What Is Chronic Pain?

The Difference Between Chronic and Acute Pain

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Pain is one of the most common complaints people go to the doctor with. In the U.S. alone, more than 100 million people are estimated to live with chronic pain.

Chronic pain is very different from acute pain. Acute pain is what you experience when you get hurt—say, when you break a bone or burn your hand—or when something goes wrong in your body, such as indigestion, appendicitis, or a passing kidney stone.

Acute pain is like an alarm system. It tells you your body is being or has recently been damaged so that you can do something about it. The message can be, "The burner is hot, so please stop touching it," or "The tendon in your ankle is damaged and walking on it will have negative consequences." It's information you need and can put to use.

Chronic pain is like an alarm that's malfunctioning or goes off when it doesn't need to, like a smoke alarm with a dying battery. We've all had that neighbor whose car alarm goes off any time a cat walks by or the wind blows, waking you up in the middle of the night and going on and on. Everyone on the street knows they don't need to call 911 or come flying up out of bed to chase off a thief, and yet that alarm still has an impact on your life.

When Acute Pain Becomes Chronic

Acute pain can turn into chronic pain. Different doctors have different benchmarks for how long it takes to become chronic.

Some say three months, others say six months or a year. Still, others consider it chronic if the pain has persisted longer than it typically would for whatever caused it.

Medical science didn't used to understand why pain would linger after something was healed. Often, they'd say the pain was "all in your head."

More recently, though, researchers have discovered that acute pain sometimes changes how our brains are wired.

When you sense pain, what's happening is that your nerves are detecting a problem and sending signals to your brain. Your brain then sends signals out to your body aimed at removing danger and directing the healing process.

When signals are constantly going back and forth, it's like your nervous system gets in the habit of sending them, and sometimes, it doesn't stop even when it should. The physical structures that carry those signals have changed, similarly to how pathways in your brain change when you learn a new skill.

When Chronic Pain Develops on Its Own

Sometimes, chronic pain crops up when there hasn't been anything like an injury or surgery to cause it. Usually, this is because of an illness.

Scores of conditions can cause chronic pain, either in specific areas or body-wide. Some common ones include:

These conditions are caused by a wide variety of things and they can't all be treated the same way.

If you develop chronic pain, it's crucial that you see a doctor and get a proper diagnosis. That gives you a far better chance of finding effective treatments and management strategies.

Types of Chronic Pain

Not all pain feels the same. If you've had a cut, a bruise, a burn, and a sprain, you know that they're all different. Chronic pain also varies by cause.

Chronic pain is often described as:

  • shooting
  • burning
  • electrical (zingy, prickly)
  • stabbing
  • dull
  • achy
  • throbbing
  • tender
  • stiff

Less common descriptions may include words like "deep" or "warm."

A doctor may be able to tell a lot from how you describe your pain.

For example, shooting electrical pain most likely comes from a nerve.

Unusual Pain Types

Certain types of pain are less common than others and may only be related to certain conditions.

Hyperalgesia is pain amplification—basically turning up the volume of pain. When they detect pain signals, the nerves send more signals than they should, and the brain over-responds as well. The result is that you experience far more pain than you normally would.

Hyperalgesia is linked to:

Another unusual pain type is allodynia, which means pain from something that isn't typically painful. That can include a light touch, fabric brushing against the skin, or moderate cold or heat.

Allodynia is a feature of:

  • migraine
  • fibromyalgia
  • other central sensitivity conditions

Other people often judge those with hyperalgesia and allodynia harshly, believing they're making too big a deal out of their pain, or faking it, or somehow too mentally weak to handle it. The pain from them, however, is real and often debilitating.

Pain Triggers

Chronic pain is sometimes constant, but it doesn't have to be. The pain of a condition like irritable bowel syndrome may only be present after eating certain foods, but it could still be considered chronic. The same goes for knee pain that's triggered by cold or overuse but isn't there all the time.

Your pain triggers can also tell a doctor a lot about what's going on in your body. In some cases, it can even point toward specific management strategies.

Symptoms Linked to Chronic Pain

While pain is the primary symptom, other symptoms frequently accompany chronic pain. These often include:

  • fatigue
  • poor sleep
  • depression
  • anxiety
  • decreased appetite
  • impaired mental function
  • nausea
  • poor coordination

Not everyone with chronic pain will experience all of these symptoms. Also, some chronic-pain conditions include many additional symptoms, as well.

Diagnosing Chronic Pain

Like with acute pain, if you go to the doctor and say, "I have chronic pain," he or she will probably ask, "Where does it hurt?"

If you can point to a place (or a few places,) that's usually a big help when it comes to diagnosing you. The doctor will likely examine the area and may get an x-ray or other scan to see what's going on internally.

If they ask "where" and you say "everywhere," the process will go differently. Expect blood tests to look for signs of inflammation or other disease markers. Your doctor may also order scans as well, depending on your symptoms and medical history.

The more complicated your pain is, the more it may help to keep a pain journal. That can help you identify triggers, answer questions about when and for how long you hurt, and the intensity and quality (i.e., burning, stabbing) of your pain. (The pain journal is a tool for you, so you can understand your pain better. Don't hand it to the doctor and expect him/her to pore through it for you.)

Treating Chronic Pain

Treatments for chronic pain can vary greatly depending on your diagnosis.

Medications for pain may include:

Depending on your symptoms and overlapping conditions, your doctor may recommend additional treatments, such as:

Lifestyle changes may also help you feel better. These can include:

  • dietary changes
  • modified activity levels
  • special accommodation at school or work
  • leaving school or work
  • quitting smoking
  • limiting or eliminating alcohol
  • stress management
  • mobility aids

Daily Life With Chronic Pain

Living with chronic pain is hard. At times, you may feel hopeless or desperate for relief.

With proper diagnosis and treatment, some chronic pain goes away over time. Some does not. While there's no one-size-fits-all treatment, you do have a lot of options available for reducing your pain, which can improve your functionality and quality of life.

By working with your doctor to find the right treatment regimen, and by making smart, healthy choices, you may be able to make significant improvements.

Sources:

Blackburn-Munro G, Blackburn-Munro RE. Chronic pain, chronic stress and depression: coincidence of consequence? Journal of neuroendocrinology

National Academies of Science. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research.

Ren W, Centeno MV, Berger S, et al. The indirect pathway of the nucleus accumbens shell amplifies neuropathic pain. Nature Neuroscience. 2016 Feb;19(2):220-2.

Yunus MB. Central sensitivity syndrome: a new paradigm and group nosology for fibromyalgia and overlapping conditions, and the related issue of disease versus illness. Seminars in arthritis and rheumatism. 2008 Jun;37(6):339-52. 

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