Chronic Pain Therapy

What is Chronic Pain?

Chronic pain is defined as pain that persists for more than three months, extending beyond the normal healing time of an injury or illness. It is a widespread condition that affects millions of people in the United States, with research showing that over 20 percent of Americans experience chronic pain regularly.

This type of pain can manifest in various forms, including stiffness, aching, burning, or throbbing sensations, and it can occur anywhere in the body. Chronic pain often disrupts daily activities, making it difficult to move, work, or enjoy everyday life. The ongoing nature of this pain can severely impact physical mobility and overall quality of life, highlighting the importance of effective management and treatment strategies.

What Causes Chronic Pain?

Many things can cause chronic pain. Common causes of chronic pain include: 

• Injuries – Broken bones and previous injuries can cause lasting pain that continues even after the injury has healed. 
• Back problems  – Back problems and injuries to the spinal cord are common causes of chronic pain.  
• Arthritis and joint problems – Arthritis and other inflammatory conditions can result in chronic pain. 
• Nerve damage – Chronic diseases like diabetes can damage nerves and lead to pain. 
• Cancer and other illnesses –  Cancer, shingles, and other infections can result in chronic pain. Some people have fibromyalgia, which is a disease that causes chronic pain. 
• Idiopathic – Sometimes there is no known cause of chronic pain. When this happens, it is called idiopathic. 
• Predisposed – Some people are more at risk of chronic pain than others due to genetics, environmental, and other risk factors.

How is chronic pain related to mental health? 

Dealing with physical pain is challenging enough, but studies have shown that chronic pain extends far beyond the physical. Mental health and chronic pain are closely linked, often creating a vicious cycle that is hard to break. Chronic pain can significantly impact a person’s mental health, frequently leading to conditions like depression and anxiety. The constant, unrelenting nature of pain interferes with everyday activities, making it difficult to work, maintain relationships, and perform basic tasks. This ongoing struggle can leave individuals feeling overwhelmed, helpless, and isolated, further compounding the emotional toll of living with chronic pain.

Chronic pain that persists for months or even years can deeply affect one’s quality of life. It often disrupts personal relationships and professional responsibilities, creating feelings of frustration and social withdrawal. Moreover, chronic pain commonly interferes with sleep, leading to fatigue and exacerbating mental health issues. The lack of rest can heighten pain sensitivity, perpetuating a cycle of pain and emotional distress. As a result, the emotional burden of chronic pain can be just as significant as the physical pain itself, making comprehensive treatment that addresses both aspects essential.

Additionally, mental health issues can directly cause physical pain, illustrating the complex relationship between mind and body. Conditions such as depression, anxiety, and chronic stress often manifest as physical symptoms, including headaches, muscle tension, and stomach pain.

Stress activates the body’s “fight or flight” response, leading to muscle tightness and an increased perception of pain, while anxiety can amplify the body’s sensitivity to discomfort. Depression alters pain processing in the brain, making aches and pains feel more intense. This interconnectedness underscores the importance of integrated treatment approaches that focus on both mental and physical health to effectively manage chronic pain.

What is the treatment for chronic pain?

If you are experiencing pain that lasts for months and doesn’t seem to improve, it’s crucial to consult with your doctor. There are a variety of treatments available that can help you manage chronic pain and regain your quality of life. Treatment often involves a multidisciplinary approach that addresses both the physical and psychological aspects of pain.

Medical Treatments

› Medications. Both over-the-counter and prescription medications are commonly used in the treatment of chronic pain. Doctors typically start with nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen. If these are ineffective, they may prescribe medications specifically for pain management, such as antidepressants (e.g., Cymbalta), anticonvulsants (e.g., gabapentin), and muscle relaxants. While opioids may be prescribed in some cases, they are generally avoided due to their high risk of addiction, side effects, and limited long-term efficacy in chronic pain management.

› Injections. Injections such as corticosteroids can be used to reduce inflammation and pain in joints and soft tissues. Trigger point injections help relax tense muscles by targeting painful muscle knots. For more severe cases, nerve blocks or epidural steroid injections may be used to directly target the pain pathways, providing temporary relief.

