Health Education Library / Understanding Chronic Pain

Pain is called "chronic" when it lasts over a long period of time. This includes pain that you feel regularly, even if it comes and goes. Chronic pain may be due to chronic stimulus from an ongoing injury or health problem. Common causes of chronic stimulus include joint degeneration (arthritis), back injury, nervous system damage (neuropathic pain), and headaches. But chronic pain is not always a signal of harm to your body. Problems with the pain-control system may lead to a chronic pain syndrome such as fibromyalgia.

Chronic Stimulus In some cases, chronic pain is caused by an ongoing health problem, such as arthritis, back injury, or endometriosis. With this type of chronic pain, both the pain and the condition that is causing it must be treated.

Chronic Pain Syndrome Sometimes pain persists when no cause can be found. This may occur because the brain can't produce enough endorphins to shut the "pain gates." In some cases, pain signals continue after an injury has healed. In others, increased pain sensitivity makes even minor injuries very painful.

The Cycle of Chronic Pain

Pain affects your life. Your sleep, mood, activity, and energy level are all disrupted by pain. Being tired, depressed, and out of shape makes the pain worse and harder to cope with. So a "pain cycle" begins.

Note for Family and Friends:
You may be involved in the pain cycle without knowing it. You may be urging your loved one to do things that worsen pain, such as staying up late. Or you may be encouraging inactivity by waiting on him or her too much. Ask how you can help break the pain cycle.


Managing Chronic Pain: Activity

Exercise can help lessen pain. In some cases, exercise may help treat your underlying problem. Activity can improve your mood and your overall health. It can give you more energy, help you sleep, and help you control your weight.

Exercise Safely
See your healthcare professional before starting an exercise program. Consider working with a physical therapist if you haven't exercised in a long time or have physical limitations. He or she can teach you stretches and exercises that fit your condition and fitness level. Start slowly. Gradually increase time and intensity. Exercise several times a week, not just on weekends.

Ways to Exercise
Use stretching and range-of-motion exercises to condition painful muscles and joints. Choose low-impact forms of exercise such as walking, biking, swimming, and other types of water exercise. Avoid high-impact activities. These involve jumping, running, or sudden starts, stops, or changes of direction. Try strength training. Use light weights. Gradually increase the number of repetitions you do in a session.

Make a Commitment
Work toward a goal of exercising at least 3 to 5 times a week for 30 minutes at a time. Choose activities you enjoy. Exercise with a friend, or join a class. Be more active in your daily life. Walk up the stairs instead of taking the elevator. Walk instead of driving to do errands. Park your car further from your destination. Keep exercise clothes and shoes handy at work or in your car. Set small goals. Reward yourself when you meet them.


Managing Chronic Pain: Medications

Medications can help you live better with chronic pain. You may use over-the-counter or prescription medications. Work with your doctor to find the best medication for you, and to use it safely and effectively.

A Part of Your Treatment Plan
Depending on your situation and the type of pain, you may take medications: To help break the pain cycle, At times when pain is more intense than usual, For daily relief, Before activities that tend to trigger pain, To decrease sensitivity to pain and help you sleep.

Analgesics
Nonsteroidal anti-inflammatories (NSAIDs) such as aspirin and ibuprofen treat both pain and inflammation. Acetaminophen is often taken for pain when there is no inflammation. Cox-2 inhibitors are NSAIDs that may be easier on your stomach. Opiates, such as codeine, and related medications may be used to treat breakthrough pain or severe chronic pain.

Antidepressants
These are often used in low doses for sleep problems, even in people who are not depressed. They may also be prescribed if you have heightened sensitivity to pain.

Other Medications
Anticonvulsants are sometimes used to treat neuropathic pain. Topical medications are applied to the skin to treat pain in one location. Muscle relaxants may be used to stop painful muscle spasms.

Taking Medication Safely
Take your medication on time and in the right dose. Tell your healthcare professional if your medication doesn't relieve your pain or work for a long enough time, or if you have side effects. Don't take other people's medications. They may not be safe for you. Avoid alcohol, tobacco, and illegal drugs. These may interact with your medications or make your pain worse.


Therapies for Mind and Body

Both the brain and the body are involved in 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. Talk to your healthcare provider about trying one or more of the therapies listed below.

Learned Therapies
Yoga is a physical meditation that can relax your body and mind. It's also a good way to become more flexible. Relaxation, visualization, and meditation are methods for relaxing muscles and concentrating on something outside of your body. This can lessen the feeling of pain or help you work through it. Coping skills are ways of feeling more in control. These use humor, distraction, or positive thinking to put the pain in its place. Biofeedback is a technique for learning to have more control over your body. This can help you better control your response to pain. Self-hypnosis is a way to train your mind to change your perception of pain.

Counseling and Support Groups
Chronic pain support groups can help you feel less isolated. They can also give you tips for coping with pain. Support groups for an underlying condition can help you learn more about controlling that condition and the pain that it causes. Individual counseling can help you learn coping skills and techniques such as visualization and relaxation. Counseling can also help with mood problems. Working with a counselor does not mean that you're mentally ill.

Complementary Therapies
Massage helps you relax. It may also help relieve some kinds of muscle and joint pain. Acupuncture and acupressure are treatments in which small needles or pressure is applied to certain sites on the body. They may stimulate the body's natural pain-control system. Chiropractic is a treatment based on manipulation of the spine. It may help with some kinds of back pain. Certain vitamins or herbs may help with some conditions that cause chronic pain. But they may interact with your medications, so check with your healthcare provider or pharmacist before you try them.