Most of the time pain is your body’s way of protecting you — reminding you to take your hand off a hot stove or rest a sprained ankle. Pain is critical to survival. It sets limits and teaches us to avoid repeated dangerous mistakes.
But sometimes, the pain protection system starts to misfire. It constantly sends pain signals to the brain that serve no protective function. When this lasts more than a few months, it’s called chronic pain.
According to the National Institutes of Health (NIH), about 20.4% of U.S. adults have chronic pain. That means approximately 50 million people have chronic pain in the United States alone. Chronic pain affects more Americans than cancer, heart disease and diabetes combined.
Chronic pain definition and how does it work?
Chronic pain is defined as pain experienced on most days, or every day, for three months or more. Around 7.4% of U.S. adults have high-impact chronic pain, which is defined as pain that limits their life or work activities most days for three months or more.
What causes chronic pain?
Sometimes chronic pain stems from a known cause, like arthritis. With arthritis, persistent joint inflammation triggers repetitive nerve impulses that signal injury. Other examples of known causes of chronic pain include cancer, multiple sclerosis and AIDS.
But chronic pain can happen without an obvious injury or disease. In these cases, medical tests, such as laboratory tests or imaging, don’t show a problem. But these chronic pain syndromes are just as real as other medical conditions. Just ask the many people who suffer from conditions like fibromyalgia, persistent headaches or irritable bowel syndrome.
How does chronic pain work?
With everyday pain — for example, if you cut yourself or have a stomachache — pain receptors in your skin, muscles and organs send a signal through your nerves to the spinal cord. The signal travels through the spinal cord to your brain. When the pain signals get to the brain, you feel the pain and react accordingly.
The brain, and the pathways that lead to it, can change over time — rerouting messages through new paths in the central nervous system. This is called neuroplasticity, and it usually helps the brain function more efficiently. But as the brain gets faster at processing sensory signals, it can become so sensitive it can no longer accurately detect danger and the messages get distorted. When the central nervous system can’t accurately detect danger, it sometimes sends frequent pain signals to the brain, leading to chronic pain.
What are the symptoms of chronic pain?
Chronic pain can make it hard to participate in your life. It can take control of your mood, job, relationships and productivity.
Common chronic pain symptoms include:
- Pain that interferes with your daily life, including taking care of yourself, working or leisure activities
- Motion sickness
- Trouble sleeping
- Sensitivity to sensory stimuli, like loud noises, smells and touch
Can chronic pain cause high blood pressure?
The relationship between pain and hypertension, known as high blood pressure, is not clear. However, a 2013 study found that chronic pain intensity was a significant predictor of hypertension — regardless of the person’s age, race, ethnicity and family history of hypertension.
Who’s at risk for chronic pain?
It’s hard to predict who will get chronic pain. Even people if two people had the same history of illness and injury, they could have different outcomes. However, people who are more at risk for chronic pain include:
- Non-Hispanic white adults
- Military veterans
- People who live in rural areas
- People ages 65 and older
- Depression and anxiety
- Those who have an existing chronic inflammatory condition, such as rheumatoid arthritis
- Those who have a nerve-related condition, such as diabetes
How can you learn to deal with chronic pain?
Chronic pain usually doesn’t go away, but there are many ways to manage and minimize the pain. For many years, pain medications were the primary way to treat pain. But recent research has shown that exercises, mindfulness practices and other complementary health approaches can lead to pain relief and overall well-being.
Exercise and therapy
Getting your body moving while you’re in pain might feel counterintuitive, but it’s a good idea. Studies show physical activity reduces chronic pain and slows pain progression. While every person is different, some activities recommended to alleviate chronic pain include:
- Aerobic exercise. Activities such as walking, cycling and swimming have been shown to decrease stress, ease depression and anxiety, and manage chronic pain.
- Strength training. Strength training, sometimes called resistance training, involves contracting your muscles against resistance such as free weights, elastic bands or your body weight to help build strength and endurance. For example, in one study, older adults with chronic pain reported fewer areas of pain and said pain diminished after strength training.
- Flexibility training. Stretching increases blood flow to your muscles — improving your range of motion and reducing stiffness.
- Tai chi. Tai Chi originated as a Chinese martial art, and studies show Tai Chi’s slow movements and meditative aspects decrease the intensity of pain and improve everyday function.
- Physical therapy. Physical therapists help you move and restore function. Activities may include massage, applying heat and ice, limb manipulation and other exercises.
- Occupational therapy. Occupation therapists will help you work around your limitations — helping you learn to adapt to your home or work environment in new ways.
Mindfulness and mind-body techniques
Changing the way you think about chronic pain can help you learn to live with it more successfully. You may want to try:
- Cognitive behavioral therapy (CBT). CBT is a form of psychotherapy used to treat chronic pain. The goal of CBT is to learn how to manage unhealthy thoughts, feelings and behaviors related to their chronic condition.
- Biofeedback. Biofeedback is a mind-body technique where sensors measure various activities in your body, such as heart rate or muscle contractions. Biofeedback can provide information that helps people learn to make subtle changes that lead to positive outcomes such as pain relief or increase physical performance.
- Spirituality. Engaging in spiritual practices can calm anxiety, provide perspective and help bring a sense of purpose and resolve.
- Yoga. Yoga combines breathing techniques and meditation with poses designed to stretch and strengthen muscles, improve physical fitness, enable relaxation, induce stress relief and lessen pain.
- Massage therapy. Massage therapy uses systematic rubbing and manipulation of body parts to reduce muscle tension and stress, treat pain, promote relaxation and create a feeling of general well-being.
- Acupuncture. Acupuncture is a traditional Chinese practice that involves inserting thin needles at certain places on the body to alleviate pain and nerve tension.
- Deep breathing. Deep breathing creates relaxation by slowly and repetitively breathing air in and out using the diaphragm.
- Music-based interventions. Creating music or simply listening to it as part of therapy can reduce pain and depression symptoms in people with chronic pain.
Is chronic pain a disability?
While chronic pain is often recognized as a disability in the health care industry, the law is still catching up. Currently, the Social Security Administration (SSA) defines “disability” as the “inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment.” In other words, you need medical evidence (i.e., tests) showing the progression of your disease.
Some chronic conditions — such as fibromyalgia or rheumatoid arthritis — have established guidelines for what evidence is needed. But for many other chronic pain issues, guidelines don’t exist yet. Ask your doctor, or a disability lawyer, for more information about evidence requirements for your specific condition.
There are signs that the law is beginning to change. In a 2018 decision, Saunders v. Wilkie, the United States Court of Appeals for the Federal Circuit agreed that “pain is enough” for a veteran to be eligible for disability compensation, even if the claimant is unable to establish a current, underlying cause of their pain. This is thought to be a first step toward disability benefits for people with a wide variety of chronic conditions.
Living with chronic pain
Although no one would choose to have chronic pain, many people live long and rewarding lives despite the pain. To learn more about living successfully with chronic pain, check out these other resources from Mayo Clinic Press:
- Mayo Clinic Guide to Pain Relief, Second Edition
- Opioids aren’t the only effective treatment for pain management
- What those with chronic conditions wish their friends knew
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