Understanding chronic pain

Chronic pain is a serious medical problem. It's defined as pain that lasts longer than 3 months. Chronic pain includes pain that you feel regularly, even if it comes and goes. The pain may be from an ongoing injury or health problem. Or it may be because of a chronic pain syndrome, such as fibromyalgia. Sometimes pain persists when no cause can be found. 

Pain should be treated

You have a right to have your pain treated. Untreated chronic pain can affect your overall health. It can lead to depression, anxiety, anger, and personality changes. It can also disrupt work, sleep, relationships, and other aspects of normal life. It may not be possible to relieve all of your pain. But it can be reduced to a level you can cope with. 

Your role in treatment

Your healthcare provider will work closely with you on a plan to manage your pain. But it’s up to you to put this plan into action. Control of chronic pain is done mainly through self-management. This means that you take an active role in your care. Getting support from family and friends is important too. 

Planning your treatment

Your healthcare provider will first look for a cause of your pain that can be treated. They will also assess your pain level. This may be done by asking you to rate your pain on a scale from 1 (low pain) to 10 (severe pain). Your provider will also ask you to describe the pain. For instance, is your pain sharp or dull? Is it constant or does it come and go? You may be asked to keep a pain log. This is a diary in which you track your pain. It may help identify things that tend to make your pain worse. You and your healthcare provider can make a plan to help prevent and cope with pain on a daily basis. In some cases, you may be referred to a special pain program or clinic. Your treatment plan may include:

• Medicines

• Complementary therapies

• Mind and body therapies

• Other medical treatments

• Getting physical activity 

Medicines

Medicine will most likely be a part of your treatment plan. Your provider will evaluate which are the best medicines for your pain. You may use over-the-counter or prescription medicines. You may need to take more than 1 medicine. It may take some time to find the best medicine or combination of medicines for your pain. Take all medicines as directed. Pain medicines can be used in many ways. You may take medicines:

• Every day to help “stay ahead” of the pain so that it doesn’t flare up

• At times when pain is worse than normal

• Before activities that tend to trigger pain

• To decrease sensitivity to pain

Medicines for chronic pain include:

• Nonsteroidal anti-inflammatory medicines (NSAIDs) for pain from swelling and inflammation. Your provider may prescribe a type of NSAID called a COX inhibitor.

• Acetaminophen

• Anticonvulsants to treat nerve pain called neuropathy

• Antidepressants to treat neuropathy

• Muscle relaxants for muscle spasms

• Topical medicines. These are put on the skin.

• Opioids, or narcotics, to treat severe pain. These very strong medicines can help ease certain kinds of pain. They most often are used for short periods of time. Your provider will keep track of your care very closely if you take opioids to reduce the risk for addiction. 

Complementary therapies

These are treatments that can be used along with medical care to help relieve pain. Look for a licensed practitioner with experience treating chronic pain. Talk with your healthcare provider about using complementary therapies, such as:

• Massage

• Physical therapy

• Acupuncture and acupressure

• Chiropractic

• Vitamins or herbal supplements 

• Naturopathy

• Dry needling

Mind/body therapies

The brain and the body are both part of the pain response. The brain reads the pain signals from the body. This means that your mind has some control over how pain signals are processed. Mind/body therapies may help change how your brain reads pain signals. They may be learned with the help of a trained therapist or in a class. They include:

• Deep breathing

• Distraction

• Visualization

• Meditation

• Biofeedback 

• Yoga

Other medical treatments

If other treatments don’t work for you, 1 of these procedures or devices may help:

• Nerve blocks to numb nerves in a painful area

• Trigger point injections for painful muscles

• Steroid injections for joint pain 

• Transcutaneous electrical nerve stimulation (TENS) to block pain signals to the brain

• Spinal stimulation to block spinal pain

• Implanted spinal pump that contains pain medicine

• Ablation using heat, cold, or chemicals to destroy painful nerves                                                                                                                  

Getting physical activity

Being physically active has many benefits. It can improve your ability to cope with pain. It may also help improve your mood, sleep, and overall health. Your healthcare provider can help you plan an exercise program that’s right for your needs. This may include:

• Stretching and range-of-motion exercises

• Low-impact exercise, such as walking, biking, swimming, and other water exercise

• Strength training using light weights

• Walking up the stairs instead of taking the elevator

• Riding a bike instead of driving

• Parking your car farther from your destination 

You may need to stay away from high-impact activities. These involve jumping, running, or sudden starts, stops, or changes of direction. If you haven’t exercised in a long time or you have physical limitations, your healthcare provider may refer you to a physical therapist. They can teach you stretches and exercises that fit your condition and fitness level. 

Being active and healthy

A healthier lifestyle makes it easier to cope with pain and function better. Follow these tips:

• Choose a balance of healthy foods and drinks.

• Limit alcohol and caffeine.

• Go to bed at about the same time each day and get enough restful sleep.

• Don’t let pain keep you from others. Spend time with friends and family.

• Keep your mind active. Read books or take classes.

• If you’re not working, volunteer or join a club or social group. 

Getting support

A support group lets you talk with others who also have chronic pain. Chronic pain support groups can help you feel less isolated. They can also give you tips for coping with pain. To find a local support group, contact your nearest hospital or pain clinic. 

You may also want to try counseling. Counseling can help you learn coping skills and methods, such as visualization. It can also help with mood problems. When choosing a counselor, look for someone who has worked with people who have chronic pain. 

See your provider for regular visits and let them know how well treatments are working for you. Also reach out to family and friends for help and support.                            

For more support and information, contact these groups:

• American Academy of Pain Medicine at www.painmed.org

• American Chronic Pain Association at www.theacpa.org

• U.S. Pain Foundation at www.uspainfoundation.org