What is chronic pain?

Chronic pain is frequent or constant pain that does not respond to the usual treatments. Unlike acute pain, which gets better and goes away in a short time, chronic pain persists for at least several months. It often causes depression. You may lose your desire to eat. You may have trouble sleeping. You may be taking several pain medications and may be functioning poorly at home and on the job.

How does it occur?

Pain usually starts as the result of some injury to the body. The pain you feel, however, depends on a combination of responses by your body and your brain. Each person experiences pain differently.

Acute pain lasts only a short time. It has a distinct beginning and a clear cause. In contrast, chronic pain usually lasts more than 3 months and often produces a greater reaction than is usual for the cause. It leaves you distressed and unable to function normally.

How is it evaluated?

Your chronic pain will need to be evaluated thoroughly. Several types of health care providers may take part: physician, nurse, psychologist, social worker, physical therapist, and/or occupational therapist.

Your health care provider will take a complete medical history. You will have a thorough physical exam. How you feel, physically and emotionally, and what you can and cannot do will be taken into account. New and chronic illnesses will be reviewed, as will any medications you are taking. Your body language (grimacing, limping, restlessness) may also provide clues.

You may be asked to keep a personal diary charting how often you hurt and for how long. The diary may help find the cause of your pain. You should include the following:

• what you were doing when you had the pain

• the time the pain started and how long it lasted

• how the pain felt (for example, stabbing, crushing, aching, throbbing, burning)

• how bad the pain was (for example, you might rate it with a number from 1 to 10)

• the medicines you took for the pain, noting whether or not they worked

• anything that made the pain better or worse, such as heat, cold, exercise, baths, massage, rest.

How is it treated?

Treatment of chronic pain usually requires several approaches combined into a pain management program designed just for you. Both drug treatment and nondrug treatment are usually included.

The right medication for your pain may be one medicine or a combination of medicines. Drugs other than narcotics are used to treat mild to moderate pain. Among these medicines are acetaminophen (Tylenol), aspirin, and nonsteroidal anti-inflammatory drugs such as ibuprofen (Motrin, Advil, Nuprin). These drugs are not addicting. However, they may have side effects such as upset stomach, bleeding in the stomach, kidney damage, or confusion. The side effects vary from one drug to another and from person to person.

Narcotics such as codeine, oxycodone, and morphine are strong drugs that are used to relieve moderate to severe pain. These drugs are sometimes used to manage chronic pain, but only after trying other medicines and nondrug treatments. Narcotics can be addicting. However, people using these drugs for pain usually do not become dependent on them if they use the drugs as prescribed. Narcotic drugs may be given in several different forms, including by shot, pill, liquid, suppository, or skin patch. These drugs have a range of side effects including nausea, drowsiness, confusion, breathing problems, and hallucinations. The side effects depend on the drug and the dose. You and your health care provider must decide which side effects you can live with.

Other types of medicines used for pain control include steroids, sedatives, and drugs usually used to control depression or convulsions. Although none of these drugs work like the usual kind of painkillers, they can be useful in managing certain types of chronic pain.

Pain often cannot be managed by medication alone. Other treatments may include:

• heat

• cold

• an exercise program, which might include walking, swimming, aerobics

• physical therapy

• devices called TENS, which electrically stimulate nerves

• water therapy (hydrotherapy), using swimming pools, hot tubs, or whirlpools

• hypnosis

• acupuncture or acupressure

• massage therapy

• counseling

• biofeedback, especially for headache pain

• programs to change behavior, including use of relaxation methods, imagery, music, and meditation

• healthy diet

• hobbies and social activities

• in severe cases, cutting the nerves causing the pain.

Treatment of chronic pain can be difficult for both you and your health care provider. Keep your follow-up appointments so your provider can find out what is helping and what is not. Together you can continue to seek a solution.