Chronic Pain

What is chronic pain?

Chronic pain is pain that lasts for months or years. The pain may come and go or you may have it all of the time. The pain may make it hard for you to keep doing your normal activities. There are many different kinds of chronic pain, such as:

  • Headache
  • Low back pain
  • Joint pain
  • Pain in your hands or feet

What is the cause?

Pain may be caused by an injury, illness, or medical problem such as arthritis or cancer. These conditions can damage the nerves or change the way nerves send pain signals to your brain. Because of these changes, you may keep having pain even after the injury or condition has healed. Sometimes the cause of chronic pain is not known.

Things that can make pain worse include:

  • Worsening disease
  • More damage to joints or muscles
  • Poor posture or the wrong kind of activity
  • Tense muscles
  • Being tired
  • Stress and worry
  • Depression or anxiety

What are the symptoms?

Pain can feel different to each person. For example, it may be burning, aching, stabbing, or throbbing. You may have the same pain most days, or it may change over time. You may feel pain more easily or more strongly than you did before an injury or illness. Activity that didn’t cause pain before, such as a simple touch or walking, may now be painful. You may have pain in more parts of your body than you used to.

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. Keeping notes about your pain in a diary can be very helpful. It can help you and your provider learn what things help your pain, and what things make it worse. It is very helpful if you keep track of:

  • Where it hurts
  • When it hurts, such as day or night, just in the morning, with activity, or after sitting or standing for a long time
  • How long it hurts, such as all the time, for 5 to 60 minutes at a time, or off and on
  • What kind of pain it is: for example, if it is sharp, dull, burning, or stabbing, or if it is a feeling of pressure
  • How bad it is, for example, on a scale of 1 to 10, with 10 being the worst
  • What makes it better and what makes it worse

Knowing these things helps your provider to make the diagnosis and recommend the right kind of treatment for you.

How is it treated?

The treatment of chronic pain depends on the cause of your pain, the kind of pain you have, how long you’ve had it, and how much it affects your day-to-day life.

Nondrug treatments

A physical therapist (PT) can check how well you can use the painful part of your body. You may have learned ways to control pain by bracing your body, limping, or standing differently. The PT can help you learn to stand, sit, lift, and move in ways that lessen the stress on your spine and muscles and help prevent injury or flare-ups of pain. The therapist may help you stretch, relax, and strengthen that area. They may also use ultrasound, heat, ice, or a TENS unit to help reduce the pain. TENS relieves pain by sending small electrical impulses to your nerves through patches put on the skin. The electrical impulses block pain. You may have PT at a clinic or gym. You may be given exercises to do at home.

Physical and occupational therapists often work together to help you. An occupational therapist (OT) can help you learn different ways of doing everyday tasks, so that they are easier and less painful. The OT may recommend bathroom or shower equipment, reachers, or tools for opening jars.

Your provider may recommend other treatments, such as:

  • Putting an ice pack, gel pack, or package of frozen vegetables wrapped in a cloth on the sore area every 3 to 4 hours for up to 20 minutes at a time.
  • Doing ice massage. To do this, freeze water in a Styrofoam cup, then peel the top of the cup away to expose the ice. Hold the bottom of the cup and rub the ice over the painful area for 5 to 10 minutes. Do this several times a day.
  • Putting a hot water bottle or heating pad on the painful areas. Cover the hot water bottle with a towel or set the heating pad on low so you don’t burn your skin.
  • Water therapy in swimming pools, hot tubs, or whirlpools
  • Adjustment (movement) of your muscles and joints, which may ease pain
  • Massage by a trained massage therapist
  • Acupuncture, which uses special needles to stimulate the release of your body’s natural painkillers
  • Biofeedback therapy. Biofeedback is a therapy that trains you to be aware of your body and how it works. You are connected to a machine that senses your body’s response when you have pain and gives you feedback in the form of lights or sounds. During the treatment sessions you will be asked to relax and pay attention to how you feel and how your feelings change the feedback. You can learn to control some of your thoughts and feelings with biofeedback.
  • Learning ways to relax such as deep breathing, mental imaging, or relaxing muscle groups one at a time. Yoga and meditation may also be helpful. You may want to talk with your healthcare provider about using these methods along with medicines and therapy.
  • A portable TENS unit that you can use at home or while you are doing your daily activities.
  • Counseling to help you learn stress management and to help with depression or anxiety

Treatment with medicine

  • Your healthcare provider may recommend medicine to help with the pain. This may be nonprescription pain medicine or stronger painkillers that you need a prescription for. Some commonly used nonprescription medicines are acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs). Read the label and take as directed. Unless recommended by your healthcare provider, you should not take these medicines for more than 10 days.
    • Nonsteroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen, naproxen, and aspirin, may cause stomach bleeding and other problems. These risks increase with age.
    • Acetaminophen may cause liver damage or other problems. Unless recommended by your provider, don’t take more than 3000 milligrams (mg) in 24 hours. To make sure you don’t take too much, check other medicines you take to see if they also contain acetaminophen. Ask your provider if you need to avoid drinking alcohol while taking this medicine.
  • Check with your healthcare provider before you give any medicine that contains aspirin or salicylates to a child or teen. This includes medicines like baby aspirin, some cold medicines, and Pepto-Bismol. Children and teens who take aspirin are at risk for a serious illness called Reye’s syndrome.

