Chronic pain: Take steps to regain your life

Pain is a normal, expected part of the healing process following surgery, procedures, injuries and some illnesses. Pain occurs when nerves in your body send signals to your brain, and the brain interprets those signals to mean that you are in danger.

Typically, pain has a purpose because it gets your attention to let you know you’ve had an “injury” or there’s a risk of being injured. Having pain does not always mean that something is wrong or that you’re having complications.

Pain is usually referred to as acute or chronic.

Acute pain is a sudden, short-term episode of pain. Examples include pain after surgery or pain from an injury such as a broken bone. Acute pain decreases naturally as your body heals and generally lasts only for hours or days.

Pain is called chronic when pain becomes long-lasting, persisting for months or years. Chronic pain does not necessarily follow the natural pattern of improvement with healing. It may come from a medical condition that cannot be cured or is hard to treat. For some people, chronic pain seems to have no clear source at all.

Another term you may hear for pain is called “acute pain on top of chronic pain.” This happens when you have an acute pain from an injury, illness, surgery or procedure in addition to an existing chronic pain condition such as arthritis.

Chronic pain can be frustrating and exhausting. It can interfere with your work, sleep, emotional health, sexuality and your relationships with family and friends.

While dealing with pain is challenging, try not to let it overwhelm you. Feeling overwhelmed or fearful makes it more likely that your brain thinks you are in danger, and it interprets neutral signals from your body as if you might get injured. As a result, fear, anxiety and focus on pain can actually make pain worse.

There is no cure for chronic pain, although it can improve. Like other chronic conditions, such as diabetes and arthritis, it’s a matter of learning strategies to help you live well and manage your condition.

The goal of chronic pain management is to help you have the best function and quality of life possible despite the pain.

Remember that you do not have to deal with chronic pain alone. Your health care team can work with you to help you create a plan to safely manage your current pain and eventually, help you have good quality of life.

Sometimes, chronic pain comes from an ongoing condition, such as arthritis. Other times, it may stem from nerve damage due to an accident, surgery or medical condition, such as diabetes. This is called neuropathic pain. The damaged nerve misfires and sends signals that the brain interprets as pain long after the injury has healed.

Often, however, no ongoing disease or injury can be linked directly to chronic pain. Research suggests that many chronic pain conditions arise from a process called sensitization. In this process, the brain and other parts of the nervous system overreact to sensory signals and those signals are perceived as pain.

Sensitization can be compared to the volume control on a radio. Sensitization “turns up the volume” of messages sent from your senses, making them stronger and, at times, distorted.

The biology of sensitization is complex, but the basic idea behind it is fairly simple:

1. As signals travel through the nervous system, they may turn on, or “activate,” circuits. The brain uses these signals to warn you that something is happening that might be dangerous for you.
2. Pain results from the brain’s attempt to warn you of danger. The more the circuits turn on, the easier it is for them to turn on again and again.
3. Repeated warning signals can cause changes in the brain. The brain may start to use more areas to process danger signals. In time, even one danger signal may activate many regions of the brain, triggering pain.

It is normal for the brain to change in response to sensory input. This can actually be helpful. For example, a concert pianist likely plays the piano many hours each day. With repeated practice, more areas of the brain help to move the fingers. In time, finger movements become “hard wired” in the brain. Then the person can play almost without thinking.

Unfortunately, the same thing can happen when the sensory input is danger. As more of the brain processes danger, the resulting perception of pain becomes the response. This can lead to:

• Pain that hurts more or lasts longer than is usual for an injury or illness.
• Pain from something that typically does not cause physical pain, such as moderate activity, a light touch or a hug.
• Pain that spreads to other parts of the body.
• Pain with no known trigger.
• Burning or tingling sensations without underlying nerve damage.

Why sensitization happens to some people and not to others is still not known. Factors that may play a role include:

• Injury or infection.
• Family history.
• Use of opioid pain medicines for more than 30 days.
• Poor sleep.
• Low mood.
• Smoking.
• Trauma.
• Prolonged physical, emotional or social stress.
• Hormonal factors. Chronic pain is more common in women than men.

The good news is that you can “retrain your brain.”

You can change your thought patterns and behaviors in ways that help your brain be less likely to process input from your senses as dangerous, so that you will have less pain.

When you have chronic pain, research shows there are things you can do that will be helpful and others that will not be helpful. All the tips listed under “What is helpful” should be regular parts of your pain self-management plan.

Effective treatments are available for both depression and anxiety. Studies have shown that treating depression and anxiety may result in less pain and better quality of life. If you have symptoms of depression or anxiety that linger for several months, or if they begin interfering with your daily life, talk to your health care provider.

Having a positive outlook — A positive outlook and being open to change increase your chance of managing pain well. If you have a negative outlook and see yourself as a victim of pain, pain will control you and become the focus of your life.

