chronic pain

Chronic Pain

Chronic pain is a condition characterized by pain that lasts longer than three to six months. This pain interferes with the day-to-day functioning of an individual and can even lead to depression or anxiety.

Table Of Contents


What Is Chronic Pain?

Chronic Pain


Pain is an essential part of life. In case of an injury, pain sends signals to the brain to take action and tend to the wound. Chronic pain is a condition wherein the body constantly sends pain signals to the brain even when the injury has healed. This pain lasts longer than six months. It usually results due to an injury or a disease. According to the International Association for the Study of Pain 1 , this condition is “pain which has persisted beyond normal tissue healing time”. A 2006 study 2 pointed out that depression, anxiety, and negative beliefs about pain are not only related to developing chronic pain but also increases the likelihood to experience worse symptoms due to it. Often, it is also found that personal beliefs and attitudes can affect a person’s likelihood of long-term chronic pain.

However, this condition is entirely different from acute pain. The pain may feel like a sharp burning or aching sensation in the affected areas. In case of acute pain, it usually becomes less severe as the injury begins to heal. However in case, it’s chronic, the pain persists even after the injury heals. This can result in the reduced flexibility, endurance, strength, mobility and can even hinder daily activities.

What Chronic Pain Feels Like?

This condition is different from acute pain. Many patients describe it as follows:

  • Aching
  • Burning
  • Stiffening
  • Stinging
  • Throbbing

Understanding Chronic Pain

A 2012 study 3 found that patients who adopted passive coping strategies such as “resting and taking medications”, were found to use three times the amount of healthcare appointments. They were also found to have increased levels of disability from pain in comparison with those who adopted active strategies such as exercise. A 2009 study 4 also pointed out that changing a patient’s attitudes to their pain can reduce their level of pain and significantly improve their quality of life. Some experts 5 also believe that people who experience adversity or emotional trauma such as the death of a parent or physical trauma, such as preterm birth in childhood, have a higher risk of having chronic pain in their adult lives. Early stress in life can hinder the function of the hypothalamic pituitary-adrenal axis that ultimately affects the stress response. A 2008 study 6 pointed out that people who have experienced personal violence or abusive relationships are more likely to experience subsequent chronic pain.

With treatment and medications, it is possible to treat and manage the symptoms of this condition. Effective and open interprofessional communication is a crucial part of optimal management and minimizing the adverse effects of this condition.

Prevalence Of Chronic Pain

A 2016 research 7 suggests that this condition affects 13-50% of adults in the UK. It was also found that older patients have a higher prevalence than younger patients. A 2017 study 8 found that 1.9 billion people were found to be affected by recurrent tension-type headaches, which were the most common symptoms of this condition. A 2007 study 9 pointed out that men are less likely to report or experience this condition than women.

Another 2008 study 6 found that people who have low levels of education, income inequalities, and high levels of neighborhood deprivation are more likely to experience chronic pain than those who have high levels of education, income equality and who live in more affluent neighborhoods. A 1976 study 10 also found that people with this condition are more likely to smoke than those with no pain.

Acute Pain vs Chronic Pain

Acute pain Vs Chronic Pain


Acute pain is caused by an injury or damage that usually lasts less than six months. This pain acts as a warning for the body to indicate that the individual’s health has been compromised. This type of pain is usually caused by:

  1. Broken bone
  2. Cuts
  3. Burns
  4. Ligament damage
  5. Labor or childbirth

Diagnosing acute pain can be challenging since the symptoms can start and stop without any warning. Doctors usually use the Wong-Baker Faces 11 pain rating scale to assess the intensity of pain on a scale of 1-10. On the other hand, it is often hard to diagnose and even misdiagnosed in certain cases. This pain interferes with the quality of life of the individual. It is often caused by some underlying issue and it requires a combination of treatments to manage the symptoms. A 1991 study 12 suggests that the therapy of acute pain is aimed at treating the underlying cause and interrupting the nociceptive signals. On the other hand, the therapy for chronic pain must rely on a multidisciplinary approach and should involve more than one therapeutic modality.

