What Is Chronic Pain? Here Are the Symptoms, Causes, and Treatments
What Is Chronic Pain? Here Are the Symptoms, Causes, and Treatments
© laflor/Getty Images What is Chronic Pain?
Chronic pain is any pain that persists or recurs for 3 to 6 months or longer. Acute pain, such as flu-related body aches or pain due to an injury, can be mild or severe but generally goes away relatively quickly—either almost immediately or at least within a few days or weeks. Generally acute pain subsides when the original trigger, such as an infection, injury, or surgery, resolves or heals.
After that it gets complicated, because there are many conditions, such as cancer and multiple sclerosis, which have pain as a secondary symptom , according to the World Health Organization's International Classification of Diseases.
Unfortunately, there's also pain no one can explain. What is known, however, is that chronic pain is common. About 20 percent of people worldwide are thought to be in chronic pain, and it accounts for 15 percent to 20 percent of doctor's visits.
Symptoms of Pain
There are all types of pain: dull or throbbing, popping or burning, widespread or limited to a one spot or area.
No matter the source, common signs and symptoms that someone is in pain include:
Frowning or grimacing
Writhing or inability to get comfortable
Noises such as moaning, whimpering, or shouting
Sudden movements, such as kicking or clenching
Inability to focus
Symptoms that occur with pain include:
Apathy or depression
Flu-like symptoms, such as fever
Numbness in other parts of the body
Inability to sleep
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What Causes Pain?
The most common causes of pain are tension, stress, overuse, and minor injuries. Pain that racks your whole body—systemic pain—is more likely caused by an illness or condition, like fibromyalgia, cancer, infection, or even emotional distress.
Pain can also be a side effect of a medicine you're taking—cancer drugs, or statins for high cholesterol, for example, sometimes can cause painful side effects. And pain may be linked to a chronic condition, like osteoarthritis , an autoimmune disease, like the joint-damaging rheumatoid arthritis , or nerve problems.
For example, shingles , a reactivation of the chickenpox virus that can happen later in life, can sometimes trigger postherpetic neuralgia, a condition marked by ongoing, excruciating nerve pain that can last months or even years. And conditions like diabetes can cause peripheral neuropathy , which is damage to nerves (often in the hands or feet) that can cause tingling, burning, and stabbing sensations.
How to Prevent Pain
There's little you can do to prevent pain caused by a serious condition like cancer or lupus , but simple lifestyle changes can help stave off many other types of chronic pain. Exercise regularly, and try not to spend your life hunched over a computer or phone, which can increase the risk of repetitive strain injuries like carpal tunnel syndrome and overuse syndromes like text neck .
Practice good posture and make sure your desk, keyboard, and monitor are properly aligned and at the right height so you don't strain your neck and back. Or if your job has you lifting, bending a lot or standing for long periods, be sure to protect your joints, lift from your knees, try to limit twisting, and wear supportive shoes. This can help you avoid back pain or foot pain .
Eat a healthy, high fiber diet to keep belly aches at bay. If you're prone to head pain, try hot or cold packs on your head or eyes or dimming the lights. Also, stress is a known pain-inducer, and whatever pain you're feeling is likely to be worse when you're stressed . It's easier said than done, but if you can take steps to minimize the many emotional, mental and physical stressors in your life, you're less likely to be burdened with chronic pain or at least reduce the risk of developing it.
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Chronic Pain Management Tips
The most important thing to know about managing or treating pain is that some types need immediate attention. If you have a sudden high fever, bleeding, chest pain, nausea, or vomiting, head for an ER or urgent care center right away. While it may be nothing, only a healthcare professional can rule out something serious, such as meningitis or a heart attack . Here are the types of pain you should never ignore .
Chronic pain can be managed or sometimes even eliminated, usually with a trial and error approach. There are several types of medications available to treat chronic pain. Each of these has varying degrees of effectiveness and may cause side effects, so it's important to speak with your doctor before using them.
Commonly used pain medications include:
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. Many of these are available over-the-counter (OTC), but some are prescribed. When these are used often, they can cause cause stomach and other problems, so talk to your doctor.
Antidepressants. Even if you're not clinically depressed, experts find that some antidepressants can effectively manage nerve and migraine pain.
Muscle relaxers. If your chronic pain is caused by cramps or other types of muscle pain , these might provide relief. Some muscle relaxers are available over-the-counter, while others require a prescription.
Opioids. This class of pain medication shouldn't be your first choice, but if you have chronic pain they can literally be life-saving. If you take prescription opioids exactly as your doctor recommends, and follow a plan to get off when your pain abates, you reduce your risk of becoming addicted , according to the U.S. Department of Health and Human Services.
