Clearing's Chronic Pain Blog
Chronic Pain Guide: Types, Treatments & FAQs
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Everyone feels pain from time to time, of varying degrees of severity. When you stub your toe or cut yourself, you feel an instant “ouch!” You also feel pain when you develop an injury or illness, like appendicitis, that makes you writhe in distress. And you feel pain from long-lasting injuries or conditions that don't seem to resolve. While unsettling, pain is the body’s way of highlighting that something is wrong.
Pain serves an adaptive role by signaling your brain that you need to change your behavior to stay safe and healthy. Sometimes pain provokes an almost instantaneous reaction and other times it can motivate you to make more deliberate changes.
For example, if you put your hand on a hot stove, pain spurs you to yank your hand away, preventing a more severe burn. Or, if you twist your ankle, you will feel pain when you try to put weight on it. So you will try to keep your weight off, giving the ankle a chance to repair and heal the injured tissue. These experiences are typically classified as instances “acute pain,” and when your body heals, the pain usually stops.
Sadly, however, for many people, the pain doesn’t go away, even when the injury or illness resolves. This is known as “chronic pain,” and it impacts millions of people globally. In some cases, people develop chronic pain syndrome, which can take a toll on their mental health as well.
The bottom line? Pain is pain — but some types of pain can cause more damage than others. By better understanding what chronic pain is, you can work to treat your symptoms and seek professional help if you need it.
Types of Pain Levels
Acute pain is a sudden, sharp feeling caused by something specific, such as a burn or pulled muscle. It's a bodily response triggered by the nervous system, alerting you to a possible threat or injury. It generally lifts once the threat is gone and the injury or illness has been resolved. Acute pain decreases in severity throughout the healing process, which typically lasts from days to weeks and often tapers to a dull pain before it dissipates completely.
Chronic pain, on the other hand, is different. As its name suggests, it persists. Even after the injury has healed or the illness has subsided, the pain prompts our brain to keep firing signals to the nervous system for months — or years — thereafter. When pain lasts for three to six months or more, doctors define it as chronic pain. Usually, chronic pain arises from a known injury or illness, but sometimes it occurs without an apparent precipitating event. It's possible, for example, for joint pain to happen during slowly progressive arthritis or to simply wake up with pain and not know why it's there.
Chronic pain is a severe problem. In a 2018 report, the Centers for Disease Control and Prevention (CDC) estimated that 1 in 5 American adults — or about 50 million people — suffer from chronic pain. Of these, 20 million have high-impact chronic pain, defined as chronic pain that results in a disability or a critical limitation to one's life or work activities. When your body hurts day after day, it can significantly impact not only your physical health but your mental and emotional wellbeing, too.
Chronic pain syndrome
About a quarter of people who suffer from chronic pain develop Chronic Pain Syndrome (CPS), which involves developing pain-associated symptoms like depression, anxiety, and sleep disturbances. The psychological effects of CPS can be severe and just as debilitating as the pain itself. CPS is highly unpleasant, potentially disruptive, and able to greatly diminish one's quality of life.
It is essential to recognize that each patient’s chronic pain experience is unique. So there is no one-size-fits-all approach to managing or treating chronic pain conditions.
Common chronic pain conditions
Although chronic pain can happen without any obvious precipitating event, for most people it begins after an injury or illness. Most often, chronic pain is due to a musculoskeletal injury, a nervous system injury or dysfunction, a chronic disease, or an autoimmune disorder. Some of the common injuries or health conditions that can lead to chronic pain include past acute injuries or surgeries, infections, back problems, migraines or other types of headaches, arthritis, nerve damage and fibromyalgia.
4 common types of chronic pain
- Chronic back pain
- Chronic neck pain
- Chronic joint pain
- Chronic nerve pain
1. Chronic back pain
Back pain is widespread and will be experienced by about 80 percent of adults in America at some point in their lives. About 5 percent of these will become cases of chronic back pain. Back pain can be caused by an injury or develop progressively due to arthritis, scoliosis, or general wear and tear.
Similarly, common causes of chronic back pain include:
- Spinal stenosis, which is the narrowing of the space within the spine that can lead to compressed spinal nerves
- Slipped or bulging discs, which are often from a lifting or twisting-related injury
- Compression fractures, which are often associated with osteoporosis
- Structural deformities like scoliosis
- Damage or strain to the soft tissue in the back, including the muscles, tendons, or ligaments
2. Chronic neck pain
If you venture to the United States' southern regions, you may hear someone mention having a “crick” in their neck. They’re likely referring to the kind of neck pain that affects around 30 percent of Americans. Sadly, roughly half of those cases will turn into chronic neck pain.
