What is chronic pain?

Chronic pain affects more than 100 million Americans, and the treatment and loss of productivity stemming from this epidemic costs the nation as much as $635 billion.

Pain is a protective response initiated by receptors in the body when tissue damage by injury, disease, or an illness is detected.  The impulse sensed at the site of injury is converted to an electrical stimulus that sends a signal through the nerves to the spinal cord before being relayed to the brain.

Acute pain is self-limiting, typically with a specific diagnosis and treatment plan resulting from a sudden injury such as a sprained ankle.  In some instances, it can lead to chronic pain.

Chronic pain is pain that lasts for greater than 12 weeks and can be the result of pain associated with a chronic illness, cancer, an ongoing injury such as a herniated disc, or from an injury in which the tissue damage has healed but the pain signal from the central nervous system persists.  The nervous system then becomes distorted – pain signals are intensified and can migrate to other sites away from the original site of injury.  Sometimes there is no cause found for initiating the pain signal.


Why is chronic pain so difficult to treat?

The pain experience varies per person even between those that may have exactly the same illness or disease and it is entirely subjective; thus, it is difficult to measure.  It is still widely misunderstood by the medical community on how to be managed especially when there is no underlying disease or injury, and it is often misdiagnosed.  It cannot be treated by the individual symptoms in the same manner as acute pain – taking medications, resting, and then healing.  Research still does not provide evidence as to why some patients are more prone to developing chronic pain than others.  Scientists believe genetic variation plays a role in being susceptible to chronic pain and in sensitivity to pain.  It can also be worsened by environmental and psychological factors.

The experience is frustrating for both doctors that are unable to provide a cure, and for patients that feel misunderstood.  Often the greatest challenge for patients is dealing with the psychological consequences from their condition –  loss in activities they once enjoyed, feelings of isolation, changes in sleep and appetite, increased stress and anxiety, altered relationships, changes in employment, and depression.

Chronic pain is now being viewed as a chronic disease condition.  Some pain is not curable, but it is treatable.  Chronic pain requires a multidisciplinary approach to treating the whole body using a blend of treatments.

What alternative treatments are available?

  • Physical therapy and rehabilitation
  • Acupuncture
  • Chiropractic care
  • Massage (deep tissue massage)
  • Trigger point therapy massage
  • Tai chi
  • Yoga
  • Meditation
  • Low impact exercises (swimming, walking, biking)
  • Cognitive-behavioral therapy

Elliot Krane describes in the TED talk below how a young girl with a wrist fracture turned into a nightmare of chronic pain.  He estimates that’s about 10% of the population that experiences acute pain will go on to develop chronic pain.  Only further research can help identify why those 10% are more vulnerable to chronic pain and how it can be both prevented and treated more effectively.