Types Of Chronic Pain

Chronic Pain


A 2008 study 13 pointed out that patients with this condition often complain of more than one type of pain. For instance, a patient with chronic back pain may also suffer from fibromyalgia. Some of the types of pain associated with this condition are as follows:

1. Neuropathic Pain

Neuropathic pain is characterized by damage or injury to the nerves that process information between the brain and the other parts of the body. The pain is described as a burning sensation in the affected areas. This type of pain includes:

  • Peripheral neuropathic pain as the case post-herpetic neuralgia or diabetic neuropathy
  • Central neuropathic pain

2. Nociceptive pain

This type of pain is characterized by the pain caused due to actual tissue injuries such as burns, bruises, or sprains. It is a common type of pain and is usually triggered by inflammation, chemicals, or physical injuries. For instance, stubbing a toe on your way to the kitchen.

3. Musculoskeletal pain

Musculoskeletal pain is characterized by the pain caused in the bones, muscles and joints, ligaments, tendons, and nerves. This pain can be located in one area of the body such as back pain. Some of the most common musculoskeletal pain conditions are:

  • Arthritis
  • Osteoporosis
  • Sarcopenia
  • Fractures or dislocations
  • Scoliosis

4. Inflammatory pain

Inflammatory pain is characterized by a spontaneous hypersensitivity to pain occurring due to tissue damage and inflammation. Inflammation can be acute or chronic. Acute inflammation lasts for a couple of hours or days. However, chronic inflammation lasts for months or even years. Some of the conditions are as follows:

  • Cancer
  • Heart conditions
  • Asthma
  • Diabetes

5. Psychogenic pain

Psychogenic pain is a form of physical pain caused by mental, emotional, or behavioral factors. This condition is usually induced by social rejection, grief, broken heart, or any other extreme emotional life event. Some of the most common psychogenic pain are:

  • Back pain
  • Headache
  • Stomach pain

6. Mechanical pain

Mechanical pain is any type of back pain characterized by placing abnormal stress and strain on muscles of the vertebra. This pain can occur as a result of bad habits such as poor posture, or lifting something heavy incorrectly.

Causes Of Chronic Pain

The exact cause of this condition is unknown. It usually begins with an injury or a condition. These may include:

  • Back pain
  • Headaches
  • Muscle sprains
  • Arthritis
  • Other bone joint problems
  • Cancer
  • Broken bones
  • Surgery
  • Lyme disease
  • Nerve damage
  • Irritable bowel syndrome
  • Fibromyalgia (condition that causes musculoskeletal pain throughout the body)
  • Post-surgical pain
  • Post-trauma pain

Diagnosis Of Chronic Pain

Everyone experiences chronic pain differently. The person experiencing it can only describe the intensity of the pain. In case the pain persists for six months or more, it is essential to seek medical attention. The doctor may ask several questions to ascertain the intensity of the pain experienced by the patient. These can include:

  • What is the intensity of the pain on a scale of 1-10
  • What is the frequency of its occurrence
  • Where the pain is located
  • Is it affecting your life and work?
  • What do you do that makes the pain worse?
  • What do you do that makes the pain better?
  • Do you have a lot of stress or anxiety in your life?
  • Did you go through any surgery?
  • Have you had any illness before?
  • Are you experiencing the pain for more than six months?

A 2000 study 14 found that psychiatric disorders can amplify pain and can make the symptoms even worse. Psychiatric disorders can include major depressive disorder and generalized anxiety. The doctor may also recommend a mental health professional in order to determine any underlying mental conditions that may contribute to developing this condition. Effective diagnosis may also include the following:

1. Lab Tests

The physician may also conduct tests in order to determine the cause of the pain. They can include:

  • X Rays
  • MRI
  • Electromyography
  • Spinal fluid tests
  • Blood tests
  • Urine tests

2. Questionnaires

There are several questionnaires that the doctor may use to diagnose this condition. They are as follows:

1. The Brief Pain Inventory 15 is used to assess a patient’s beliefs on pain and the impact of pain on their lives.

2. The McGill Pain Questionnaire 16 (SF-MPQ-2) includes:

  • A drawing for the location of the pain on the human body
  • A questionnaire regarding previous pain medication usage
  • Any past experiences with pain

3. The Minnesota Multiphasic Personality Inventory-II 17 or Beck’s Depression Scale is used to screen for depression for patients with chronic pain.