Common causes of chronic neck pain include:
- Poor posture, especially “tech neck,” which describes the forward tilting head posture many people adopt while using a mobile device
- Cervical spondylosis, a term that encompasses spinal degeneration that occurs in the neck, including osteoarthritis and herniated discs
- Structural deformities, such as a curved spinal or malalignment of the spinal bones
- Injuries such as those resulting from a contact sports, whiplash or a fall
- And, in rare cases, an illness such as an infection or a tumor in the neck. It is not uncommon for the precipitating cause of neck pain to remain unknown even after examination, however
3. Chronic joint pain
The leading cause of chronic joint pain is arthritis. Both forms of this condition can lead to ongoing symptoms, as well as other causes.
- Osteoarthritis, which is the wearing away of cartilage in the joints
- Rheumatoid arthritis, an autoimmune disease affecting the joints
- Repetitive motion injury, which is common in athletes
- Bursitis, which is inflammation of the fluid-filled sacs that act as cushions for joints
- Tendonitis, which is inflammation of tissues that connect muscle to bones
4. Chronic nerve pain
Chronic nerve pain is also known as neuropathic pain, and affects 1 in 10 Americans. It happens when nerves are damaged or compressed, or when the protective nerve layer, called the myelin sheath, is damaged.
Some of the more common types of chronic neuropathic pain include:
- Diabetic neuropathy, which typically occurs in the hands and feet
- Carpal tunnel syndrome, the compression of a nerve in the wrist that causes pain and numbness in the hands
- Postherpetic neuralgia, a pain that persists after a shingles outbreak
- Sciatica, a pain that radiates along the sciatic nerve from the lower back down the leg, typically due to nerve compression
- Trigeminal neuralgia, which creates a radiating pain along the trigeminal nerve of the face when doing tasks like putting on makeup or brushing your teeth
Approximately 60 million Americans suffer from chronic back and neck pain, according to two studies conducted by the Mayo Clinic and Vanderbilt University.
How chronic pain impacts mental health
Mental and physical health are fundamentally linked. Chronic pain is no different: it has long been known that chronic pain and mental health go hand-in-hand. When people suffer from ongoing pain without any relief, it can make them more likely to develop negative mental conditions, including mood disorders. And, sometimes, when they have been suffering from depression, anxiety or another diagnosis, it can also make it more likely for them to develop chronic pain. In fact, epidemiological research suggests that a bidirectional relationship exists between the two.
The factors that impact the close relationship between chronic pain and mental health conditions are complex and varied, involving biological, psychological and socioeconomic factors. For example, mental health conditions often impact things like hormones and sleep cycles, which then impact physical health. They also make it more challenging to adopt healthy habits like eating well and exercising regularly. This, among many other things, can make a person more susceptible to developing poor physical health. Inversely, chronic pain can severely limit a person’s ability or willingness to spend time around others, increasing their risk for social isolation, which can subsequently lead to loneliness, depression, and other mood disorders. Social determinants of health, such as poverty, can also increase the likelihood of a person developing a mental health or chronic pain condition in their lifetime.
As for the neurobiological explanation behind the chronic pain/mental health relationship, functional imaging studies suggest this is partly due to shared neural mechanisms. Neurotransmitters, neuromodulators and neurohormones all play a role, including serotonin and norepinephrine. In other words: chronic pain is a vicious, self-perpetuating cycle that needs to be broken before it can be fixed.
This may be why some antidepressant medications can help with chronic pain management. In fact, pain and depression share common neurobiological pathways. This may be why people who suffer from chronic pain and those with significant depression have similar symptoms, including fatigue, sleep disturbances, difficulty concentrating and memory problems.
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How to treat chronic pain
Currently, there is no cure for chronic pain. And for many, that’s a hard, excruciating truth to accept. After all, who wants to be told their pain will never, ever go away? However, there is some hope — and we’re here to spread that message.
The focus of treatment is often on rehabilitation and increasing one's quality of life. Chronic pain can be managed through a combination of physical therapies, medications and psychological support. Because chronic pain is complex, affecting different body systems and involving multiple physiological processes in the body, the experience of a person suffering from chronic pain is highly personal and subjective. What works for your best friend might not be exactly what helps you recover. Treatment plans must therefore be customized to be effective. In the best-case scenario, a chronic pain management plan will be holistic and will involve a close partnership with the patient.
However, it can be difficult to find a chronic pain specialist near you, since few doctors have specific expertise in chronic pain management. In fact, according to statistics provided by the American Board of Medical Specialties, there are only around 7,000 board-certified pain specialists in North America. It may seem like a lot, but keep in mind, they are serving 50 to 100 million chronic pain sufferers, who are mostly located outside of major metropolitan areas. To address this access gap, Clearing is building a comprehensive digital healthcare platform to help democratize access to advanced pain care.
