What is chronic pain? Here's what you need to know

Chronic pain is typically defined as pain lasting longer than three to six months. “It lasts beyond the usual injury-recovery period. Or it’s related to a chronic illness,” explains Lynn Kohan, MD. She’s a director at large for the American Academy of Pain Medicine (AAPM). She’s also a professor of anesthesiology and pain medicine for the University of Virginia Health System. Chronic pain is one of the most common reasons adults seek medical care in the U.S.¹

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Chronic pain is very common. Here are some key statistics:

• It affects about 50 million adults in the U.S. each year.¹ And it’s the leading cause of disability. (A disability keeps you from carrying out basic daily activities.)
• Roughly one-third have high-impact pain. This limits life or work activities.
• The risk of chronic pain increases as we age. More than 30% of adults over the age of 65 live with it.³

Normal pain can be minor or severe. Think of a headache (minor) or a broken bone (severe). But it’s short-term. Yes, healing from a broken arm can take weeks. But once you’re better, the pain is gone. That doesn’t happen with chronic pain.

Chronic pain can feel different for different people. People can have chronic pain anywhere in the body. And the intensity varies widely. Chronic pain can be constant. Or it can come and go. There’s no way to measure pain other than patient reporting.

Doctors typically ask patients to rate their pain on a scale from 0 to 10. That’s a way to measure and track a patient’s pain over time. Zero is no pain and 10 is extreme.

One can feel chronic pain through different sensations as well. Common descriptions of chronic pain include:

• Aching
• Burning
• Dull
• Piercing
• Pulsating
• Sharp
• Shooting
• Stabbing
• Throbbing

Let’s start with how any type of pain starts. When you get hurt, your body releases certain chemicals that alert your nerves. Your nerves send messages back and forth to your brain. In this case, they’re sending off pain messages. Your body is on high alert.

As you heal, it’s normal to be extra sensitive to pain for days or weeks. The tissues are surrounded by inflammation (soreness). Even a slight touch or movement can make it hurt more. But eventually, the injury hurts less and less. You get better and the pain is gone.

Sometimes, though, the sensitivity doesn’t go away. The pain messages keep on firing. And experts think this mix-up is one of the reasons chronic pain happens.^3,4

“We know that a hypersensitive nervous system leads to chronic pain,” says Colleen Louw, PT. “There’s growing research to support it.” She’s a spokesperson for the American Physical Therapy Association. (Physical therapy uses exercise to care for pain and weakness.) She’s also the program director for the therapeutic pain specialist certification for Evidence in Motion.

It’s sort of a vicious cycle. The more the brain processes pain, the more sensitive it gets and the more pain you can feel.^3,4

Injuries are clear causes of chronic pain. But other health conditions can lead to it as well.

Some common ones include:

• Arthritis: This health problem damages the joints, resulting in swelling and stiffness.

• Cancer. Tumors can destroy or press on tissue, bones and nerves.

• Diabetes. High blood sugar causes nerve damage. And those damaged nerves can misfire and send pain messages for no reason. They can also make you feel severe pain even with a light touch.⁵

• Fibromyalgia. This medical problem causes pain all over the body, as well as problems with sleep.

• Inflammatory bowel disease (IBD). This group of diseases causes the body to attack the lining of the digestive tract.

Finding the underlying issue can sometimes help lessen the pain. But many patients have chronic pain without a clear illness or injury.

If you are experiencing chronic pain, seek help from a health care provider. “Pain is subjective. So chronic pain is typically diagnosed by [talking with the patient],” says Dr. Kohan. Your health care provider may ask you to describe the pain. How long have you been experiencing the pain? What does the pain feel like? Where is the pain located?

Your provider will likely carry out a full pain assessment. They will ask you about your past medical history, what you do for work and other activities that might add to your pain. Your provider will also look at muscle strength, joint motion and sensation. More tests may be ordered, including:

• Bloodwork. It will check for infections and other medical problems, like with the liver and kidney. (The kidney is an organ that filters blood.)
• Magnetic resonance imaging (MRI). It will check for bone or tissue damage.
• A nerve conduction study. It will measure how fast electrical impulses move through your nerves.
• X-ray. It will check for bone fractures, breaks or abnormalities.