Not everyone wants to—or can—take medication. Fortunately there are many self-care and alternative medical treatments that can reduce pain. Many people find the most effective relief comes from combining prescription, OTC, and natural or complementary treatments, including:
Acupuncture. Research shows that this practice, a staple of traditional Chinese medicine, can provide relief for many types of chronic pain, including migraine, arthritis, and musculoskeletal pain, and some medical centers are even incorporating this approach into their pain relief programs .
Medical cannabis. More people are turning to this treatment for relief from many chronic health issues , including pain.
CBD products. CBD or cannabidiol, is one of the hundreds of compounds found in the marijuana or hemp plant. Unlike THC, the psychoactive compound in marijuana, it doesn't make you feel high. It may help with problems related to slee p, anxiety , dental pain , peripheral neuropathy , rheumatoid arthritis , and more.
Yoga and other types of stretching. OK, the last thing you feel like doing is exercising when you have chronic pain. Do it anyway—gently—because, studies show, it can help. A 2019 review of yoga-for-pain studies in the journal Medicine concluded that yoga can relieve pain intensity , improve pain-related disability, and boost mood.
Breath exercises. Stress can make chronic pain worse, and deep breathing exercises are an easy and accessible way to try to reduce both pain and stress.
Anti-inflammatory foods. Switching up your eating habits won't immediately turn off your pain symptoms, but a diet high in fruit and vegetables, whole grains, fish, and lean protein might reduce pain related to an autoimmune condition over the long term. These foods to manage pain also happen to be delicious!
Don't suffer in silence. It's important to recognize when your pain management options are no longer working and speak to your doctor to find something that will.
The Science of Pain
When someone complains of persistent pain long after the healing process ends, some assume it's all in their head. New research into how pain affects the brain supports this theory, but not in the way you might expect. Many studies have found a high correlation between depression and pain, and people with both have poorer outcomes. But is depression a symptom of chronic pain? Yes and no.
Chronic pain doesn't just come from neurological signals. It might create its own, finds a 2019 study in the International Journal of Molecular Sciences that reviewed brain imaging studies. In other words, pain may be a driving force that changes the brain , carving pathways in the area called the prefrontal cortex and potentially altering a sufferer's personality.
Specifically, chronic pain and depression cause similar changes in neuroplasticity, or the ways the brain forms new connections. For example, both alter levels of neurotransmitters such as serotonin, dopamine, and norepinephrine, which regulate mood. It's also worth exploring the fact that brain regions that control pain , including the prefrontal cortex, hippocampus, and amygdala, also control mood disorders, according to a 2017 study published in the journal Neuroplasticity.
There are many holes in our understanding of the brain in pain. Scientists don't yet know if brain reorganization is a response to pain, or a pre-existing factor that puts you at risk. Why can one person with an injured hip fully heal, while another with the same injury develops a chronic pain condition and a mood disorder? Future research will address these questions. Meanwhile, rest assured: your chronic pain is not your imagination. But it is in your head.
Living With, and Managing, Chronic Pain: A Patient's Story
If you need additional help with chronic pain, where do you go next? Here are some foundations, support groups, medical societies, and a Facebook group that may help.
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What happens under anesthesia?
If you've ever had a medical procedure where you've been asleep during surgery, you've been under general anesthesia. Anesthesia helps prevent pain, relax muscles, and keep you unconscious so that doctors can easily perform the procedure. But what really happens once you're under? Here's what anesthesiologists have to say.
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Your brain quiets down like it's getting deep sleep
As the anesthesiologist asks you to count down from 100 in the operating room, here's what's taking place in your head: "A hypnotic agent is given to quiet the thinking part of the brain, the cerebral cortex, and areas of the brain stem associated with awareness," explains Jennifer Kollman , MD, director of anesthesia at UCHealth Memorial Hospital Central in Colorado Springs, Colorado. You can expect your breathing to slow and your body to relax. "When you awaken, it's almost like you've time-traveled, feeling like you only fell asleep moments ago," says Dr. Kollman. "Some people even report dreams afterward."
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You might not fall completely asleep, though
Rarely—in about one or two out of 1,000 cases—a person might become aware during anesthesia, but they won't usually feel pain, says James D. Grant , MD, president of the American Society of Anesthesiologists and chair of the department of anesthesiology at Beaumont Hospital-Royal Oak in Royal Oak, Michigan. "Anesthesia awareness can occur for a few reasons. There are some procedures, because of either urgency or unstable patient conditions, that warrant using lower doses of drugs that could place patients at a higher risk for awareness," he says. These higher-risk procedures may include trauma, cardiac surgery, and emergency C-section delivery .
