Understanding Chronic Pain: Causes, Diagnosis, and Treatment

Pain is an important messenger. It tells you that something in your body needs attention. It may arrive quickly, like a signal to pull away from something hot or sharp. Or it might last a while as your body heals from an illness or injury. But there are times when pain persists for months or even years. 

What is chronic pain?

Chronic pain lasts a long time. It’s often defined as pain that lasts or recurs for more than 3 months. It might be constant, or it could come and go. Some days, there may be no pain at all. And there are usually things that make it better or worse. 

How does chronic pain differ from other pain?

Acute pain is a message from your nervous system that something is wrong right now. Chronic pain may be a similar type of message when you have an ongoing health condition like cancer or arthritis. But sometimes, nerve cells keep on sending pain signals after the body has healed. And other times, the reason for chronic pain isn’t clear.

Chronic pain is a biopsychosocial condition. This means that your body, mind, and life situation can impact your experience of pain and its effects on you. 

Acute pain may be severe or limit your normal activities. But you can often manage it in a straightforward way, and it usually gets better as your body heals.

Chronic pain needs a different approach. That may include more than one form of treatment. And it needs to address the whole person.

What does chronic pain feel like?

What chronic pain feels like is personal. There are many health conditions associated with chronic pain. The type of pain can vary, depending on the diagnosis. Two people with similar health conditions may have different experiences of pain. 

Descriptions of pain include: 

• Aching

• Stiffness

• Burning or stinging

• Sharp or stabbing

• Throbbing or pulsing

The pain may be in one part of your body. Or it might start in one place and travel somewhere else. It may even feel like it includes your whole body. Many people with chronic pain also have trouble sleeping, changes in mood, and shifts in energy. 

What causes chronic pain?

Pain is a symptom, not a diagnosis. And chronic pain is a complex symptom. Besides what’s going on in your body, your mental health and social situation also affect your experience of pain. The amount of physical damage doesn’t always predict the level of pain or degree of limitation that you feel. 

There are several categories of chronic pain:

• Chronic cancer pain: This kind of pain may come from the cancer itself or from side effects of cancer treatments.

• Chronic postsurgical or post-traumatic pain: This is pain that persists after the expected recovery period from a surgery or injury.

• Chronic neuropathic pain: Damage to some part of the nervous system causes this type of pain. Some examples are pain that occurs after a stroke or nerve damage from diabetes.

• Chronic headache and orofacial pain: This is pain in any part of the head or face that is present on at least half the days for 3 months or more.

• Chronic visceral pain: This comes from injury or illness to internal organs like the liver or intestines.

• Chronic musculoskeletal pain: This is pain that arises from bones, joints, muscles, or tendons.

• Chronic primary pain: This kind of pain interferes with everyday activities but isn’t defined by another category.

How common is chronic pain?

A large national survey in 2019 found that about 1 in 5 of U.S. adults had chronic pain in the 3 previous months. And for almost 10% of them, the pain was severe enough to limit normal life or work activities. The number of people with chronic pain increases with age. It is most common in adults over 65.

Other studies have shown similar numbers around the world. About 1 in 5 adults worldwide have some type of chronic pain. And it’s a common reason to seek medical attention. About 15% to 20% of healthcare visits include a concern about chronic pain.

How is chronic pain diagnosed?

Pain is a symptom that affects people in different ways, so a thorough conversation with your healthcare provider is the first step. That includes not only the type and location of the pain, but also how it affects your ability to function. Talking about other symptoms is also important, like whether pain is impacting your sleep, energy, or mood. 

Chronic pain will prompt a search for a cause. But an underlying cause may or may not show up on a blood test or imaging study. Not every test is appropriate for every type of pain. 

But depending on your symptoms, some types of testing may include:

• Blood and urine tests

• Imaging studies like X-rays, ultrasounds, CT scans, or MRIs

• Nerve conduction studies (measures how well electrical signals are moving through your nerve cells)

• Electromyography (EMG) (looks at the connection between nerve cells and muscles)

• Pain inventories and questionnaires (help get a baseline understanding of your pain, as well as how it’s doing over time and with different treatments)

How is chronic pain treated?

Because chronic pain is different from acute pain, it requires a many-sided approach. It’s important to work with your healthcare provider to find treatments that are effective and safe. The best treatment for you will depend on the:

• Type of pain

• Its underlying cause

• Your other health conditions

• Possible side effects 

Here are some treatment options that may be used alone or together to treat chronic pain.

Medications

Most people with chronic pain take some type of pain medication. Some are taken every day, while you take others only when needed. They may include:

• Non-narcotic pain relievers include things like aspirin, acetaminophen, and NSAIDs like ibuprofen and naproxen. 

• Opiate and opioid pain medication are powerful medications to treat chronic pain, but they’re not right for everyone. Because of the potential for side effects and addiction, the CDC has guidelines for their use.

• Cannabinoids include products that contain CBD and THC. It’s a good idea to talk with your medical provider about the risks and benefits for your situation.

• Anticonvulsants treat seizures. But some are also used for pain that involves the nervous system.

• Antidepressants treat mood changes and sleep problems that often go with chronic pain. Many are also used to decrease the level and frequency of the pain itself.

• Other medications may include corticosteroids, muscle relaxers, and topical pain relievers. 

Healthcare providers start most medications at a low dose. Then, they adjust them slowly according to your needs and health conditions.

Procedures

A trained healthcare provider performs these in a clinical setting. Depending on the condition, some procedures may include: 

• Transcutaneous electrical nerve stimulation (TENS) (when a mild electrical current “distracts” nerve cells away from pain)

• Nerve blocks or ablations

• Epidural injections

• Injection in a muscle, tendon, or joint

Physical therapy and yoga

Physical therapy and occupational therapy can help treat chronic pain.

There are also many complementary approaches. Work with your healthcare provider to discuss options that might be helpful and safe for you. Some options include:

• Acupuncture 

• Yoga

• Tai chi 

• Mindfulness and meditation 

• Hypnosis 

• Massage 

• Spinal manipulation

Mental healthcare

When it comes to chronic pain, taking care of your mental health is as important as caring for the rest of your body. Many people experience mental health conditions because chronic pain limits their ability to work, spend time with friends and family, and do the things they love. So many pain experts recommend screening for and treating depression and other mental health conditions. 

Everyday practices of awareness and mindset are also valuable. This includes engaging in activities that are meaningful to you.

Health and lifestyle

Chronic pain can sap all your energy and attention. Part of treatment includes focusing on pillars to support your overall health. This includes:

•  Eating a balanced and nutritious diet

•  Engaging in moderate exercise as you’re able

•  Stopping smoking

•  Getting adequate sleep

•  Managing stress

What health complications may arise out of chronic pain?

Because chronic pain impacts your ability to live your life to the fullest, many people experience  complications, like lower mood and substance misuse. Chronic pain can also put people at risk of health conditions that can develop when you’re less active. 

People with untreated chronic pain often report a lower quality of life. That’s why a comprehensive approach is so important.

Is there a cure for chronic pain?

Chronic pain often can’t be cured. But it can be treated and controlled so you can get back to the things you love. Current pain treatments can decrease a person’s pain score by about 30%. That may not sound like a lot, but that can translate into a much better quality of life. And it improves even more when treating mental health conditions together with physical sources of pain.

Why trust our experts?

Written by:

Anne Jacobson, MD, MPH

Anne Jacobson, MD, MPH has been a board-certified family physician since 1999. She worked as a full-scope family physician (inpatient, outpatient, obstetrics, and office procedures) in the Cook County Ambulatory Health Network for 15 years.

Reviewed by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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