Persistent headaches and back pain. Achy bones, especially feet and hands. Gnawing, cramping guts. Whole-body soreness. So many people live with various flavors of chronic pain, and often go months or years without finding relief.
Some 20 percent of Americans are affected by chronic pain, according to the Centers for Disease and Prevention (CDC) — making it one of the most common reasons adults seek medical care. Chronic pain can be caused by ailments like fibromyalgia, rheumatoid arthritis, and inflammatory bowel diseases, or it can spring from stubbornly lingering injuries. Left untreated, pain can limit mobility, curb daily activities, and lessen quality of life — often leading to anxiety and depression.
Chronic pain is different from its cousin, acute pain. The latter occurs in response to tissue damage and inflammatory processes that follow, where the pain is viewed as part of the healing process, Steven P. Cohen, MD, chief of pain medicine at the Johns Hopkins School of Medicine in Baltimore, wrote in an overview of chronic pain published in May 2021 in The Lancet.
Once the immediate and intense period has passed — generally said to be roughly three to six months — pain that continues is a burden, increasingly viewed as a disease in and of itself.
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For years, the quest to battle chronic pain led doctors to prescribe opioid medications, although the drugs proved to be addictive, which is why prescriptions for opioids are now declining. That drastic decrease, though, left many so-called “legacy” chronic pain patients without the medications they had come to depend on, sometimes leading to terrible consequences. The CDC acknowledged as much in February 2022, when it released a draft of new, more nuanced guidelines for dispensing opioids, including the removal of controversial dose ceilings.
Are Pain Treatment Recommendations Changing?
For people who have never used opioids, the CDC’s draft pain treatment guidelines recommend that nonopioid therapies be tried first, including medications like ibuprofen, acetaminophen, or gabapentin — and also various nondrug therapies, such as cognitive behavioral therapy (CBT), massage, physical therapy, and other evidence-backed modalities.
Effective Alternatives to Pain Medications Exist — but Are They Accessible?
These more holistic approaches may be valuable for some types of pain, but society has a long way to go before enough Americans can access them, says Shravani Durbhakula, MD, an interventional pain physician at the Johns Hopkins School of Medicine and host of the American Academy of Pain Management’s podcast Pain Matters. Insurance coverage, access issues, and social barriers are limiting factors, she says. Realistically, many drug-free pain relievers are out of reach for some people.
Still, people with chronic pain should not feel alone, nor should they feel hopeless, Dr. Cohen says. Doctors are increasingly recognizing the importance of treating pain in its own right, and research continues to test various modalities. “There are numerous resources available for chronic sufferers,” he says.
Chronic Pain Falls Into 3 Categories
Chronic pain resulting from injury to tissue in the body is likely the most well-known type of pain. And indeed, this “nociceptive pain,” as it’s called by medical professionals, is very common. This category includes all types of musculoskeletal pain, which means pain affecting bones, muscles, joints, tendons, or ligaments, such as osteoarthritis, rheumatoid arthritis, and cancer pain.
Experts categorize a second type of chronic pain as “neuropathic pain,” meaning it results from injury to nerves, as in carpal tunnel syndrome