Pain is a very normal, human experience. We all feel it at times and when we do, it’s usually helpful and functional. Pain acts as an alarm bell, signaling to us that some damage has occurred and that we should take action to protect ourselves from further injury. For example, you’ve probably had the experience of touching a hot surface and quickly withdrawing your hand in response to feeling pain. Without pain, you might not be aware that your body was being damaged.
Pain normally disappears when the injury is healed or when the danger is over. However, sometimes pain does not go away and becomes a source of distress and suffering. This is called chronic pain.
What is chronic pain?
Chronic pain refers to the long-term (three months or more) experience of pain, where pain persists beyond a normal healing time and is no longer functioning as a warning sign. Chronic pain can range from mild to severe and may be experienced daily, or come and go.
Chronic pain can impact significantly on people’s lives. It can restrict participation at school or work, or make it difficult to go about other usual activities. With therapy and pain management strategies in place, it is possible to have a better quality of life, feel happier, and experience less pain.
Causes of chronic pain
Pain is a complex phenomenon that is the result of both psychological and physical factors. Chronic pain can occur for a variety of reasons but is often related to injuries or health conditions such as fibromyalgia, arthritis or other musculoskeletal conditions.
When there does not appear to be a medical condition explaining chronic pain, neuroscience shows that it can be due to the nervous system being oversensitive. In such situations, the nervous system continues to respond as though there is an ongoing illness or injury. Additionally, our thoughts and feelings can also influence our experience of pain.
Types of chronic pain
There are different types of chronic pain, including:
- Neuropathic pain: This is a type of chronic pain associated with nerve damage, which leads to faulty pain signals being sent to the brain. Nerve damage might occur as a result of an injury or accident, or during surgery.
- Nociceptive pain: This type of chronic pain is associated with damage, disease or injury affecting a part of the body outside of the nervous system. This can be somatic (affecting ligaments, muscles, bones, or skin) or visceral (affecting internal organs).
Prevalence of chronic pain
Many people will experience chronic pain at some point in their lives. The 2016 National Health Interview Survey indicated that around 20.4% of Americans had chronic pain. Higher rates of chronic pain were found in women, older adults, and adults living in poverty.
Symptoms of chronic pain
If you experience some of the following symptoms, seek an evaluation from your physician. Symptoms persisting for three months or longer may indicate chronic pain.
- Sleeping difficulties
- Discomfort, or feeling sore or stiff
Psychological challenges associated with chronic pain
Living with chronic pain is distressing and can impact our ability to function. Some people experience symptoms of mental health conditions, including:
- Somatic Symptom Disorder (SSD): Some people with chronic pain may fit the diagnostic criteria for SSD. SSD is a mental health condition in the Diagnostic and Statistical Manual for Mental Disorders (DSM 5). It involves physical symptoms (such as pain) that cause significant distress or impact on daily functioning, as well as excessive thoughts, feelings or behaviors about the symptoms.
- Anxiety or worry: You may worry about pain excessively, or find that anxiety interferes with your daily activities. This can even make your pain worse.
- Sadness or depression: The ongoing experience of pain can be distressing and prevent us from doing the things we want. This can lead to feeling sad, hopeless, or depressed, and can make your pain feel worse.
- Self-esteem issues: Because pain usually stops when an injury is healed, there is sometimes a stigma attached to chronic pain. The inaccurate assumption that the pain is “all in their head” can make people feel like they aren’t believed and lowers self-esteem.
- Anger or frustration: Chronic pain can stop us from doing the things we need to and impact on our quality of life, leading to feelings of anger.
- Difficulty sleeping: Feeling pain and discomfort can interfere with regular sleeping patterns. This, in turn, can exacerbate stress and pain.
- Substance use problems: You may use alcohol, other drugs, or prescription medications to help manage pain. This can be unhelpful or lead to problems with addictions. For example, chronic pain has been linked to opioid dependency.
Treatment options for chronic pain
Chronic pain is complex and can be the result of a combination of physical, psychological and social factors. As such, a multidisciplinary treatment approach is common, meaning that you might see a few different types of health providers. Treatment often includes a combination of education, therapy and medication.
If you’re experiencing chronic pain, consult with your physician about one or more of the following options:
- Therapy: Therapy can help people address the psychological symptoms of chronic pain, and improve their quality of life. Look for a therapist who can help you understand your challenges and find strategies for managing your pain. See more tips below on types of therapy and selecting a therapist.
- Check-ups: Because pain is functional and alerts us to injuries or medical conditions, it’s important to have a check-up with your doctor. This can help you to get treatment for or rule out physical conditions that may contribute to your symptoms. In some cases, medication can be prescribed. Painkillers need to be used carefully and in consultation with your physician.
- Exercise: When we feel pain, we tend to avoid moving for fear of causing further damage. However, studies show that regular physical activity can help to reduce chronic pain. Exercise, such as walking or swimming, helps to stimulate the release of chemicals in our bodies that act as natural painkillers. Activities like yoga and tai chi have also been found to be helpful.
- Complementary therapies: Evidence suggests that acupuncture and massage may help reduce pain.
- Plan your day: Make sure you pace yourself. Schedule in time for activities that help you to manage your pain, like a relaxation exercise or a massage, for example.
- Talk to others: Talking to family and friends about chronic pain can help you to feel understood.
- Hotlines: If you’re having thoughts of suicide or need immediate support, call the National Suicide Prevention Hotline at 1-800-273-8255. You can call Pain BC’s Pain Support Line at 1-844-880-7246.
- Online resources: The American Chronic Pain Association has some helpful information and resources.
Therapy for chronic pain
Psychological treatment is an important part of a pain management plan. Many effective types of therapy can help improve your mood and quality of life.
Common evidence-based therapeutic approaches include:
- Cognitive Behavioral Therapy (CBT): CBT helps us to become aware of and change unhelpful thinking patterns and behaviors that can worsen our experience of pain, such as catastrophizing.
- Mindfulness Practices: Mindfulness helps us to be aware of the sensations of pain without automatically reacting to them as problematic.
- Acceptance and Commitment Therapy (ACT): ACT involves components of both CBT and mindfulness as well as other strategies to help us take an acceptance approach to respond differently to pain.
What to look for in a therapist for chronic pain
There are several factors to keep in mind when selecting a mental health professional, including:
Specialization: Look for a therapist who has experience and specialized training in pain management. Many therapists have a particular interest in treating chronic pain, and some even work in dedicated chronic pain treatment teams. Therapists often include this kind of information in their biographies so that it’s easy for you to find.
Qualifications: With so many different provider types available, it can be difficult to decide which type of mental health professional to see. The most important thing is to look for a currently licensed therapist.
That said, if you think medication might be needed, make sure you see a psychiatrist. This particular type of mental health professional is able to prescribe.
Personal fit: The trusting relationship between you and your therapist, known as the “therapeutic alliance” can have a huge impact on the efficacy of therapy. Many people with chronic pain struggle with feeling that others don’t believe them, so it’s important to work with someone you trust and feel understood by.
The best way to judge how you might feel about a therapist is to ask for a preliminary phone call. This also enables you to ask about their experience treating chronic pain and what therapy with them will be like. Try to speak to a few different therapists before deciding on a provider.
- American Psychiatric Association, “What is Somatic Symptom Disorder”
- Centers for Disease Control and Prevention, "Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults — United States, 2016”
- Chou R, Deyo R, Friedly J, et al., 2016, ”Noninvasive Treatments for Low Back Pain”
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