Chronic pain has a lot of causes. Maybe you were in a car accident a few months ago and still wake up with a stiff neck or back. You might have had surgery in the past year and still feel burning or throbbing. Perhaps as you get older you’re experiencing new aches and pains that don’t go away. It’s possible that you don’t even know what the cause is—you just know that it hurts.
It’s estimated that more than 20 percent of adults in the United States experience chronic pain, but its prevalence doesn’t make it easy to treat. In fact, there’s not even a standard medical definition for chronic pain, though UNC Health pain management specialist Maryam Jowza, MD, says that about three months of persistent pain could be considered “chronic.”
“We often know what started the pain—someone will have an injury to a tissue or nerve—but when the tissue is healed or the nerve is freed up, it can be unclear why the pain continues,” Dr. Jowza says.
That doesn’t mean your pain should be dismissed, she adds. If your doctor isn’t sure how to help, “ask for a referral to someone with more knowledge about helping with pain, whether that’s a physical therapist, sports medicine doctor, orthopedist or pain specialist.”
Dr. Jowza identifies four top treatment options for chronic pain.
Physical and Occupational Therapy for Chronic Pain
When you’re in pain, you may spend a lot of time being still, sitting or lying in the one position that gives you some relief. You may fear moving your body because it will cause more pain, but “not moving your body can be detrimental in other ways down the line,” Dr. Jowza says.
That’s why your doctor will often recommend physical therapy, which focuses on improving the ability to move certain body parts, or occupational therapy, which helps in performing activities of daily living.
“Physical and occupational therapy can help someone regain function and the use of their body,” Dr. Jowza says. “Movement is medicine. With chronic pain, it’s a misconception that if an area of the body is painful, you need to nurse it and not move it.”
Therapists will identify exercises and activities that you can do safely and help you recondition your body if you’ve been inactive due to pain. They can also help you learn to modify some of your regular activities. By incorporating regular exercise, people are often able to reduce existing pain and prevent future pain.
“Every day is a little bit different, so take it one day at a time,” Dr. Jowza says. “Give yourself grace, but continue to do your best to move.”
Pain Management Procedures for Chronic Pain
Depending on the cause of your pain, you may respond to a medical procedure to relieve your symptoms.
“Certain spine conditions and back pain may respond to injections,” Dr. Jowza says. “Acute sciatica pain may respond to an epidural steroid injection, for example.”
For some, a nerve block—an injection of anesthetic delivered to the area where the pain is located—can provide relief.
Other options include ablation, in which heat is delivered to destroy tissue and disrupt pain signals, and the implantation of devices that deliver medication or block pain signals.
Your doctor can guide you to what’s appropriate for your situation and provide a referral to a specialist in these procedures.
Medication for Chronic Pain
If you have an acute symptom such as cough or headache, there are several medications you can take, so it’s natural to wonder if a pill can help your pain.
But it’s not that simple, Dr. Jowza says.
“There’s not a medication for every type of pain,” she says. “One of the most harmful behaviors I see is someone taking an excessive amount of a medication that doesn’t help.”
That said, there are some types of pain where medications are appropriate, such as certain nerve-related pains or musculoskeletal issues that respond to anti-inflammatory drugs, nerve pain medications or muscle relaxants.
You may be curious about whether your doctor will prescribe opioids, given the crisis of opioid addiction and overdose.
“Opioids are sometimes used, but not as a first-line treatment,” Dr. Jowza says. “It’s more common to use them for acute pain, such as after a surgery, for a short period of time. The data doesn’t support long-term use, and there’s a lot of risk. They are not the main medication for chronic pain.”
Emotional Support for Chronic Pain
While your doctor is determining the best way to treat your physical pain, they may also refer you to psychological services to help you manage the emotional experience of chronic pain.
“Pain and mood are linked, so that pain makes you anxious, and then the anxiety makes the pain worse, and the pain makes the anxiety worse,” Dr. Jowza says. “It’s a negative snowball effect.”
Dr. Jowza says therapy approaches including cognitive behavioral therapy and acceptance and commitment therapy have been shown to help with coping with the effects of pain on your quality of life.
In addition to therapy, Dr. Jowza says it’s important to stay in contact with your friends and family and ask for help when needed. Though people tend to withdraw from others when they’re dealing with pain, feeling alone can make the pain worse.
“Chronic pain can change a person’s sense of self, their relationship to others and their plans for the future,” Dr. Jowza says. “It’s important to recognize that and talk about it, so people don’t feel isolated.”
Struggling with persistent pain? Talk to your doctor. If you need a doctor, find one near you.