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, getting enough sleep,
and eating healthy foods 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.
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, good nutrition, 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 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.
If you are able to control pain with exercise, healthy eating, 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
Doctor of osteopathy, a doctor who uses manipulation or manual treatment, but also medicine, surgery, and other kinds of 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.
Your doctor will take a detailed medical history, asking you questions about 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.
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 Treatments.
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 factors 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 to prevent chronic pain from
developing.
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.
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.
Anticonvulsants, such as gabapentin (Neurontin) and
pregabalin (Lyrica).
Opiate pain relievers, such as hydrocodone (for example, Vicodin). These may be used when other medicines do not help.
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:
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.
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.
Trigger point
injections. These may relieve pain by injecting a local anesthetic into trigger
points (or specific tender areas) linked to chronic fascial 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.
Intrathecal drug delivery sends medicine to the area of your pain.
Chemical sympathectomy uses chemicals to destroy nerves. This
treatment may be used for a type of chronic pain called
reflex sympathetic dystrophy, which affects the
nervous system.
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.
It's common to respond to chronic
pain with feelings of frustration, depression,
anxiety, fear, and even anger. These feelings can make
it tough to conquer chronic pain, especially if you use alcohol or drugs to
manage your symptoms.
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
Trying one or more of these complementary therapies may reduce pain, help you cope with stress, and improve your emotional and
physical well-being:
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
NIH Neurological Institute
P.O. Box 5801
Bethesda, MD 20824
Phone:
1-800-352-9424
Phone:
(301) 496-5751
TDD:
(301) 468-5981
Web Address:
www.ninds.nih.gov
The National Institute of Neurological Disorders and
Stroke (NINDS), a part of the National Institutes of Health, is the leading
U.S. federal government agency supporting research on brain and nervous system
disorders. It provides the public with educational materials and information
about these disorders.
American Chronic Pain Association
(ACPA)
P.O. Box 850
Rocklin, CA 95677
Phone:
1-800-533-3231
Fax:
(916) 632-3208
Email:
ACPA@pacbell.net
Web Address:
www.theacpa.org
American Chronic Pain Association (ACPA) is a not-for-profit
organization that provides information and support to help people live more
fully in spite of their pain. ACPA groups across the U.S. are open to anyone
who is living with an ongoing pain problem. These groups provide support,
validation, and education in basic pain management and life skills.
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: http://guidance.nice.org.uk/TA159.
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
By
Healthwise Staff
Primary Medical Reviewer
Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer
Nancy Greenwald, MD - Physical Medicine and Rehabilitation
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