Pain is an unpleasant sensory and emotional experience associated with potential damage to your body.1 The purpose of pain is to alert us that something may be wrong. For sufferers of chronic pain, the condition can be debilitating and affect many aspects of life.

Read on to find out more about the condition, including symptoms and treatment options.

What is chronic pain?

The International Association for the Study of Pain describes chronic pain as ‘pain that persists past normal healing time’.2 Pain is defined as chronic if it lasts for more than three to six months.2 It can involve complex psychological and social factors.

What are the main types of chronic pain?

Chronic pain is a long-term condition, with examples including arthritis, fibromyalgia, migraine, and back pain3:

  • Neuropathic pain: This kind of pain refers to damage to the nerves, this could be caused by a sciatica, for instance3.
  • Nociceptive pain: this is pain which is caused by an injury to the body, such as a broken bone3.

How many people have chronic pain?

At least 10% of the global population suffers with chronic pain, while estimates of prevalence in some countries and regions are around 20–25%. A further one in 10 people develop chronic pain every year worldwide.4 In Europe, 19% of the adult population report having moderate or severe chronic pain.5

Symptoms

What are the symptoms of chronic pain?

If a pain persists for longer than 12 weeks, it is chronic pain.2 The pain could be related to a previous trauma or injury, or it could be caused by damage to the nervous system (such as sciatica).3 In adults chronic pain could develop because of a condition such as arthritis.3 Chronic pain can interfere with the ability to perform daily activities and may have an impact on sleeping and mental health.6 Sufferers can find they are doing less activity in an effort to minimise the pain, and could put on weight and grow lethargic as a result. The impact on daily life linked to long-term pain can include6:
  • Reduced involvement in family or social activities
  • Difficulty concentrating
  • Missing work
  • Economic burden

What are the stages of chronic pain?

There are no specific stages of chronic pain but In some cases – for example, back pain –  the pain may start off as short-term following an accident or strain and become chronic even after the injury has healed. Pain can also develop over time as we age.7

Causes, risk factors and life expectancy

What causes chronic pain?

Chronic pain is common and has many different causes. While the pain can be related to other medical conditions, trauma or injury, it can also be caused by problems with the nervous system, which can send pain signals to the brain despite a lack of obvious tissue damage. Potential causes of chronic pain include:
  • Cancer: Chronic pain can occur as a result of either the disease or its treatment.8
  • Trauma: Surgical or accidental trauma to tissue can lead to chronic pain.9
  • Musculoskeletal: This can include pain from an injury and damage to the tissues. These often include a broken bone or a pulled hamstring.3

Is chronic pain hereditary?

Chronic pain itself is not hereditary, but there is evidence to suggest that some conditions which can lead to chronic pain may be.

A team of UK researchers carried out a study involving 4,282 sets of twins looking at four conditions that can manifest as chronic pain: irritable bowel syndrome, musculoskeletal pain, pelvic pain, and dry eye disease. The study showed that if one identical twin suffered from one of these ailments, then it was likely the other twin did as well. As identical twins share virtually the same genetic code, this suggests a heritable element to these conditions.10

Who gets chronic pain?11

In a 2019 study the association between risk factors and the development, persistence, or severity of chronic pain was assesssed. They found that the most important clinical risk factor (or ‘tell-tale sign’) for chronic pain to develop is the presence of another site of acute pain within the body. In other words, people who experience short-term severe pain (for example, as a result of an injury) are more likely than people without any pain to develop chronic pain. The study also found that patients with depression or cardiovascular disease were more likely to suffer with chronic pain than those without.

How long can you live with chronic pain?

Chronic pain does not reduce life expectancy, and most patients can find ways to manage their pain in order to live a full life. Chronic pain can have a profound effect on quality of life and mental health.12

Diagnosis

If someone thinks they are suffering with chronic pain, it is important to visit a doctor so that they can make a diagnosis.

How is chronic pain diagnosed?13

As pain measurement is subjective and very personal to each individual, the healthcare provider will need to carry out a comprehensive assessment to better understand the pain experienced.