› Physical Therapy. Physical therapy is one of the most effective non-drug treatments for chronic pain, focusing on improving movement, range of motion, and muscle strength. A physical therapist can tailor exercises to help manage pain, improve mobility, and reduce the recurrence of pain episodes by teaching proper body mechanics and strengthening supportive muscles.

› Neuromodulation. Techniques like spinal cord stimulation (SCS) and transcutaneous electrical nerve stimulation (TENS) are used to alter pain signals sent to the brain. SCS involves implanting a device that sends electrical impulses to the spinal cord to reduce pain perception, while TENS uses a portable device to stimulate nerves through the skin, providing temporary pain relief.

Psychological Treatments

› Cognitive Behavioral Therapy (CBT). CBT is one of the most extensively researched psychological treatments for chronic pain, shown to be highly effective in reducing pain-related distress. CBT helps patients identify and change negative thought patterns that can amplify pain perception, such as catastrophizing, and equips them with coping strategies to manage pain more effectively.

› Mindfulness-Based Cognitive Therapy (MBCT). MBCT combines elements of CBT with mindfulness practices like meditation and breathing exercises. This therapy helps individuals break the cycle of negative thinking that often accompanies chronic pain, promoting relaxation and reducing stress, which can alleviate pain intensity.

› Biofeedback Therapy. Biofeedback is a non-invasive therapy that teaches patients to control physiological processes that contribute to pain, such as muscle tension and heart rate. Through real-time feedback using sensors, patients learn to recognize and alter their body’s response to pain, fostering relaxation and reducing pain symptoms.

› Acceptance and Commitment Therapy (ACT). ACT is another psychological approach that focuses on helping patients accept their pain and commit to living a meaningful life despite it. This therapy emphasizes psychological flexibility and encourages patients to focus on values-based actions, reducing the emotional impact of chronic pain.

Holistic Treatments

› Lifestyle Changes. Adopting a healthy lifestyle is a cornerstone of chronic pain management. Regular exercise, stress management techniques, maintaining a consistent sleep routine, and avoiding alcohol and tobacco can significantly improve pain outcomes. Exercise, in particular, helps release endorphins, the body’s natural painkillers, and reduces inflammation.

› Acupuncture. Acupuncture involves inserting thin needles into specific points on the body to stimulate nerves and release neurotransmitters that can help reduce pain. It is commonly used for chronic pain conditions like migraines, osteoarthritis, and low back pain. Acupuncture has a low risk of side effects and can be a valuable component of a pain management plan.

› Chiropractic Treatment. Chiropractic care focuses on spinal manipulation and adjustment to relieve pain and improve mobility, particularly for back, neck, and shoulder pain. This hands-on approach can help correct misalignments that contribute to chronic pain.

› Mindfulness Meditation. Mindfulness meditation encourages patients to focus on the present moment and release negative thoughts. This practice has been shown to reduce pain perception, lower stress, and increase overall well-being. Regular meditation helps decrease pain sensitivity and improve emotional resilience, which is crucial for managing chronic pain.

› Yoga. Yoga integrates physical postures, breathing exercises, and meditation to enhance flexibility, strength, and mental clarity. Research supports yoga’s effectiveness in reducing pain for conditions like fibromyalgia, migraines, and chronic low back pain. Yoga’s calming effects on the nervous system counteract the pain response, promoting relaxation and improving pain management.

› Complementary Treatments. Other complementary therapies, such as tai chi, massage therapy, and herbal supplements, may also provide relief for some individuals. These treatments can be especially beneficial when used alongside conventional therapies, offering additional ways to manage pain holistically.

How to get the most from treatment?

A comprehensive approach that combines medical, psychological, and holistic treatments is often the most effective strategy for managing chronic pain. Consulting with healthcare providers to create a personalized pain management plan can help individuals find the right combination of treatments to reduce pain and improve their quality of life.

Although there is no cure for chronic pain, it can be managed successfully through a consistent and well-coordinated treatment approach. It is essential to adhere to the pain management plan developed with your doctor, as consistency in following the prescribed treatments, medications, and therapies is key to achieving the best outcomes.

