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
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
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
arthritis, which can lead to ongoing 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
Common symptoms of chronic
have pain for a long time, it can make you feel very tired and may lead to
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
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.
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.
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.
You can use home treatment for
mild pain or pain that you have now and then. Exercising and getting enough sleep may help reduce chronic pain.
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
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,
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.
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
Learning about chronic pain:
Living with chronic pain:
The cause of
chronic pain is not clear.
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
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:
You can have more than one kind of pain at the same time. For example, fibromyalgia can cause pain in muscles and nerves.
The symptoms of
chronic pain include:
Pain can lead to other problems, such as:
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.
may be mild to severe. It may come back from time to time over
several weeks, months, or years. Exercise, regular massages, and
pain-relieving medicines—such as
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 (changes in the body caused by long-term pain) 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
Family therapy or involvement in a caregiver support
program may help.
Risk factors are things that increase your chances of getting sick or having a problem. Risk factors for chronic pain include:
Other risk factors include stress, relationship problems, or a history of physical, sexual, or emotional abuse.
Call a doctor about
chronic pain if:
Watchful waiting is a period of time during
which you and your doctor watch your symptoms without using
During this period of watchful waiting, your doctor may have you try to get more sleep, work on reducing stress, and get more exercise. If you are able to control pain with exercise, 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
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
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
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
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Your doctor will take a detailed medical history, asking you questions about your overall health; past illnesses, surgeries, or injuries; and your pain. He or she may ask you to start keeping a pain diary(What is a PDF document?).
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:
One or more of these tests may help your doctor rule out health problems that can cause chronic pain.
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
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.
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:
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 things that may cause your 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.
If you are tired
during the day and have trouble sleeping, try to:
Treat medical conditions and mental health
concerns early, before they get worse and become harder to treat.
health conditions (such as
shingles) or mental health problems (such as
anxiety) can make chronic pain harder to
Get regular aerobic exercise—such as swimming,
stationary cycling, and walking—to build your strength and health.
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.
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
With self-massage you can help relax your own back muscles using a tennis ball.
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
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. 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.
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.
A variety of creams, gels, sprays, and patches may be used to relieve chronic pain, including:
Injected medicines—shots—may be used to treat chronic pain, including:
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 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.
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.
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
range-of-motion exercises to maintain strength,
flexibility, and mobility.
Transcutaneous electrical nerve stimulation (TENS) applies brief pulses of electricity to nerve endings in the
skin to relieve chronic pain.
It's common to respond to chronic
pain with feelings of frustration, depression,
anxiety, fear, and even anger. These feelings can make
it harder to manage chronic pain, especially if you use alcohol or drugs to
deal with your symptoms.
A counselor may use
treatments such as
cognitive-behavioral therapy to help you cope with
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.
find a group near you, contact the American Chronic Pain Association at
1-800-533-3231 or online at www.theacpa.org.
Trying one or more of these complementary therapies may reduce pain, help you cope with stress, and improve your emotional and
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.
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) 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.
Other Works ConsultedAmerican Society of Anesthesiologists (2010). Practice guidelines for chronic pain management. Anesthesiology, 112(4): 810–833.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.National Pharmaceutical Council (NPC), Joint Commission on Accreditation of Healthcare Organizations (JCAHO) (2001, with 2005 update). Pain: Current understanding of assessment, management, and treatments.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.
January 9, 2013
Anne C. Poinier, MD - Internal Medicine & Nancy Greenwald, MD - Physical Medicine and Rehabilitation
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