What Happens

In some cases, chronic pain develops after an injury or illness. The pain continues even after you have recovered from the injury or illness. For example, many people who have had a limb amputated report feeling chronic pain in the missing limb (phantom limb pain). Chronic pain can also develop even though you have not had an injury or illness. The result, however, is often the same—a cycle of sleeplessness, inactivity, irritability, depression, and more pain.

Chronic pain may be mild to severe. You may develop pain that comes back from time to time over several weeks, months, or years. Occasional, mild to moderate pain can usually be managed at home. Exercise, good nutrition, regular massages, and pain-relieving drugs—such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin—may be enough to manage your symptoms.

On the other hand, you may develop constant chronic pain that is severe. You may be unable to work, and physical activity may be too painful or exhausting. Sleeping at night may be difficult, resulting in fatigue and irritability. Your outlook on life may change and strain your relationships with family and friends. Prolonged pain may restrict your daily activities and eventually lead to disability.

After treatment begins, many things can interfere with your recovery, such as dependency on drugs or alcohol, overwhelming stress, lack of motivation, depression or other mental health problems, or ongoing litigation because of a workers’ compensation claim. If your pain is disabling, you may want to seek an evaluation at a pain management clinic, where a team of health professionals works together to treat your pain.

The lives of your family members, friends, or caregivers can also be affected. The people you count on to help you may also need some support. Family therapy or involvement in a caregiver support program may help.

In addition to medicine or surgery, other treatments can be helpful in reducing chronic pain.

Other Treatment Choices

Additional treatments for chronic pain may include:

• Physical therapy. This may include hot and cold therapy to relieve painful areas of the body. It may also include stretching and range-of-motion exercises to maintain strength, flexibility, and mobility.
• Transcutaneous electrical nerve stimulation (TENS). TENS applies brief pulses of electricity to nerve endings in the skin to relieve chronic pain.
• Professional counseling (such as cognitive-behavioral therapy). This treatment focuses on your mental health and conditions such as stress and depression, which can accompany chronic pain and make it worse. It is important to be healthy emotionally as well as physically, to recover from chronic pain.

Your health professional may refer you to a pain management clinic to receive these treatments. These clinics provide a setting where you can receive treatment and learn to cope with chronic pain. Treatment is usually provided by a team of health professionals who work together to address the many possible causes of your chronic pain. You may also receive these treatments from your own health professional or from specialists who treat chronic pain.

Complementary therapies

Complementary therapies may reduce pain, help you cope with stress, and improve your emotional and physical well-being. These include:

• Acupuncture, a treatment based on traditional Chinese medicine, where very thin needles are inserted into the skin at certain points on the body to produce energy flow.
• Aromatherapy, or essential oils therapy, which uses a plant’s aroma-producing oils (essential oils) to treat disease.
• Biofeedback, a method of consciously controlling a body function that is normally regulated automatically by the body, such as skin temperature.
• Chiropractic therapy, a hands-on therapy based on the theory that many medical disorders (especially disorders of the nervous system) may be caused by subluxations in the spine.
• Guided imagery, a series of thoughts and suggestions that direct a person’s imagination toward a relaxed, focused state.
• Healing touch, which influences a person’s physical or emotional health without physically touching the person.
• Homeopathy, or homeopathic medicine, which is a medical philosophy and practice based on the idea that the body has the ability to heal itself.
• Hydrotherapy, which uses water, in any form, to treat a disease or to maintain health.
• Hypnosis, which is a state of focused concentration during which a person becomes less aware of his or her surroundings. Some people learn to manage pain through concentrating in this special way.
• Magnet field therapy, a treatment that uses magnets to stimulate areas of the body to try to maintain health and treat illness.
• Massage, which is rubbing the soft tissues of the body, such as the muscles, to help reduce tension and pain, improve blood flow, and encourage relaxation.
• Meditation, which is the practice of focusing your attention to help you feel calm and give you a clear awareness about your life.
• Naturopathy, which promotes using organic foods and exercise; maintaining a healthy, balanced lifestyle; and applying concepts from other areas of complementary medicine (such as ayurveda, homeopathy, and herbal therapies) to try to improve health, prevent disease, and treat illness.
• Yoga, which uses meditation and exercises to help you improve flexibility and breathing, decrease stress, and maintain health.