Your provider may recommend creams or ointments with numbing medicine that you put on your skin.

Narcotics are sometimes prescribed to manage chronic pain, but you may become dependent on them. If you use the drugs exactly as prescribed, you are not as likely to become dependent on them. Other kinds of medicine, such as steroids and medicines for seizures, depression, or anxiety may be helpful.

Medicine may not get rid of all pain, but it can help control the pain so you feel better and are able to do more. Take all medicines as directed. Taking your medicine at higher doses or more often than prescribed may be harmful. Read and follow all label directions and your healthcare provider’s instructions. If you are having side effects from the medicine or the medicine is not working well for you, tell your provider.

You and your healthcare provider need to work together to find what works best for you. If you are following your treatment plan and the pain has not gotten any better, you may be referred to a pain management specialist. Other possible treatments include shots of medicine into a nerve to numb the pain, surgery to cut the nerves causing the pain, or surgery or other procedures to relieve pressure on a painful area.

How can I take care of myself?

Work as a partner with your healthcare provider, physical therapist, and others providing care for you. This can help you be in control of your pain, instead of the pain controlling you. Follow your healthcare provider’s instructions, including any exercises recommended. Ask your providers:

  • What activities you should avoid and what activities will help
  • How to take care of yourself at home
  • What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup.

Different things work for different people. Here are some things you can try to see what works best to manage your pain.

  • Use your pain medicine correctly.
    • If you take pain medicine, take it before the pain gets really bad. If you wait until the pain gets really bad before your take medicine, it’s harder to control it. If you are taking more, or taking it more often, talk with your provider about changing your medicine.
    • If you take pain medicine on a regular schedule, make sure you take it even if you don’t feel you need it. This helps keep pain under control.
  • Get some physical exercise or activity on most days. This will build your strength. Ask your provider to help you plan an exercise routine that works for you. Depending on your type of pain, regular exercise may be a good way to help you feel better without needing to take more medicine. Even on a bad day, it might help to take a short walk or do just part of your regular exercise routine
  • Pace yourself. Spread out activities and rest between activities. Break tasks down into small steps that are easier to manage.
  • Be social. Even when you don’t feel like it, get out and be with people. Spend time with friends and family who are supportive. Share your thoughts and feelings with others.
  • Learn to manage stress. Ask for help at home and work when the load is too great to handle. Find ways to relax, for example take up a hobby, listen to music, watch movies, or take walks. Try deep breathing exercises when you feel stressed.
  • Use positive self-talk. Negative thoughts can increase your stress.
  • Focus on something other than your pain. Even if just for a short time, do something such as counting backwards, listing things such as flowers or types of cars, watching sports, or working on a puzzle. Give your attention to things that you enjoy instead of focusing on pain.
  • Eat a healthy diet. Ask your provider about the benefits of talking to a dietician to learn what you need in a healthy diet.
  • Try to keep a healthy weight. If you are overweight, lose weight. Especially if your pain is in the joints, being overweight can make the pain worse. Losing weight can lessen joint pain.
  • If you want to drink alcohol, ask your healthcare provider how much is safe for you to drink.
  • Try to get at least 7 to 9 hours of sleep each night.
  • Limit caffeine.
  • If you smoke, try to quit. Talk to your healthcare provider about ways to quit smoking. Nicotine narrows blood vessels, which means that less oxygen-rich blood reaches your joints and muscles. It can make you more tired and feel less like being active, which can worsen pain. Smoking makes you heal more slowly. Smoking and smoker’s cough can trigger headaches and increase back pain.
  • Practice good posture. Avoid activities that increase stress on your spine and muscles such as lifting heavy objects, twisting or bending while lifting, or sitting without support for a long time.
  • Keep a pain diary. It can help you learn what helps your pain and what makes it worse. Share what you learn with your healthcare provider or counselor.

Talk with your healthcare team before you try unproven therapies such as magnets, herbs, or fad treatments.

You can get more information from:

The American Chronic Pain Association

Developed by RelayHealth.
Adult Advisor 2015.1 published by RelayHealth.
Last modified: 2014-10-22
Last reviewed: 2014-06-02
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
Copyright ©1986-2015 McKesson Corporation and/or one of its subsidiaries. All rights reserved.

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