Staying connected — When you are dealing with chronic pain, you may start to withdraw from friends and family. But it is important to stay connected to those who care about you. Your friends and family can help you manage your pain and take your focus off it. Your family and friends can provide encouraging words, offer helpful feedback and lend a hand when you need assistance. Instead of drawing away from those you are close to, help them understand your pain, and allow them to tell you how your pain has affected them.

Decreasing pain behaviors — Pain behaviors keep the focus on pain and what you cannot do. Instead, direct your thoughts and actions toward what you can do.

Moving away from seeking medical answers — Reducing or stopping pain medication and reliance on medical therapies can help you change your focus to more productive strategies.

Getting the sleep you need — Poor sleep can make you more sensitive to developing chronic pain and make it harder to improve your condition.

Thinking about pain all the time — Keeping your attention on your pain prevents you from focusing on activities that can improve your overall well-being. Distracting the brain is helpful in reducing overall pain levels.

“Over-focusing” on symptom relief and not enough focus on regaining function — You may have to live with chronic pain, but it does not need to control your life. Instead, try to keep your attention on activities that improve your function and quality of life.

Being afraid to move so you don’t move — Staying active can actually improve pain by stretching tense muscles and allowing the body to release natural chemicals that reduce danger signals.

Medication is not the answer!

People with chronic pain often have taken many medications to manage their pain. This may include over-the-counter pain relievers and prescribed medications such as opioids. Some people with chronic pain turn to other substances such as alcohol, marijuana or other drugs for relief.

While pain medications and other substances may have helped at first, over time, they bring less and less relief. For chronic pain, medication can become part of the problem rather than an answer to pain.

Research shows that medication and other substances are not helpful for long-term pain management. In fact, they can make pain worse and cause unwanted side effects and other problems such as feeling very tired, constipation, memory issues, and increased risk of falls and injuries.

Over time, the search for pain relief may result in taking more medications, both prescription and over-the-counter, increasing the risk for drug interactions and harm.

Physical dependence can happen when your body adapts to a substance used for a long time. Opioid pain medications are very likely to lead to dependence. Dependence can lead to tolerance. This means you need more of a substance to feel its effects.

In someone with chronic pain, use of long-term opioids can actually worsen pain. Opioids also have many side effects, some of which may be life-threatening, including overdosing, breathing problems and addiction.

Learn to manage chronic pain without medication or other substances. If you believe you have a problem with medication, seek help right away. There are programs that can help you safely taper off medications.

Managing chronic pain typically involves moving away from medical therapies. However, the following therapies may be helpful when used as part of a self-management plan:

Cognitive behavioral therapy (CBT) — This therapy helps you replace thoughts about pain with more helpful, accurate thoughts so that your brain doesn’t become overly protective and produce too much pain. This therapy also helps you take part in fewer behaviors related to pain and, instead, do activities that are distracting and meaningful to you. Research about CBT shows it can reduce chronic pain over time.

Physical and occupational therapy — These therapies help you learn new ways to do tasks with less pain. Stretching, strengthening and aerobic exercises can help to increase your strength, flexibility and energy level and reduce pain.

Biofeedback — Biofeedback may help you learn to control some of your body functions related to pain, such as brain activity, blood pressure, muscle tension and heart rate. It can help you find out which types of relaxation strategies work best for you so you can learn to dial down your brain’s protection system. This can improve your ability to function and reduce pain.

Mind-body methods, such as:

• Meditation — Focusing on deep breathing or a simple phrase to calm your mind and body
• Yoga and tai chi — Using gentle movements and deep breathing to promote flexibility, strength and relaxation
• Paced breathing — Using controlled breathing to help lower heart rate, pain and stress

Pain rehabilitation programs — Professionals in these programs help people learn to better manage their pain, reduce reliance on medication, and improve their functioning and quality of life.

Some pain management programs specialize in specific types of pain, such as back pain or headaches. Other programs handle many types of pain.

Most programs include a variety of health care providers who specialize in pain management, including physicians, psychologists, nurses, physical therapists, occupational therapists and dietitians.

For information about pain management programs, talk to your health care provider. Your provider can help you find a pain management program that fits your needs.

Everyone has pain at some time. When you have pain that persists, this can be frightening and discouraging. This can have a huge impact on your life.

However, there are effective strategies that can help “re-wire your brain” so that persistent pain can be improved over time. Many people have learned these strategies and have resumed happy and fulfilling lives.

Ask your health care provider about self-management strategies to help you actively manage your pain, improve your health and function, and reduce your pain without medications.

Pain does not have to rule you. With knowledge about pain and effective strategies, you can regain control of your life.

This material is for your education and information only. This content does not replace medical advice, diagnosis or treatment. New medical research may change this information. If you have questions about a medical condition, always talk with your health care provider.