It’s important to remember that some people may have pain even if these tests can’t find a clear cause. This can be frustrating and upsetting for patients. And it doesn’t make the pain any less real.⁶

Chronic pain and mental health are often deeply intertwined. Sometimes emotions can show up as physical pain. On the flip side, physical pain can lead to feelings of hopelessness, frustration and anger. That can take a toll on your well-being.

Being in pain for any amount of time is emotionally stressful. And chronic pain can make anxiety or depression worse. Plus, pain can also prevent a patient from doing the activities they enjoy. That could be caring for a grandchild or participating in a running club. Missing out can lead to even more negative feelings.

“Patients often feel isolated. They think no one can understand what they are going through,” says Dr. Kohan. She says emotional distress and physical pain can make sleep difficult as well. That’s why it’s important to have a mental health professional on your care team. They can help you cope with the emotions and behaviors that often come with chronic pain.⁷ (Optum offers mental health self-care tools and one-on-one support. See how we can help.)

While chronic pain can be disruptive and distressing, there are several ways to feel better. When treating chronic pain, your doctor will first try to find the underlying issue. They will also likely prescribe medication. There are many different choices. What you choose to do depends on your specific situation. You can learn more about common pain medications here.

It’s important to remember that no two treatment plans are alike. Arthritis pain will need a different care plan than ongoing stomach problems. Along with medication, below are some other ways to feel better.^{8, 9, 10}

• Injections. Medicines that can be injected directly into the area of pain. Some reduce swelling, some block pain messages to the brain.

• Neurostimulation. This treatment involves electrical currents. They alter how the brain and spinal cord relay pain messages.

• Occupational therapy. This helps the patient get back to the activities they enjoy. And it helps ease the pain brought on by everyday activities

• Physical therapy. This uses exercise to reduce pain and help you move more easily.

• Psychotherapy. Therapy helps you find ways to feel more in control of your pain.

• Surgery. Your doctor may suggest it to decrease or end pain.

• Meditation/mindfulness. Focusing the mind may help to reduce pain and improve quality of life.

• Acupuncture. This is a form of Eastern medicine in which very fine needles are pushed into the skin. Research suggests it may help ease chronic pain.⁸

• Massage. Massage therapists use pressure and different types of touch to relax muscles.

• Virtual reality (VR). Devices that simulate 3D surroundings. They may help control stress and mood and improve pain symptoms.

Changing other daily habits can help ease the symptoms of chronic pain as well. “Eating well, exercising, losing weight, [quitting] smoking and good sleep hygiene may all be helpful,” says Dr. Kohan. “The most important thing is that patients don’t feel that chronic pain is their fault.”

If you’re dealing with ongoing pain, help is available. Your doctor can help you create the care team you need so you can get back to focusing on what you love most.

Find mental health resources that fit with your life. Work one-on-one with a virtual coach or therapist from AbleTo. Find support now.

1. Centers for Disease Control and Prevention. Managing chronic pain. Last reviewed December 18, 2019. Accessed July 19, 2022.
2. Centers for Disease Control and Prevention. NCHS data brief: Chronic pain and high-impact chronic pain among U.S. adults, 2019. Last reviewed November 2020. Accessed July 19, 2022.
3. American Physiological Association. The physiology of pain. Published March 2022. Accessed July 26, 2022.
4. Arthritis Foundation. The connection between pain and your brain. N.D. Accessed July 26, 2022.
5. National Institute of Neurological Disorders and Stroke. Peripheral neuropathy fact sheet. Published August 18, 2018. Accessed July 26, 2022.
6. National Center for Complementary and Integrative Health. Chronic pain: In depth. Last update September 2018. Accessed July 26, 2022.
7. American Psychological Association. Managing chronic pain: How psychologists can help with pain management. Last reviewed 2013. Accessed July 19, 2022.
8. National Institute of Neurological Disorders and Stroke. Chronic pain: What research is being done? Last reviewed July 25, 2022. Accessed July 26, 2022.
9. National Center for Complementary and Integrative Health. Massage therapy: What you need to know. Last updated May 2019. Accessed July 26, 2022.
10. U.S. Food & Drug Administration. FDA authorizes marketing of virtual reality system for chronic pain reduction. Published November 16, 2021. Accessed July 26, 2022.