Treatment For Chronic Pain

Chronic Pain


The pain may be located in multiple locations that require multimodal treatment. The doctor may also increase the dosages for adequate pain control or invasive procedures to control pain. A 2006 study 18 pointed out that the treatment of pain and comorbid psychiatric disorder leads to a significant reduction of pain and symptoms of the psychiatric disorder.
There are multiple pharmacological, therapy, and other methods to treat chronic pain.

1. Medications

The pharmacological options for this condition are quite extensive. Some of the medications include:

  • Nonopioid analgesics such as nonsteroidal anti-inflammatories (NSAIDs), acetaminophen, and aspirin
  • Tramadol
  • Opioid
  • Antiepileptic drugs such as gabapentin or pregabalin
  • Antidepressants such as tricyclic antidepressants and SNRIs
  • Topical analgesics
  • Muscle relaxers
  • N-Methyl-D-aspartic acid

A 1996 study 19 found that Venlafaxine is an effective treatment for neuropathic pain. A 2017 study 20 found evidence that medical marijuana can be an effective form of treatment for neuropathic pain.

2. Therapy

Therapy can be used to treat the underlying comorbid conditions associated with chronic pain. It is used to address the conditions related to emotions, feelings, or somatic responses. Some of the treatment methods include:

  • Cognitive-behavioral therapy
  • Group counseling
  • Occupational Therapy

3. Physical therapy

Physical therapy is used to evaluate and treat abnormal physical function and other injuries endured by the patient. It is usually used to treat an injury, disability, disease, or condition. Physical therapy for patients with this condition includes heat and cold therapy, stretching exercises, or transcutaneous electrical nerve stimulation (TENS). A 2019 study 21 found efficacy in using TENS for chronic pain management. The therapists will look for areas that are weak or stiff and will massage those points to release the pain.

4. Non-pharmacological treatment

Some of the non-pharmacological treatment includes:

  • Biofeedback
  • Ultrasound stimulation
  • Acupuncture
  • Aerobic exercise
  • Osteopathic manipulative medicine
  • Chiropractic

5. Interventional Techniques

Interventional techniques can also be used to treat chronic pain. Some of these options include:

  • Spinal cord stimulation
  • Epidural steroid injections
  • Radiofrequency nerve ablations
  • Botulinum toxin injections
  • Nerve blocks
  • Trigger point injections
  • Intrathecal pain

6. Lifestyle Changes

There is no cure for chronic pain. However, some lifestyle changes may help in easing the pain. They are as follows:

  • Meditation
  • Yoga
  • Practicing mindfulness
  • Art therapy
  • Regular exercise
  • Music therapy
  • Massage

Recovery From Chronic Pain

There is no cure for this condition. However, with therapy and medications, it is possible to manage and relieve the symptoms. Chronic pain can be treated and managed by addressing the causes and effects of this condition. In order to reduce and prevent this condition, modifiable risk factors such as lifestyle, behavior, or acute pain need to be addressed first. Sometimes physical pain may also be connected to emotional pain. Hence it is crucial to address the mental health needs of the patient as well.

