Chronic Pain: Symptoms, Causes and Treatment Options
Approximately 1 in 5 adults in the United States suffers from chronic pain. While pain can be your body’s normal response to an injury or illness, chronic pain can persist after healing and is defined as lasting three months or more. It is no surprise that this distressing and difficult-to-treat condition is commonly associated with emotional difficulties.
Before jumping into the complicated topic of chronic pain, let’s discuss the basics of pain.
What is Pain?
The International Association for the Study of Pain (IASP) recently redefined pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. They also expanded the definition to include the following key points:
- A person’s report of pain should always be respected.
- Pain is always a personal experience influenced to varying degrees by biological, psychological, and social factors.
- Through their life experiences, individuals learn the concept of pain.
- Pain and nociception are different phenomena.
Let’s dive deeper into this last point about the difference between nociception and pain. Nociception refers to your body’s processing of stimuli or information through the central nervous system (your brain and spinal cord) and peripheral nervous system (nerves outside your brain and spinal cord).
- Nociception is how your body processes stimuli.
- Pain is the unpleasant sensory experience your brain generates as a product of these activated nociceptors.
Nociception and the experience of pain are not the same for everybody and can change due to a person’s individual experiences. Each person’s brain can process the information sent by nociceptors differently, leading to the generation of more or less pain sensitivity. Functional MRI studies have demonstrated that patients report different pain levels for standard stimuli. These differences can be caused by neuroplasticity, the adaptive changes that can occur in the brain as a response to stimuli such as an injury. In the case of chronic pain, neuroplasticity leads to central sensitization, the negative consequence of nociceptive pathways becoming enhanced.
When a structural cause (e.g., joint damage, joint inflammation, etc.) can not be identified in a diagnostic workup, many people face the challenge of their chronic pain not being perceived as valid. Neuroplasticity and central sensitization theory can help us understand why many forms of chronic pain do not have these clear structural origins. As pain becomes chronic, it can start to impact multiple areas of a person’s life. Chronic stress can induce negative emotions such as avoidance, stress, lack of motivation, anxiety, and depression.
This does not mean that the pain a person may experience is not real or exaggerated. Many of our body’s reactions, such as a fast heart rate, sweating, or blushing, are based on emotional stimuli. This “fight or flight” response is an automatic physiological reaction your body has to stressful stimuli such as pain.
Because of this phenomenon, it is essential for doctors not to dismiss a patient’s pain when an anatomical or structural cause can not be identified in the diagnostic workup for the pain.
Causes and risk factors of chronic pain
The cause of chronic pain is specific to each person and can be a combination of factors such as:
- Psychological traumas
- Infectious processes
- Chronic underlying illnesses (such as rheumatological and autoimmune diseases)
- Multiple episodes of acute pain
Chronic pain is often classified into primary and secondary causes.
- Chronic primary pain is pain in one or more anatomical regions that another chronic pain condition cannot explain.
- Chronic secondary pain is associated with other underlying medical conditions as the cause of pain. This can include:
- Chronic cancer pain. Pain is caused by the cancer itself or by the cancer treatment (surgical, chemotherapy, radiotherapy, etc.).
- Chronic post-surgical and post-traumatic pain. Pain that develops after a surgical procedure or a tissue injury.
- Chronic neuropathic pain. Pain caused by an injury to the nervous system. Examples include stroke, nerve trauma, and diabetic neuropathy.
- Chronic headache and orofacial pain are defined as headaches or orofacial pains that occur on at least 50% of the days and for at least three months.
- Chronic visceral pain is pain that originates from the internal organs. The pain is perceived in areas such as the skin and muscle that receive the same sensory innervation as the internal organ at the origin of the symptom.
- Chronic musculoskeletal pain is defined as persistent or recurrent pain that arises as part of a disease process directly affecting bone(s), joint(s), muscle(s), or related soft tissue(s).
Symptoms of chronic pain
- Muscular pains
- Burning pain sensation
- Sleep disturbance
- Joint discomfort
- Lack of energy and flexibility as a result of decreased activity
- Anxiety, depression, and mood swings
How is chronic pain diagnosed?
The first step in evaluating chronic pain is for your doctor to perform a comprehensive history and physical to determine the nature of the pain and its impact on your life. Your doctor will then order imaging and diagnostic testing based on your physical exam findings (if your physical exam is normal, additional testing is likely not required). Further testing may include:
- Blood, urine, or spinal fluid tests.
- Electromyography to test muscle activity.
- Imaging tests, such as X-rays and MRI.
- Nerve conduction studies to see if your nerves are reacting correctly.
Treatment options for chronic pain
A multidisciplinary approach is always best when treating the symptoms of chronic pain. Chronic pain does not respond to medications alone. Ideally, a team that includes a primary care physician, pain specialist, psychologist, and physical therapist can work together to provide education, therapy and monitor symptom progression. Specific treatment options include:
- Muscle relaxers.
- Non-steroidal anti-inflammatory drugs (NSAIDs) or acetaminophen.
- Topical products that contain pain relievers or ingredients that create soothing heat or cold.
- Sedatives to help with anxiety or insomnia.
- Medical marijuana.
- Neuropathic pain agents include antidepressant medications, selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRI), tricyclics, and gabapentinoids.
