What Is Chronic Pain? Causes, Symptoms, Diagnosis, and Treatment

Pain is an important messenger. You feel pain when chemical signals are carried to your brain from other parts of your body that may be in distress. Pain tells you that something in your body needs attention. It may arrive quickly, like a signal to pull away from something hot or sharp. It might last a while as your body heals from an illness or injury. In some instances, it can develop slowly over time. But there are also times when pain can be chronic, and persists for months or even years. 

What is chronic pain?

Chronic pain, sometimes called “chronic pain syndrome” (CPS), is often defined as pain that lasts or recurs for more than 3 months. It might be constant, or it could come and go. And there are usually things that make it better or worse. The pain may vary in intensity, from quite mild to very severe. Some days, there may be no pain at all. 

Importantly, chronic pain can have a negative impact on a person’s quality of life. It can lead to anxiety, depression, opioid dependence, and social isolation. It’s necessary to find the root cause of chronic pain in order to effectively treat it and avoid its complications.

Types of chronic pain

Chronic pain can develop in any part of the body and in any organ system. Some types of chronic pain are more common than others. Chronic pain can be broken down into three types: pain due to nerve damage (neuropathic), inflammation (nociceptive), or increased pain signals (nociplastic).

Examples of neuropathic pain due to nerve damage include conditions such as:

• Trigeminal neuralgia 

• Diabetic neuropathy

• Postherpetic neuralgia (after herpes infection), HIV neuropathy

• Sciatica

• Autoimmune disease pain

Examples of nociceptive pain due to inflammation include:

• Rheumatoid arthritis

• Back pain

• Endometriosis

• Migraines

• Gout

Nociplastic pain due to increased pain signals often has no signs of tissue damage. Examples of this type of chronic pain include:

• Fibromyalgia

• Complex regional pain syndrome

• Chronic tension headaches

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Each type of pain can happen along with the other types or in isolation. A healthcare professional can help determine the best course of treatment for your type of pain.

What do symptoms of chronic pain feel like?

Symptoms of chronic pain and what it can feel like is very personal. And the type of pain can vary, depending on the diagnosis and health condition linked to it. Two people with similar health conditions may have different experiences of pain. 

Descriptions of pain symptoms 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. Its causes will vary based on what’s going on in your body. Chronic pain is also a complex symptom. Besides the physical condition that may be producing pain, 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’s 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 is chronic pain diagnosed?

Pain is a symptom that affects people in different ways, so a thorough conversation with a healthcare professional is the first step. This includes having a discussion about 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 affecting 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. 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, which measure how well electrical signals are moving through your nerve cells

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

• Pain inventories and questionnaires that 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 a healthcare professional 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 like aspirin, acetaminophen, and nonsteroidal anti-inflammatory drugs or NSAIDs (ibuprofen and naproxen) 

• Opiate and opioid pain medication, but they’re not right for everyone due to potential side effects and addiction

• Cannabinoid products that contain CBD and THC

• Anticonvulsants to treat seizures, especially for pain that involves the nervous system

• Antidepressants for mood changes, sleep problems, and also to decrease the level and frequency of the pain itself

• Other medications like corticosteroids, muscle relaxers, and topical pain relievers 

• Ketamine infusions for people with neuropathic pain that doesn’t respond to traditional treatment.

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

Procedures

A trained healthcare professional will perform 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 a healthcare professional 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

Care for mental health

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. Several different therapies can help patients manage chronic pain, including cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT).

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, if you smoke

•  Getting adequate sleep

•  Managing stress

How does chronic pain differ from acute 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.

Is there a cure for chronic pain?

Chronic pain often can’t be cured. But it can be treated and managed so you can get back to the things you love. Current pain treatments can lower 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.

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Written by:

Anne Jacobson, MD, MPH

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

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

Reviewed by:

Frank Schwalbe, MD

Frank Schwalbe, MD, is an assistant professor of anesthesiology at the Yale School of Medicine. He has practiced anesthesiology for 30 years.

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