 

A detailed pain assessment will allow the healthcare professional to determine whether the pain being experienced matches a pain syndrome, or whether there is a disease that may help explain the pain.

Test to diagnose chronic pain

There are tools that healthcare providers can use to help determine the severity of pain and the impact it has on daily life. A pain assessment chart may be used to help gather a clear history of the pain while assessing its nature and severity. The three types of assessment chart that are usually used rate pain on a numerical scale, a verbal scale, or a visual scale.14

There are other methods healthcare professionals can use to diagnose chronic pain, these depend on the type of pain being experienced. For example, in the case of nerve damage a nerve function test called electromyography (EMG) could be used. This involves an electrode being inserted into a muscle to record electrical activity and assess the severity of the damage .15 The healthcare professional may perform a nerve conduction study to record the nerves’ responses to an electric current by attaching a flat electrode to the skin that emits a low electric current.

Treatment and medication

How is chronic pain treated?

Treatment plans are tailored to the individual and usually consist of a combination of medication, exercise, and physical therapy. No single technique is guaranteed to provide complete pain relief, but most patients are able to find a combination of treatment options that helps them manage their condition.

Medication

As chronic pain is so personal to each patient, any medication plan will be tailored to the individual and should be overseen by a healthcare professional. Below are some options that may be offered as part of a treatment plan.

  • Epidural steroid injections may be offered for some types of nerve pain originating in the spine.3
  • Anti-convulsants (anti-epileptic drugs) may be used to treat various neuropathic pain conditions, while sedatives or anti-anxiety agents could be prescribed for short-term treatment of sleep problems resulting from chronic pain.16
  • Anti-depressants may also be offered, types of anti-depressants that could be prescribed include tricylic anti-depressants and selective serotonin reuptake inhibitors.3
  • Non-steroidal anti-inflammatory drugs, analgesics and simple opioid drugs can help reduce pain but are not a long-term solution.17

Therapy

It’s likely a doctor will refer someone with chronic pain to services that can provide self-help techniques to manage the pain. Physical therapy is a common treatment for chronic pain and can involve manipulation, stretching, and pain relief exercises. Physiotherapists may provide exercises that can be done at home to help relieve the symptoms.18

Intervention

Many techniques are recommended that can help people manage chronic pain. These include3:
  • Deep breathing:
  • Hot or cold compresses
  • Thought distraction
  • Mindfulness techniques
  • TENS (transcutaneous electrical nerve stimulation) machine: This is a method of pain relief that uses a mild electrical current. A device is attached to the body with electrodes that deliver an electrical signal, which can reduce the pain signals going to the spinal cord and brain.19

Diet

Although there is no solid scientific evidence that a particular diet can treat chronic pain, eating a variety of foods, including fruits and vegetables, is recommended for a healthy lifestyle.

Research has suggested that magnesium, vitamin B12 and zinc  may be beneficial for those with chronic pain.20

Exercices

Although resting for short periods of time can alleviate pain, too much rest could increase the risk of injury when the person attempts to move again. Exercise is recommended as part of a daily routine for those with chronic pain as can improve strength, flexibility and balance. For many people, doing exercise each day can reduce the number of bad pain days, or at least lead to the pain becoming more manageable. Helpful gentle exercises to try include walking, swimming, using an exercise bike, and yoga.21

Prevention

Chronic pain is a serious condition that often has a huge impact on the sufferer’s life and puts a burden on health services. Unfortunately, there is no proven preventative measure for the condition, but protective factors, such as level of exercise, healthy diet, sleep, coping skills, and social support, can help to reduce risk of developing chronic pain.22

Scientific studies

As chronic pain is a condition affecting so many patients worldwide, it is unsurprising that there are a wealth of scientific studies on the topic, ranging from the efficacy of treatment options to how widespread the condition is.

