People with persistent pain often think of themselves as suffering from a specific ailment, whether it’s arthritis, back pain, migraines, or something else. But anyone who has experienced pain for several months or longer also happens to be among the millions of Americans with a condition known as chronic pain.
Chronic pain is a complex condition that affects 42 million-50 million Americans, according to the American Pain Foundation. Despite decades of research, chronic pain remains poorly understood and notoriously hard to control. A survey by the American Academy of Pain Medicine found that even comprehensive treatment with painkilling prescription drugs helps, on average, only about 58% of people with chronic pain.
What causes chronic pain, and what can you do about it?
Some cases of chronic pain can be traced to a specific injury that has long since healed -- for example, an injury, a serious infection, or even a surgical incision. Other cases have no apparent cause -- no prior injury and an absence of underlying tissue damage. However, many cases of chronic pain are related to these conditions:
- Low back pain
- Arthritis, especially osteoarthritis
- Multiple sclerosis
- Nerve damage (neuropathy)
Treating your underlying condition is, of course, vitally important. But often that does not resolve chronic pain. Increasingly, doctors consider chronic pain a condition of its own, requiring pain treatment that addresses the patient’s physical and psychological health.
Understanding the Psychological Impact of Chronic Pain
At a fundamental level, chronic pain is a matter of biology: Errant nerve impulses keep alerting the brain about tissue damage that no longer exists, if it ever did. But complex social and psychological factors are also at play, and they seem to help determine who fares well despite even severe chronic pain -- and whose lives quickly unravel.
Negative emotions, including sadness and anxiety, seem to aggravate chronic pain. For example, people who dwell on their discomfort tend to be more disabled by chronic pain than people who try to take their pain in stride. And among people with chronic pain stemming from a work-related injury, those who report poor job satisfaction fare worse than those who say they like their jobs.
But negative emotions can be a result of chronic pain as well as a cause. "If you had always been an active person and then you developed chronic pain, you might become depressed," says Roger Chou, MD, associate professor of medicine at Oregon Health & Science University in Portland and a leading expert on chronic pain. "Depression is common in chronic pain patients, but people who think chronic pain is ‘all in the head’ are not being realistic."
Because chronic pain affects all aspects of your life, it’s important to treat chronic pain both medically and emotionally.
"People with chronic pain shouldn’t assume that they have to tough it out," says Russell K. Portenoy, MD, chairman of pain medicine and palliative care at Beth Israel Hospital in New York City and past president of the American Pain Society. "And they should not be satisfied with a doctor who doesn’t want to treat it aggressively."