace yourself. Break up large jobs into smaller tasks. Save harder tasks for days when you have less pain, or go back and forth between hard tasks and easier ones. Take rest breaks.
• Relax, and reduce stress. Relaxation techniques such as deep breathing or meditation can help.
• Keep moving. Gentle, daily exercise can help reduce pain over the long run. Try low- or no-impact exercises such as walking, swimming, and stationary biking. Do stretches to stay flexible.
• Try heat, cold packs, and massage.
• Get enough sleep. Chronic pain can make you tired and drain your energy. Talk with your doctor if you have trouble sleeping because of pain.
• Think positive. Your thoughts can affect your pain level. Do things that you enjoy to distract yourself when you have pain instead of focusing on the pain. See a movie, read a book, listen to music, or spend time with a friend.
• If you think you are depressed, talk to your doctor about treatment.
• Keep a daily pain diary. Record how your moods, thoughts, sleep patterns, activities, and medicine affect your pain. You may find that your pain is worse during or after certain activities or when you are feeling a certain emotion. Having a record of your pain can help you and your doctor find the best ways to treat your pain.
• Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.

Reducing constipation caused by pain medicine

• Talk to your doctor about a laxative. If a laxative doesn't work, your doctor may suggest a prescription medicine.
• Include fruits, vegetables, beans, and whole grains in your diet each day. These foods are high in fiber.
• If your doctor recommends it, get more exercise. Walking is a good choice. Bit by bit, increase the amount you walk every day. Try for at least 30 minutes on most days of the week.
• Schedule time each day for a bowel movement. A daily routine may help. Take your time and do not strain when having a bowel movement.

Surgery for chronic pain isn't common. It's usually an option only after other treatments haven't worked or if it's thought to be medically necessary.

Surgery may provide pain relief. But it also may permanently 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.

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.
• Lifestyle choices. These may include smoking, drinking alcohol, or using other drugs.
• Social factors. These may include loneliness and feeling disconnected from others.
• 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.

Living with pain can be hard, especially if it's long-term (chronic) pain. Chronic pain is pain that lasts for 3 months or longer. It can make you sleep poorly, feel tired and irritable, and have a hard time being active or working. It may strain your relationships with loved ones too. You may feel stressed or get depressed or anxious. And these feelings may make your pain worse, because they can make it harder to manage your pain.

One way you can help manage and cope with your pain is through healthy thinking. A type of therapy called cognitive behavioral therapy (CBT) can help you learn healthy thinking habits.

Chronic pain can lead to other problems. You may feel depressed or feel anxious and stressed. You may stop doing activities such as going to work or school. You may not be able to sleep, and you may feel very tired.

Chronic pain can develop after a major injury or illness. It may also occur because certain brain chemicals aren’t working correctly. Sometimes damaged nerves can cause the pain. Or the brain may become more sensitive to the feeling of pain or touch. Sometimes the cause of chronic pain isn't known.

Pain is your body's way of warning you that something may be wrong. Pain can affect your emotions as well as your body. When pain lasts longer than 3 months, it is called chronic pain.

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.