References:
  1. Treede R. D. (2018). The International Association for the Study of Pain definition of pain: as valid in 2018 as in 1979, but in need of regularly updated footnotes. Pain reports3(2), e643. https://doi.org/10.1097/PR9.0000000000000643 []
  2. van der Windt D, Croft P, Penninx B. Neck and upper limb pain: more pain is associated with psychological distress and consultation rate in primary care. J Rheumatol. 2002 Mar;29(3):564-9. PMID: 11908574. https://pubmed.ncbi.nlm.nih.gov/11908574/ []
  3. Darlow B, Fullen BM, Dean S, Hurley DA, Baxter GD, Dowell A. The association between health care professional attitudes and beliefs and the attitudes and beliefs, clinical management, and outcomes of patients with low back pain: a systematic review. Eur J Pain. 2012 Jan;16(1):3-17. doi: 10.1016/j.ejpain.2011.06.006. PMID: 21719329. https://pubmed.ncbi.nlm.nih.gov/21719329/ []
  4. Butchart A, Kerr EA, Heisler M, Piette JD, Krein SL. Experience and management of chronic pain among patients with other complex chronic conditions. Clin J Pain. 2009 May;25(4):293-8. doi: 10.1097/AJP.0b013e31818bf574. PMID: 19590477; PMCID: PMC2709743. https://pubmed.ncbi.nlm.nih.gov/19590477/ []
  5. Sachs-Ericsson N, Kendall-Tackett K, Hernandez A. Childhood abuse, chronic pain, and depression in the National Comorbidity Survey. Child Abuse Negl. 2007 May;31(5):531-47. doi: 10.1016/j.chiabu.2006.12.007. PMID: 17537506. https://pubmed.ncbi.nlm.nih.gov/17537506/ []
  6. Jordan KP, Thomas E, Peat G, Wilkie R, Croft P. Social risks for disabling pain in older people: a prospective study of individual and area characteristics. Pain. 2008 Jul 31;137(3):652-661. doi: 10.1016/j.pain.2008.02.030. Epub 2008 Apr 22. PMID: 18434022. https://pubmed.ncbi.nlm.nih.gov/18434022/ [][]
  7. Fayaz A, Croft P, Langford RM, Donaldson LJ, Jones GT. Prevalence of chronic pain in the UK: a systematic review and meta-analysis of population studies. BMJ Open. 2016 Jun 20;6(6):e010364. doi: 10.1136/bmjopen-2015-010364. PMID: 27324708; PMCID: PMC4932255. https://pubmed.ncbi.nlm.nih.gov/27324708/ []
  8. GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017 Sep 16;390(10100):1211-1259. doi: 10.1016/S0140-6736(17)32154-2. Erratum in: Lancet. 2017 Oct 28;390(10106):e38. PMID: 28919117; PMCID: PMC5605509. https://pubmed.ncbi.nlm.nih.gov/28919117/ []
  9. Greenspan JD, Craft RM, LeResche L, Arendt-Nielsen L, Berkley KJ, Fillingim RB, Gold MS, Holdcroft A, Lautenbacher S, Mayer EA, Mogil JS, Murphy AZ, Traub RJ; Consensus Working Group of the Sex, Gender, and Pain SIG of the IASP. Studying sex and gender differences in pain and analgesia: a consensus report. Pain. 2007 Nov;132 Suppl 1(Suppl 1):S26-S45. doi: 10.1016/j.pain.2007.10.014. Epub 2007 Oct 25. PMID: 17964077; PMCID: PMC2823483. https://pubmed.ncbi.nlm.nih.gov/17964077/ []
  10. Vogt MT, Hanscom B, Lauerman WC, Kang JD. Influence of smoking on the health status of spinal patients: the National Spine Network database. Spine (Phila Pa 1976). 2002 Feb 1;27(3):313-9. doi: 10.1097/00007632-200202010-00022. PMID: 11805698. https://pubmed.ncbi.nlm.nih.gov/11805698/ []