- Opioids (narcotics). While drugs such as opioids can be helpful for short-term acute pain, long-term use has risks of dependency and overdose. Your healthcare providers should try other pain treatment options before prescribing opioids.
- Transcutaneous electrical nerve stimulation (TENS). A procedure that delivers small shocks through patches on your skin.
- Nerve blocks. An injection of anesthetic near the site of your pain.
- Epidural steroid injections. An injection of anti-inflammatory medicine into the space around your spinal nerves (the epidural space).
- Counseling or talk therapy.
- Cognitive-behavioral therapy (CBT) can help you think differently about pain and ways to cope.
- Occupational therapy teaches how to do everyday tasks differently to lessen pain.
- Physical therapy involves exercises that stretch and strengthen your body.
Unfortunately, most of these therapies focus on improving a person’s day-to-day function and provide limited benefits for reducing a person’s felt pain.
Alternative or complementary modalities
include acupuncture, aromatherapy, biofeedback, mindfulness training, and relaxation techniques, such as massage and meditation.
include reducing stress, exercising, a healthy diet, and getting enough sleep.
Neuroplasticity and Chronic Pain
Researchers are now looking into the role of neuroplasticity in chronic pain and how to create new therapies that focus on central factors like psychosocial processes. Therapies such as psychophysiologic symptom relief therapy (PSRT) and pain reprocessing therapy (PRT) focus on rewiring the brain’s neural pathways to reinterpret pain as a neutral sensation coming from the brain rather than dangerous or stressful. In other words, it teaches your brain to redefine chronic pain as a false alarm. Therapies often focus on the following areas:
- Education. Personalized education is provided on the evidence of centralized or psychophysiologic pain.
- Desensitization. While engaging in fearful positions or movements, guidance is provided on how to reevaluate pain sensations.
- Emotional expression. Techniques to address psychosocial warnings and difficult emotions that can potentially amplify pain.
- Stress reduction. Techniques to increase positive emotions, self-compassion, and stress reduction.
What have researchers found on psychophysiological treatments like PSRT and PRT? While most studies have focused on patients with chronic back pain, the results show these therapies have a high potential to benefit patients with chronic pain. Researchers at Harvard Medical School found patients enrolled in PSRT reported significantly less pain and pain-related anxiety than patients who received usual care, or care solely under the guidance of their physician. After 26 weeks of therapy, 63% of patients who received PSRT were pain-free, compared to 17% of patients who received usual care.
What is re-origin?
re-origin is a science-based, self-directed neuroplasticity training program and supportive community designed to help people suffering from chronic conditions. The goal of re-origin is to educate and guide you through the concepts of neuroplasticity and how to retrain your brain to respond differently to adverse stimuli.
Components of the re-origin program
Understanding neuroplasticity. The training program includes interactive modules, specially designed worksheets, and self-assessment quizzes where you’ll learn:
- How chronic conditions form
- How to calm your racing mind and break anxiety loops
- How to be more resilient to stress
- How to transform your “threat response” to a “challenge response” and learn to stay calm and relaxed under pressure
Connecting with a Community. You’ll join a curated uplifting community with weekly group coaching calls, live Q&As and online events.
Group coaching or “Momentum Sessions” to inspire motivation & accountability through weekly “momentum group” coaching calls.
It is important to understand the content in re-origin is for informational purposes only and is not a substitute for a medical diagnosis, treatment, or advice. Your doctor should always be involved in the management of any health conditions. Consult with your doctor prior to starting re-origin to discuss a plan for your overall health.
If you are having thoughts of suicide or self-harm, a mental health professional can help. If you are having thoughts of suicide, a mental health professional can help. The American Society for Suicide Prevention provides direct services dedicated to crisis intervention. The Lifeline provides 24/7, free and confidential support for people in distress, prevention and crisis resources for you or your loved ones. Call or text 988 or text TALK to 741741.
Frequently Asked Questions
Below are answers to a few of the most commonly asked questions about chronic pain:
Approximately 40% of people with chronic pain experience depression. Chronic pain often affects sleep and increases stress levels which can contribute to depression.
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- Walk D, Poliak-Tunis M. Chronic Pain Management. Medical Clinics of North America. 2016;100(1):1-16. doi:10.1016/j.mcna.2015.09.005
- Treede R, Rief W, Barke A et al. A classification of chronic pain for ICD-11. Pain. 2015;156(6):1003-1007. doi:10.1097/j.pain.0000000000000160
- Ashar YK, Gordon A, Schubiner H, et al. Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: A Randomized Clinical Trial. JAMA Psychiatry. 2022;79(1):13-23. doi:10.1001/jamapsychiatry.2021.2669
- Donnino M, Thompson G, Mehta S et al. Psychophysiologic symptom relief therapy for chronic back pain: a pilot randomized controlled trial. Pain Rep. 2021;6(3):e959. doi:10.1097/pr9.0000000000000959
- Puderbaugh M, Emmady PD. Neuroplasticity. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557811/
- Latremoliere A, Woolf CJ. Central sensitization: a generator of pain hypersensitivity by central neural plasticity. J Pain. 2009;10(9):895-926. doi:10.1016/j.jpain.2009.06.012