The European Commission is currently funding an international collaborative research project called QSPainRelief, which uses computer modelling to implement new personalised treatments for chronic pain patients. Researchers are hoping to find combinations of existing medications that may provide relief for these patients.23

Referenced sources

  1. Definition of pain. International Association for the Study of Pain.
  2. Updated December 14, 2017. Accessed October 20, 2021
  3. Treede RD, Rief W, Barke A, et al. A classification of chronic pain for ICD-11. Pain. 2015;156(6):1003-1007. doi:10.1097/j.pain.0000000000000160
  4. Jackson TP, Sutton Stabile V, McQueen KAK. The global burden of chronic pain. ASA Newsletter. 2014;78(6):24-27.
  5. Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2006;10:287-333.
  6. Dueñas, M., Ojeda, B., Salazar, A., Mico, J. A., & Failde, I. (2016). A review of chronic pain impact on patients, their social environment and the health care system. Journal of pain research9, 457–467.
  7. Lower back pain fact sheet. NIH. Updated March, 2020. Accessed October 28, 2021.
  8. Causes and types of cancer pain. Cancer Research UK. Updated October 20, 2020. Accessed October 20, 2021.
  9. Da Fonseca, P. R., Gatto, B. E., Tondato, V. A. (2016). Post-trauma and postoperative painful neuropathy. Review article.
  10. Vehof J, Zavos H, Lachance G, Hammond C, Williams F. Shared genetic factors underlie chronic pain syndromes. Pain. 2014;155(8):1562-1568.
  11. Mills, S., Nicolson, K. P., & Smith, B. H. (2019). Chronic pain: a review of its epidemiology and associated factors in population-based studies. British journal of anaesthesia123(2), e273–e283.
  12. Racine M. Chronic pain and suicide risk: a comprehensive review. Prog Neuropsychopharmacol Biol Psychiatry. 2018;87(Pt B):269-280.
  13. Dansie E. J., Turk D. C. Assessment of patients with chronic pain. British Journal of anaesthesia. VOLUME 111, ISSUE 1, P19-25, JULY 01, 2013
  14. Safikhani, S., Gries, K. S., Trudeau, J. J., Reasner, D., Rüdell, K., Coons, S. J., Bush, E. N., Hanlon, J., Abraham, L., & Vernon, M. (2018). Response scale selection in adult pain measures: results from a literature review. Journal of patient-reported outcomes2, 40.
  15. vello BJ, Pobre T. Electrodiagnostic Evaluation Of Peripheral Neuropathy. [Updated 2021 Oct 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from:
  16. Joseph V. Pergolizzi & Jo Ann LeQuang (2020) Reappraising the use of benzodiazepines in chronic pain patients, Postgraduate Medicine, 132:sup3, 10
  17. 12,  Rosenblum, A., Marsch, L. A., Joseph, H., & Portenoy, R. K. (2008). Opioids and the treatment of chronic pain: controversies, current status, and future directions. Experimental and clinical psychopharmacology16(5), 405–416.
  18. Coronado, R. A., & Bialosky, J. E. (2017). Manual physical therapy for chronic pain: the complex whole is greater than the sum of its parts. The Journal of manual & manipulative therapy25(3), 115–117.
  19. Vance, C. G., Dailey, D. L., Rakel, B. A., & Sluka, K. A. (2014). Using TENS for pain control: the state of the evidence. Pain management4(3), 197–209.
  20. Philpot U, Johnson M. Diet therapy in the management of chronic pain: better diet less pain? Pain Manag. 2019;9(4):335-338
  21. Geneen, L. J., Moore, R. A., Clarke, C., Martin, D., Colvin, L. A., & Smith, B. H. (2017). Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. The Cochrane database of systematic reviews4(4), CD011279
  22. Practical Pain Management. Updated September, 2017. Accessed November 13, 2021.
  23. QSPainrelief EU project. QSPainrelief. Updated 2021. Accessed October 28, 2021.
You might be interested in…

Mental health

Greater awareness and willingness to talk about mental health has ushered in a new era understanding and acceptance and broken through some layers of public stigma but there are many challenges ahead.

Stress

Stress is a common by-product of modern, busy lives. It infects work, home, relationships with multiple triggers that often appear beyond our control.

Chronic pain

Dictionary definitions don’t do it justice. Chronic pain is a complex condition that is rarely solved quickly and often requires emotional as well as physical solutions.