Chronic Pain

By Barbara Hales, M.D.

3d image CHRONIC PAIN issues concept word cloud background

What is chronic pain?

Chronic pain lingers longer than expected as healing time due to an injury or onset of a medical problem.  Typically it is pain that lasts between three and 6 months from onset. The origin of chronic pain can be traced to the body, brain or spinal cord.


There are 7 categories of chronic pain according to the ICD chronic pain classification. These are:

  1. Chronic primary pain: defined by 3 months of persistent pain in one or more anatomical regions that is unexplainable by another pain condition.
  2. Chronic cancer pain: defined as cancer or treatment related visceral, musculoskeletal, or bony pain.
  3. Chronic posttraumatic pain: pain lasting 3 months post trauma or surgery, excluding infectious or preexisting conditions.
  4. Chronic neuropathic pain: pain caused by damage to the somatosensory nervous system.
  5. Chronic headache and orofacial pain: pain that originates in the head or face, and occurs for 50% or more days over a 3 months period.
  6. Chronic visceral pain: pain originating in an internal organ.
  7. Chronic musculoskeletal pain: pain originating in the bones, muscles, joints or connective tissue.

Types of Chronic Pain

Chronic pain can be perceived in many ways with sensations such as:

  • Achy
  • Burning
  • Dull
  • Prickly
  • Shooting
  • Stabbing
  • Stiff
  • Tender
  • Throbbing

What causes chronic pain?

Though any acute pain can become chronic, there are illnesses themselves that can lead to chronic pain. Common ones include:

  • Autoimmune/inflammatory conditions
  • Arthritis
  • Cancer
  • Fibromyalgia
  • Joint dysfunction
  • Lupus
  • Migraine headaches
  • Multiple sclerosis
  • Nerve compression (e.g. sciatica, carpal tunnel syndrome)
  • Neuropathy (from nerve damage)

Hyperalgesia is a condition where pain is intensified.  The nerves send a greater number of signals and the brain over-responds creating more than usual pain sensations.

This condition is associated with:

  • Chronic use of opioid painkillers
  • Illness (as in fibromyalgia)
  • Inflammation
  • Nerve damage
  • Stroke

Allodynia is a condition where pain is felt despite it not being typically painful.

This is seen with fibromyalgia and migraines.

Symptoms Associated with Chronic Pain

These are:

  • Anxiety
  • Decreased appetite
  • Depression
  • Fatigue
  • Impaired mental function
  • Nausea
  • Poor coordination
  • Poor sleep

Home treatment options

Lifestyle changes help those with chronic pain to feel better.  These include:

  • Dietary changes as in weight reduction or better diet selection
  • Nutritional supplements
  • Exercise
  • Decreasing or eliminating alcoholic beverages
  • Smoking cessation
  • Stress management

Professional treatment options

Treatment will depend on the etiology of the pain but typically include:

  • Antidepressants
  • Anti-inflammatory drugs
  • Anti-rheumatic drugs
  • Corticosteroids
  • Epilepsy medications
  • Muscle relaxants
  • Opioids 

Additional treatments performed in conjunction with the above include:

  • Acupuncture
  • Chiropractic care
  • Massage therapy
  • Physical therapy
  • Psychotherapy

What should I expect?

People suffering from chronic pain have an increased rate of depression, sleep disturbances and anxiety. It is generally associated with less physical activity due to a worry of exacerbating pain, which leads to weight gain.

Severe chronic pain is linked to higher 10-year mortality, especially from cardiac and respiratory conditions.  Psychological therapy involving cognitive behavioral therapy and commitment therapy may improve the quality of life for those dealing with chronic pain.

There are more than 100 million people living with chronic pain in the United States.  With appropriate therapy, some chronic pain dissipates in time.  With better lifestyle choices, significant improvement may be attained.