  11. Garra G, Singer AJ, Domingo A, Thode HC Jr. The Wong-Baker pain FACES scale measures pain, not fear. Pediatr Emerg Care. 2013 Jan;29(1):17-20. doi: 10.1097/PEC.0b013e31827b2299. PMID: 23283256. []
  12. Grichnik KP, Ferrante FM. The difference between acute and chronic pain. Mt Sinai J Med. 1991 May;58(3):217-20. PMID: 1875958. https://pubmed.ncbi.nlm.nih.gov/1875958/ []
  13. Hardt J, Jacobsen C, Goldberg J, Nickel R, Buchwald D. Prevalence of chronic pain in a representative sample in the United States. Pain Med. 2008 Oct;9(7):803-12. doi: 10.1111/j.1526-4637.2008.00425.x. Epub 2008 Mar 11. PMID: 18346058. https://pubmed.ncbi.nlm.nih.gov/18346058/ []
  14. Price DD. Psychological and neural mechanisms of the affective dimension of pain. Science. 2000 Jun 9;288(5472):1769-72. doi: 10.1126/science.288.5472.1769. PMID: 10846154. https://pubmed.ncbi.nlm.nih.gov/10846154/ []
  15. Keller S, Bann CM, Dodd SL, Schein J, Mendoza TR, Cleeland CS. Validity of the brief pain inventory for use in documenting the outcomes of patients with noncancer pain. Clin J Pain. 2004 Sep-Oct;20(5):309-18. doi: 10.1097/00002508-200409000-00005. PMID: 15322437. https://pubmed.ncbi.nlm.nih.gov/15322437/ []
  16. Dworkin RH, Turk DC, Revicki DA, Harding G, Coyne KS, Peirce-Sandner S, Bhagwat D, Everton D, Burke LB, Cowan P, Farrar JT, Hertz S, Max MB, Rappaport BA, Melzack R. Development and initial validation of an expanded and revised version of the Short-form McGill Pain Questionnaire (SF-MPQ-2). Pain. 2009 Jul;144(1-2):35-42. doi: 10.1016/j.pain.2009.02.007. Epub 2009 Apr 7. PMID: 19356853. https://pubmed.ncbi.nlm.nih.gov/19356853/ []
  17. Long CJ. The relationship between surgical outcome and MMPI profiles in chronic pain patients. J Clin Psychol. 1981 Oct;37(4):744-9. doi: 10.1002/1097-4679(198110)37:4<744::aid-jclp2270370410>3.0.co;2-n. PMID: 6458625. https://pubmed.ncbi.nlm.nih.gov/6458625/ []
  18. Arnow BA, Hunkeler EM, Blasey CM, Lee J, Constantino MJ, Fireman B, Kraemer HC, Dea R, Robinson R, Hayward C. Comorbid depression, chronic pain, and disability in primary care. Psychosom Med. 2006 Mar-Apr;68(2):262-8. doi: 10.1097/01.psy.0000204851.15499.fc. PMID: 16554392. https://pubmed.ncbi.nlm.nih.gov/16554392/ []
  19. Aiyer R, Barkin RL, Bhatia A. Treatment of Neuropathic Pain with Venlafaxine: A Systematic Review. Pain Med. 2017 Oct 1;18(10):1999-2012. doi: 10.1093/pm/pnw261. PMID: 27837032. https://pubmed.ncbi.nlm.nih.gov/27837032/ []
  20. Nugent SM, Morasco BJ, O’Neil ME, Freeman M, Low A, Kondo K, Elven C, Zakher B, Motu’apuaka M, Paynter R, Kansagara D. The Effects of Cannabis Among Adults With Chronic Pain and an Overview of General Harms: A Systematic Review. Ann Intern Med. 2017 Sep 5;167(5):319-331. doi: 10.7326/M17-0155. Epub 2017 Aug 15. PMID: 28806817. https://pubmed.ncbi.nlm.nih.gov/28806817/ []
  21. Cruccu G, Aziz TZ, Garcia-Larrea L, Hansson P, Jensen TS, Lefaucheur JP, Simpson BA, Taylor RS. EFNS guidelines on neurostimulation therapy for neuropathic pain. Eur J Neurol. 2007 Sep;14(9):952-70. doi: 10.1111/j.1468-1331.2007.01916.x. PMID: 17718686. https://pubmed.ncbi.nlm.nih.gov/17718686/ []
Scroll to Top