What To Think About

If you decide to try one or more of these complementary therapies to treat your chronic pain, find a health professional who has special training and, whenever possible, certification in the particular therapy. You may get a referral from someone you trust such as your health professional, family, or friends. Make sure all of your health professionals know every type of treatment you are using to reduce chronic pain.

For many patients, that benefit lasted for a year, the team reported in the Archives of Internal Medicine.

“Our study shows that you don’t need to stick needles into people to get the same effect,” said Dr. Daniel Cherkin of Group Health Center for Health Studies in Seattle, who led the study.

“Historically, some types of acupuncture have used non-penetrating needles. Such treatments may involve physiological effects that make a clinical difference,” Karen Sherman of Group Health, who worked on the study, said in a statement.

The team, wanted to study the effects of different types of acupuncture in a large, carefully controlled study of 638 patients with chronic low back pain.

They divided patients into several groups. One got seven weeks of standardized acupuncture treatment known to be effective in back pain. Another group got an individually prescribed acupuncture treatment.

A third group was treated using a toothpick in a needle guide tube that did not pierce the skin as regular acupuncture does, but targeting the correct acupuncture “points”.

A fourth group just got standard medical treatment, which included medication and physical therapy.

After eight weeks, 60 percent of the patients who got any type of acupuncture reported significant improvement in their ability to function compared with those who got standard medical care alone.

But there was no significant difference in the pain relief people got from the acupuncture using needles or from toothpicks.

The researchers said there is some evidence that even needles were used 2,000 years ago in acupuncture treatment, and some imaging studies have shown that “superficial and deep needling of an acupuncture point elicited similar blood oxygen level-dependent responses,” the team wrote.

Another study even found that lightly touching the skin can induce some emotional and hormonal reactions, which could explain the benefit, they wrote.

Or, it may simply be the experience of visiting an acupuncturist for treatments that helps.

Regardless of how it worked, they said acupuncture appears to be a relatively safe and painless way of easing an aching back, especially when traditional medicine alone fails.

(Reporting by Julie Steenhuysen; Editing by Maggie Fox and Cynthia Osterman)

Call a doctor about chronic pain if:

• Your pain has lasted more than 3 months without a clear reason.
• You are feeling down or blue or are not enjoying the activities or hobbies that you have enjoyed in the past. You may be experiencing depression, which is common with chronic pain.
• You are unable to sleep because of the pain.
• You had an illness or injury that healed, but the pain has not gone away.
• You have a family member or friend who appears to be suffering from chronic pain, and you would like information about treatment.

Watchful Waiting

Watchful waiting is a period of time during which you and your health professional observe your symptoms or condition without using medical treatment. If you are able to control occasional, mild to moderate pain with exercise, healthy eating, massage, and pain relievers—such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin—you may not need further treatment from a health professional. However, watchful waiting is not appropriate if your pain is severe or if persistent pain interferes with your life. If you delay treatment, the pain may get worse.

Who To See

If you have mild to moderate recurring pain that cannot be managed at home, you may need to consult one of the following health professionals:

• Family medicine doctor
• Internist
• Nurse practitioner
• Physician assistant
• Doctor of osteopathy

If your chronic pain is moderate to severe and constant, or if treatment does not control the pain, your primary health professional may recommend that you see a specialist, such as one or more of the following:

• Pain management specialist
• Physiatrist
• Physical therapist
• Neurologist
• Obstetrician or gynecologist (for chronic pelvic pain)
• Anesthesiologist
• Psychiatrist, psychologist, or a licensed mental health counselor
• Orthopedic surgeon
• Rheumatologist
• Chiropractor

Often more than one specialist will treat your chronic pain. For example, a primary physician may manage your medicines, and a physical therapist may help you restore function through exercise or other therapies. A professional counselor may help you with coping and depression, and a complementary medicine practitioner may provide alternative therapies such as acupuncture or yoga.

If chronic pain persists and interferes with your daily life despite treatment, you may want to seek an evaluation at a pain management clinic. A pain management clinic is a setting where you receive treatment and learn to cope with chronic pain. Treatment is usually provided by a team of health professionals who work together to address all the possible causes of your chronic pain.