The 101 Guide to Chronic Pain
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!” And you also feel pain when you develop an injury or illness, like appendicitis, that causes you to writhe in distress. While uncomfortable, it’s not always such a bad thing that you feel pain, since it’s your body’s way of telling you that something is wrong.
Pain serves an adaptive role; it signals to your brain that you need to change your behavior to stay safe, healthy and to survive in your environment. Sometimes the adaptive behavior caused by pain comes as an instantaneous reaction, and sometimes it is a more mindful modification.
For example, if you place your hand on a hot stove, the pain will cause you to react instantly by pulling your hand away from the stove, preventing a more severe burn. Or, if you twist your ankle, you will experience pain when you try to put weight on it. So, this results in a temporary behavioral change, as you will keep weight off of your injured ankle, so your body can repair and heal the injured tissue. These experiences are typically classified as “acute pain,” and when your body heals, the pain usually stops.
Sadly, however, the pain doesn’t go away for many people, even when the injury or illness does. This is called “chronic pain,” and it impacts millions of people globally. In some cases, people who suffer from the condition develop chronic pain syndrome that takes a toll on their mental health, as well.
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.
In our 101 guide to chronic pain symptoms, management and treatment, we provide an immersive look into this issue that plagues far too many people. You will learn about:
- The difference between acute pain, chronic pain and chronic pain syndrome
- Common chronic pain conditions
- How chronic pain impacts mental health
- Treatment options for chronic pain
Types of Pain Levels
Acute pain, chronic pain vs. chronic pain syndrome
Acute pain is a sudden, sharp feeling that is caused by something specific, such as a burn or pulled muscle. As discussed, acute pain is a bodily response triggered by the nervous system, alerting you to a possible threat or injury. It goes away once the threat is gone and the injury/illness has been resolved. Acute pain decreases in severity throughout the healing process, which typically lasts from days to weeks, often tapering off to a dull pain, which itself usually goes away once healing is complete.
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 signals our brain to keep firing 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 comes about without an apparent precipitating event such as joint pain from slowly progressive arthritis or simply waking up with pain without knowing how it started.
To put it grimly: 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 50 million people — suffer from chronic pain. Of these, 20 million suffer from high-impact chronic pain, defined as chronic pain that results in disability or a critical limitation to 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.
About a quarter of people who suffer from chronic pain develop Chronic Pain Syndrome (CPS), which is when those who are experiencing chronic pain develop symptoms associated with pain, like depression, anxiety, and sleep disturbances. For those who develop CPS, the psychological effects can be severe and just as debilitating as the pain itself. CPS is highly unpleasant, disruptive and can greatly diminish the long-term quality of life.
Overall, the universe of chronic pain is large and diverse, spanning many different body systems, as well as pain symptoms and degrees of severity. It is essential to recognize that each patient’s chronic pain experience is unique. Because of this, there is no one-size-fits-all approach to managing or treating chronic pain conditions.
Common chronic pain conditions
Although chronic pain can occur without any obvious precipitating event, it begins after an injury or illness for most people. Most often, it’s from a musculoskeletal injury, 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.
We’re exploring four of the most common in our 101 guide, including:
- Chronic back pain
- Chronic neck pain
- Chronic joint pain
- Chronic nerve pain
Chronic back pain
Back pain is widespread and will be experienced by an estimated 80 percent of adults in America at some point in their lives. About 5 percent of these cases will turn into 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 injury
- Compression fractures, which are often associated with osteoporosis
- Structural deformities like scoliosis
- Damage or strain to the soft tissue in the back includes the muscles, tendons, or ligaments
Chronic neck pain
If you venture to the United States' southern regions, you might hear someone say that they have a “crick” in their neck. They’re likely referring to the neck pain that affects around 30 percent of Americans. Sadly, roughly half of those cases will develop into chronic neck pain.
Common causes of chronic neck pain include:
- Poor posture, especially “tech neck,” which describes a forward flexed head posture while frequently 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 fall, contact sports or whiplash.
- And, in rare cases, 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.
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. These include:
- 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 a fluid-filled sac that acts as a cushion for joints
- Tendonitis, which is inflammation of tissues that connect muscle to bones
Chronic nerve pain
Chronic nerve pain is also known as neuropathic pain, and it affects 1 in 10 Americans. It happens when nerves are damaged, compressed, or when the protective layer around them, 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, compression of a nerve in the wrist 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 simple tasks like putting on makeup or brushing your teeth
Approximately 60M 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 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 impact physical health. They also make it more challenging to adopt healthy habits, like a balanced diet and regular exercise. This, among many other things, makes a person more susceptible to developing poor physical health. Inversely, chronic pain can severely limit a person’s ability to socialize, increasing their risk for social isolation, leading 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 complaints.
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 the message.
The focus of treatment is often on rehabilitation and increasing 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 the trick that helps you recover. Treatment plans must therefore be customized to be effective. In the best-case scenario, a chronic pain management plan should be holistic and involve a close partnership with the patient.
However, it can be difficult to find a chronic pain specialist near you because 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 an estimated 7,000 board-certified pain specialists in North America. It may seem like a lot, but keep in mind, they are servicing 50 to 100 million chronic pain sufferers, who are mostly located outside of major metros. To address this access gap, Clearing is building a comprehensive digital healthcare platform to help democratize access to some of America’s leading clinicians.
Here, we explore the most common ways that 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 surgery pain or pain caused by cancer. These 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 the same amount of the drug has 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. It’s a vicious cycle, and one that’s tremendously difficult to break.
An overreliance on opioid medications for pain management beginning in the 1990s has led to an epidemic in the United States of opioid addiction, overdose and death. Over the last three decades, the use of opioid medications has soared. According to the CDC, the unprecedented increase 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 within our healthcare systems and directly from patients. And while those suffering from chronic pain may feel that they have limited treatment options, they need to know that there are effective treatment plans that do not involve opioids.
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 is isolating. You can say that you hurt, but if your friends and family grow weary of your complaints, you feel misunderstood and unsupported.
CBT is a widely-researched but often overlooked 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 patients to reframe and retrain their repetitive thought patterns, emotions, beliefs and behaviors that can lead to, or exacerbate, these conditions.
CBT started 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.
The Clearing solution
At Clearing, we work closely with you to customize a treatment plan to bring you 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 high-touch care from a team of expert providers delivered to you in the comfort of your own home via our telehealth platform. No more trips to the drugstore or long waits at the doctor’s office.
We believe in taking the stigma out of chronic pain. We believe that you shouldn’t have to suffer alone and in silence. We believe that managing chronic pain without dangerous opioids is possible. And we believe chronic pain management can be delivered with convenience. Most of all, we believe that you can get your life back. If you are interested in learning more and starting a free trial, please click the button below.
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.