Understanding Chronic Pain

The key to treating chronic pain is understanding the root cause. If you need help tracking and verbalizing your pain, click here for communication tools from the American Chronic Pain Association.

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Pain is the #1 reason patients go to the doctor. While we've all experienced some form of physical pain in our lives, our injuries are usually short-lived. For about 35% of Americans, however, pain escalates into a chronic problem lasting 3 to 6 months, or even longer. Approximately 50 million Americans are disabled because of chronic pain.

Chronic pain is different than the sensation you feel when you burn your finger or scrape your knee. In contrast to short-lived forms of pain, chronic pain occurs when your nervous system continues to fire pain signals for months or even years after the initial injury. Chronic pain can become worse over time because nerve fibers, like well-trained muscles, learn to deliver pain signals to the brain more effectively. The intensity of the signal increases as your brain becomes more sensitive to the pain message. Some call this the "wind up phenomenon" of chronic pain.

There are several different types of chronic pain with different underlying causes. From chronic headaches, to arthritis, to stomach pains - the key to understanding and treating your chronic pain is figuring out the root cause.

Some pains come from the outer body. These are called "somatic pains." Fibromyalgia and chronic back pain fall into this category.  In the case of chronic somatic pain, nerve fibers in your skin and muscles send pain signals to your brain. Because somatic pains are common, your brain can easily locate the source of the signal. Somatic pain tends to be in one or more specific locations. Non-steroidal anti-inflammatory drugs like ibuprofen are usually the first line of treatment for somatic pains. Acetaminophen is also an option.

Muscle pain tends to feel like a severe cramp. Pain medication may not be the appropriate line of treatment for muscular pain, especially if your muscles are constantly contracted and causing chronic pain. Muscle relaxers may be an option for severe, chronic muscle pains.

Visceral pain comes from your internal organs (stomach, colon, etc). This type of pain is more difficult for your brain to locate because visceral pain is much less common and the nerve circuits are more complex. Visceral pains from pancreatitis or hepatitis may require life long treatment. Other kinds, such as pain from gallstones or appendicitis, may require surgery.

Bone pain tends to have a gnawing or throbbing quality. Bone cancers, osteoporosis, bone infections or arthritis may all be responsible for chronic bone pains. Specific medicine may be required to treat the underlying cause of bone pain.

Another type of chronic pain is called "peripheral neuropathy," which is caused by a dysfunction in the nerves that travel from your head, face, torso, arms, and legs to your spinal cord. Irritation or damage to these nerves sends a confusing signal to the brain, which interprets the signal as pain. Sciatica is a common example of peripheral nerve pain. Sciatica usually results when the sciatic nerve gets pinched at the base of the spine. Because the sciatic nerve usually carries information from the leg, irritation to this nerve makes the brain believe there is a pain signal coming from the leg. This explains why sciatica sufferers often feel a shooting pain down the back of the leg. Shingles is another extremely painful condition that is caused by irritation to peripheral nerves. In severe cases, this pain can last for many years after the infection. 

Depending on the cause, medications, acupuncture, surgery, or electrical stimulation may be suitable treatments for certain types of chronic pain. Psychotherapy, biofeedback, and relaxation techniques may also be effective. Treating pain is often complex and may require more than one modality of therapies. For many Americans, inadequate treatment becomes the most frustrating part of chronic pain.

For now, researchers are looking to advances in neurobiology for better understanding of chronic pain. As medical professionals develop a deeper understanding of the causes and mechanisms of chronic pain, better and more effective treatments will also become possible.