Common ways chronic pain is treated (including the benefits and drawbacks of each)
- Cognitive-behavioral therapy
Opioids are a class of drugs that interact with opioid receptors on nerve cells in the body and brain to dull the sensation of pain. They include illegal drugs like heroin as well as controlled substances prescribed to treat acute conditions such as pain after an acute injury, post surgical pain or cancer pain. These drugs include:
- Fentanyl (Duragesic®)
- Oxycodone (OxyContin®)
- Hydrocodone (Vicodin®)
- Codeine (found in Tylenol #3)
- Morphine (MS Contin®)
Opioids — even prescription ones — carry a significant risk of addiction and dependence. When taken regularly, the body develops tolerance, meaning that the same amount of the drug starts to have a smaller effect on the body. When a few milligrams worked two months ago, you would now need double or triple the amount for the same relief as before. It’s a vicious cycle, and one that’s tremendously difficult to break.
A medical system over-reliance on opioid medications for pain management that started in the 1990s has led to an epidemic in the United States of opioid addiction, overdoses and death. Over the last three decades, the use of opioid medications has soared. According to the CDC, this unprecedented rise in the consumption of opioids for pain relief has led to the “worst drug overdose epidemic in history.”
The opioid epidemic and the high risks associated with these medications have created a rising interest in non-opioid therapies for pain management, both from within our healthcare systems and directly from patients. And while those suffering from chronic pain may feel that they have limited treatment options, they should know that there are effective treatment plans that do not involve opioids.
2. Cognitive behavioral therapy (CBT)
Psychological support is a critical component of an effective treatment plan for chronic pain. As we’ve discussed above, the mental health impacts of chronic pain are real and can be severe. And in many ways, the experience of chronic pain can be very isolating. You can say that you hurt, but if your friends and family grow weary of your complaints, you may feel misunderstood and unsupported.
CBT is a widely-researched psychotherapeutic approach. While it was originally used to treat depression, it has since proven effective for treating several other conditions, including anxiety, insomnia, substance abuse and chronic pain. CBT involves teaching people to reframe and retrain unhelpful thought patterns, emotions, beliefs and behaviors.
CBT started being used as a treatment method for chronic pain more than 40 years ago. Since then, a vast body of research has established how important cognitive and behavioral processes are to an individual’s ability to adapt to pain. Treatments based on CBT have been successfully applied to manage chronic pain, either delivered alone or as a part of a comprehensive, multimodal treatment program.
In fact, in multiple randomized controlled trials, CBT has proven effective both for managing the pain itself and for pain-related syndromes, including psychological conditions like depression and anxiety. Because of its efficacy, many healthcare providers, including the Department of Veterans Affairs, include CBT as a component of their chronic pain treatment programs.
3. Customized treatment plan from Clearing
At Clearing, we work closely with you to customize a treatment plan to bring relief from your chronic pain condition. Our goal is to help you participate more fully in the life you want. Our personalized, comprehensive treatment plans combine non-opioid medications, personalized exercises and stretches, and quality care from a team of expert providers, delivered to you in the comfort of your own home via our telehealth platform.
We believe in taking the stigma out of chronic pain. We believe that you shouldn’t have to suffer alone or in silence. We believe that managing chronic pain without dangerous opioids is possible. And we believe chronic pain management can be delivered with both care and convenience. Most of all, we believe that you can get your life back. If you are interested in learning more, please click the button below.
We’re still learning about all the reasons chronic pain can be so very persistent. In some cases, genetics or everyday habits may contribute to pain. In other cases, the nervous system “gets used” to being in pain and maintains a high level of awareness and sensitivity to pain. One thing we do know, however, is that there are many possible ways to tame pain. It may have been with you for quite a long time, but there are still opportunities to reduce that pain.
We, too, sometimes wish we could banish pain with a single medication. Chronic pain, however, is complex. Often it takes multiple pain management solutions working together to curb it. For many people, no one solution will do. And as powerful as many medications can be, they may not always address the root causes of chronic pain, which is where health coaching, lifestyle medicine, supplements and many other pain-management strategies come into play.
Clearing believes in whole-body medicine that takes into account what’s going on in your mind, body and life overall. We pair people with highly trained health coaches to help people meet their pain management goals. We also offer cutting-edge clinical care as well as a customized care plan built for each individual, which can include pain medications, home exercises and more. As we keep growing, we keep adding more ways to take care of pain.
This article is for informational purposes only and does not constitute professional medical advice. Always seek the advice of your healthcare professional with any questions or concerns you may have regarding your individual needs and medical conditions.