What is chronic pain and how is it treated?

Around a quarter of the population in the UK will experience chronic (long-term) pain at some point in their lives. This refers to pain that lasts for three months or more and can affect any part of your body. It may come and go or be constant but in either case, it persists after the original insult, trauma or trigger. 

What does chronic pain feel like?

Chronic pain falls into two categories: nociceptive, where the pain is caused by damage to your tissues, or neuropathic, where the pain is caused by damage to or compression of your nerves. You may experience a mix of nociceptive and neuropathic pain. 

Depending on the underlying cause, your pain may feel aching, burning, shooting, stinging or throbbing. It can feel as if part of your body is being squeezed; it can feel sharp or dull. 

When you seek medical care for your chronic pain, you may be asked to rank it on a numerical scale from 1 to 10, where 1–3 is mild pain, 4–7 is moderate pain and 8–10 is severe pain. Monitoring your pain in this way will help gauge how your pain changes over time and in response to treatment. 

Causes of chronic pain

There are many different causes of chronic pain. It is especially common if you have had multiple surgeries on your spine, which can lead to back, neck, leg and/or arm pain. Any type of surgery can also lead to pain around the scar site. 

Other causes of chronic pain include arthritis, trauma (eg a crush injury), chemotherapy that leads to malfunction of your peripheral nerves (polyneuropathy) and complex regional pain syndrome (CRPS), where a minor injury (eg a sprained ankle, crush injury or minor fall) inexplicably produces severe, ongoing pain. 

Medication can also trigger a vicious cycle of pain. For example, if you have pain and are treated with a high dose of opioids, the opioid itself can trigger hyperalgesia ie increased pain sensations. 

Similarly, if you have refractory or intractable migraines, you may be on a high dose of painkillers. Overuse of these painkillers can cause medication overuse headaches (MOHs).

Diagnosing chronic pain

Getting a diagnosis of chronic pain relies heavily on your doctor asking detailed questions about your medical history and symptoms. This includes questions such as: 

• Where is your pain and how severe is it?
• How frequently does it occur and do any factors make it worse or relieve it?
• How is it affecting your work life, home life and relationships?
• Do you have any other medical conditions and/or have you undergone any surgery?
• How is your mood affected by your pain? 
• Do you feel depressed or anxious?

Based on the answers to these questions and a physical examination, your doctor may recommend tests to investigate the underlying cause of your pain. 

This may include blood tests, urine tests, spinal fluid tests, nerve conduction studies and/or imaging tests (eg MRI scan, X-ray, CT scan).

Treating chronic pain

Chronic pain is usually treated with pain medication, which is tailored to the specific type of pain you have.

If your pain is caused by chronic inflammation, you may be prescribed non-steroidal anti-inflammatory drugs (NSAIDs). If your pain is neuropathic, your doctor may prescribe anticonvulsants (eg amitriptyline, duloxetine, pregabalin and gabapentin). Other pain medications include steroids, muscle relaxants, topical local anaesthetics and topical opioids.

Your doctor may also suggest other treatments, such as using a TENS (transcutaneous electrical nerve stimulation) machine, nerve blocks, applying heat or cold pads, occupational therapy, physiotherapy and/or hydrotherapy.

Living with chronic pain

Chronic pain often requires non-medical treatment to help you better manage, cope and live with chronic pain. 

This is usually delivered as part of a pain management programme, delivered in a community clinic. It may involve teaching you how to pace your activities and how to manage your stress levels and anxiety, as well as suggesting dietary and lifestyle changes that can improve your pain (ie following a healthy, balanced diet and taking part in regular low-intensity exercises, such as walking and light swimming).

Your doctor may also recommend psychological support, such as counselling and/or cognitive behavioural therapy (CBT). 

Outcomes for chronic pain treatment

For 60–70% of individuals with chronic pain, conservative treatments, such as medication and lifestyle changes, are effective at significantly improving their quality of life. However, for 30–40%, despite conservative treatments, their pain is still severe and interventional treatment is recommended.

Interventional treatment often involves neuromodulation. This is where electrodes are implanted into your spine (spinal cord stimulator) or near your nerves (peripheral nerve stimulator) at the site of your pain. These electrodes send out electrical impulses that help mask your pain.

Ongoing research and advances mean that more types of pain can be successfully treated with neuromodulation.