Also, continue to engage in daily activities whenever possible. This will help you decrease stress and boost your mood, both of which are important when it comes to dealing with chronic pain. It’s also helpful to join a support group. You can talk to others who have experienced chronic pain and learn what has worked for them. 

Living With Chronic Pain

Living with chronic pain can be difficult. The good news is that there are plenty of treatments that have shown promise in reducing pain. The first step in managing chronic pain is to choose a treatment plan that addresses the emotional and physical aspects of pain. Locate a therapist in your area or online who specializes in chronic pain therapy.

Post-Pandemic Update 

Because of the pandemic, people living with chronic pain experienced significant challenges in their everyday lives. Being socially isolated, losing work, and experiencing a greater degree of stress all aggravated chronic pain. This is why it’s so important for people with chronic pain to seek therapy to help them cope with stressors as these may negatively affect chronic pain. 

References

1. NIH Medline Plus. (Spring, 2011). Safely Managing Chronic Pain. Retrieved 4/27/2019 from MedlinePlus.
2. WebMD. (2019). What Is Chronic Pain Syndrome? Retrieved 4/27/2019 from WebMD.
3. Cleveland Clinic. (2019). Chronic Pain: Living With Chronic Pain. Retrieved 4/27/2019 from Cleveland Clinic.
4. Centers for Disease Control and Prevention. (November 3, 2022). Opioid Therapy and Different Types of Pain. Retrieved 8/13/2023 from CDC.
5. Lim JA, Choi SH, Lee WJ, et al. (2018). Cognitive-behavioral therapy for patients with chronic pain: Implications of gender differences in empathy. Medicine (Baltimore). Retrieved 4/27/2019 from PubMed Central.
6. WebMD. (2019). Overview of Biofeedback. Retrieved 4/27/2019 from WebMD.
7. Witt, C. M., Jena, S., Selim, D., et al. (2006). Pragmatic Randomized Trial Evaluating the Clinical and Economic Effectiveness of Acupuncture for Chronic Low Back Pain. American Journal of Epidemiology, 164(5), 487-496. Retrieved 4/27/2019 from American Journal of Epidemiology.
8. Salehi A, Hashemi N, Imanieh MH, Saber M. (2015). Chiropractic: Is it Efficient in Treatment of Diseases? Review of Systematic Reviews. International Journal of Community Based Nursing & Midwifery, 3(4), 244-254. Retrieved 4/27/2019 from PubMed Central.
9. Migraine Again. (March 2017). Four Behavioral Treatments For Migraines Worth Trying. Retrieved 4/27/2019 from Migraine Again.
10. Veehof, M. M., Oskam, M. J., Schreurs, K. M., & Bohlmeijer, E. T. (2011). Acceptance-based interventions for the treatment of chronic pain: A systematic review and meta-analysis. Pain, 152(3), 533-542. Retrieved from Pain Journal.
11. Psychology Today. (May 2015). How Does Yoga Relieve Chronic Pain? Retrieved 4/27/2019 from Psychology Today.
12. Amja, K., Vigouroux, M., Pagé, M. G., & Hovey, R. B. (2021). The Experiences of People Living With Chronic Pain During a Pandemic: “Crumbling Dreams With Uncertain Futures.” Qualitative Health Research. Retrieved from Qualitative Health Research.
13. Mills, S. E. E., Nicolson, K. P., & Smith, B. H. (2019). Chronic pain: a review of its epidemiology and associated factors in population-based studies. British Journal of Anaesthesia, 123(2), e273–e283. Retrieved from British Journal of Anaesthesia.
14. Sturgeon, J. (2014). Psychological therapies for the management of chronic pain. Psychology Research and Behavior Management, 7, 115. Retrieved from Psychology Research and Behavior Management.
15. Yong, R. J., Mullins, P. M., & Bhattacharyya, N. (2021). The prevalence of chronic pain among adults in the United States. Pain, Publish Ahead of Print. Retrieved from Pain Journal.
16. Pardos-Gascón EM, Narambuena L, Leal-Costa C, et al. (2021). Effects of Mindfulness-Based Cognitive Therapy for Chronic Pain: A Multicenter Study. International Journal of Environmental Research and Public Health, 18(13), 6951. Retrieved from IJERPH.