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Your blood pressure could dip if you don't know your correct weight
If you're unsure how much you weigh, request a scale at the hospital so you can give the anesthesiologist an accurate number. "Initial dosing is often based on weight," says Nitin Sekhri , MD, medical director of pain management at Westchester Medical Center in Valhalla, New York. "Giving a falsely low weight may lead to underdosing of both anesthetics and antibiotics. And giving a falsely elevated weight may lead to a higher-than-needed anesthetic dose, which could dangerously drop one's blood pressure ." A too-low dose of antibiotics could increase your risk of infection.
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You could bleed too much if you didn't stop taking your meds
Before surgery, your doctor will give you a list of medications you'll need to stop taking prior to surgery. This typically includes blood thinners, ibuprofen, and supplements like omega-3s and ginkgo biloba; they all can increase the risk of excessive bleeding during surgery. But if you didn't follow instructions, tell your anesthesiologist. "If you were told to stop your blood thinner on Friday and you forgot and did not do it until Monday, say something," says Steven L. Mandel , MD, an anesthesiologist at the Ketamine Clinics of Los Angeles in California. Also discuss any medications and supplements you're taking, including any recreational substances. "We are scientists, not DEA agents!" says Dr. Kollman. "Every drug with an action has a reaction, and those reactions require us to modify our medications to provide the best care for you. Help us help you."
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Your heart will work better without tobacco
"If you use tobacco products, seriously consider stopping them before surgery," says Dr. Kollman. The ideal time to quit: three to four weeks before your surgery date. But, "even one day is enough to see improved heart and lung function," she says. "The carbon monoxide clears from the red blood cells, allowing them to carry more oxygen to your tissues, which improves healing and decreases the risk of infection. It is, quite possibly, the biggest thing you can do to help yourself heal." (Need help? Here are 22 ways to quit smoking for good .)
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You could have problems breathing if your stomach isn't empty
There's a really good reason surgeons warn you not to eat several hours before an operation. While under anesthesia, "a person loses their ability to cough and protect their airway from having stomach contents enter the lungs," says Dr. Sekhri. "While often a nuisance, not eating before a general anesthetic is crucial. If your stomach has contents inside of it at the start of the procedure, stomach contents can enter into the lungs causing severe, possibly life-threatening pneumonia ." If you did eat or drink something later than instructed, tell your anesthesiologist so they can come up with a plan of action.
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You can still be uncomfortable
Be sure to talk to your anesthesiologist about any other conditions or issues that might cause pain, says Dr. Sekhri. "During your procedure, the anesthesiologist is the physician that is in charge of you outside of the surgical field," he explains. So if you suffer from back pain , ask for a cushion to be placed under your back before you go to sleep. Shoulder discomfort? Request that your arm is positioned by your side during the surgery. You also can ask the anesthesiologist to put the intravenous catheter in your non-dominant hand.
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You might not need general anesthesia
General anesthesia has the advantage of keeping you unconscious and unable to move, according to the National Institute of General Medical Sciences . But many procedures only require local or regional anesthesia in which only certain parts of the body are numbed. Surgeons will typically offer these in procedures such as C-section delivery and some arm or leg surgeries . With these types of anesthesia, the patient stays conscious through the procedure. "We are big advocates of regional techniques due to their many advantages, good pain relief with fewer side effects, better safety, and fewer complications," says Stanley Chang , MD, an anesthesiologist at Torrance Memorial Medical Center in Torrance, California.
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You'll be dehydrated
Because patients are typically instructed to refrain from eating and drinking before surgery, keeping well-hydrated for several days before the procedure is important. Carry a water bottle with you to remind yourself to drink. "Appropriate hydration prior to surgery may help with many side effects, including low blood pressure and nausea," says Dr. Sekhri. (Check out these other ways to recover faster from surgery .)
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You might become nauseated
But there are ways to minimize this risk. "Post-operative nausea and vomiting is a very common problem that is not only uncomfortable for the patient but can also keep a patient in the hospital longer," says Dr. Sekhi. He suggests letting the anesthesiologist know if you have risk factors such as motion sickness or if you've experienced feelings of nausea after anesthesia in the past. "The anesthesiologist may elect to use less or no inhaled anesthetic, which tends to be more nauseating, or even to perform acupuncture on the wrist." (This alternative therapy can effectively reduce nausea.) Post-operative nausea occurs more often with certain types of surgery, such as abdominal, pelvic, or inner ear surgery, notes Dr. Kollman.
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You may have odd side effects
"Just as your anesthesia plan is tailored specifically for you, side effects can be personal as well," says Dr. Kollman. "Some people are prone to postoperative nausea or headaches . Others may be slow to wake." Shivering is another possible strange side effect. It happens because of the way anesthetics affect the brain, says Dr. Sekhri. Shivering typically happens a few hours post-surgery, and you can ask for medication to limit the effect. Also, men with prostate problems may experience a temporary inability to urinate following anesthesia. Make sure to discuss any potential issues with your anesthesiologist ahead of time.