Lets talk about what pain is, exactly. You know its an uncomfortable physical feeling, but its actually much more than that. In fact, the International Association for the Study of Pain (IASP) defines pain as an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage. The IASP goes on to point out that the lived feeling of pain is shaped by biological, psychological, and social factors, so your version of pain will always be different from that of your spouse or siblinga sensation you describe as merely annoying could have them reeling in agony.
As, well, painful as it may be, though, pain does serve a purpose. Pain is fundamentally our harm alarm, says Sean Mackey, M.D., Ph.D., a professor and chief of the Stanford Division of Pain Medicine in Palo Alto, CA. It is an experience that keeps us out of danger. Pain is an incredibly wonderful thing when its working correctly. The problem, of course, is that it doesnt always. Lets say you break your arm. In a healthy scenario, pain signals travel from the injury site through your spinal cord to your brain to let you know that you need care and you probably shouldnt repeat whatever behavior led to the fracture. But if theres a kink in that pain-perception system, the pain could become chronic, lasting long after the wound has healeda mystery researchers are trying to untangle.
Theres a bit of controversy over the nature of chronic pain and how it evolves, says Dr. Mackey. One theory, he says, is that after an injury like that broken arm, signals get rewired in the brain to perpetuate the experience of pain even though the original pain stimulus is gone. Another theory posits that after an injury, low-grade pain signals continue to travel to your spinal cord and brain, but its as if an amplifier has been installedyour brain interprets the signals to be more intense than they are.
Because so much is unknown about the mechanisms behind chronic pain, it can be difficult to treat. For acute pain like that of a headache or a broken arm, you might take acetaminophen or a nonsteroidal anti-inflammatory (NSAID) like ibuprofen, both of which are non-opioid analgesics that decrease the production of painful mediators called prostaglandins, says Anuj Malhotra, M.D., assistant director of the Pain Management Division at the Hospital for Special Surgery in New York City.
What causes chronic pain, though, is sometimes completely different, so the same treatments may not work. You dont have the same responsiveness to those medications, or they may become less safe in certain patient populations with longer-term use, says Dr. Malhotra. For instance, too much acetaminophen can lead to liver damage, while overusing NSAIDs can put you at risk for digestive problems, kidney damage, and bleeding.
Thats why scientists are constantly searching for innovative treatments for chronic pain. Consider this: Research shows that an estimated 20% of U.S. adults (about 50 million people) have chronic pain, and 8% struggle with high-impact chronic pain (pain that has lasted three months or longer and is accompanied by at least one major activity restriction). For those with high-impact chronic pain, it can be hard to move, work, sleep, socialize, get dressed, or bathe, says Mary Driscoll, Ph.D., an assistant professor of psychiatry and a research psychologist at Yale School of Medicine in New Haven, CT. And when people have pain, theres rarely a reprieve, so it may get better or worse, but its always there.
That physical stress can have emotional effects as well, she says: It can prompt people to become socially isolated or challenge their sense of self. It can also perpetuate fears of injury or disability and elicit feelings of helplessness, anger, and frustrationand contribute to things like depression and avoidance of activity. On top of all that, chronic pain is invisible to those around the sufferer, which makes it hard for others to understand and often leads people in pain to feel stigmatized. Its no wonder sufferers may try anything to get relief.
In the late 1990s and early 2000s, when Purdue Pharma sent sales reps all over the country claiming that its new opioid, OxyContin, was effective at treating pain and had a low risk of addiction, physicians and patients were desperate to believe it. Twenty years later, opioids are still causing harmand driving the news. In September, a settlement between Purdue Pharma and thousands of state, local, and tribal governments was approved by a bankruptcy judge, then unraveled by a federal judge. In October, Hulu launched its popular drama series Dopesick, inspired by real investigations into OxyContins deceptive marketing. Finally, in November, a report from the CDCs National Center for Health Statistics declared that the number of annual deaths related to drug overdoses topped 100,000 for the first time in 2021and 75% of those were linked to opioids.
The OxyContin saga is complicated, involving failures of government oversight and accusations of greed and lies, but the upshot for patients is that even though people didnt think they would become addicted, many did. Opioids cover pain regardless of the source, but they dont treat the cause of the pain, explains Dr. Malhotra. With no way to address the pain trigger, he says, your body gets used to the medication, so youre going to need a higher dose in order to get the same results. With a higher dose come more side effects and the potential for overdose or addiction, he adds. Indeed, research has long shown that taking opioids for chronic pain increases the chances of addiction.
Pain specialists and researchers have been consumed with the aftermath of the opioid epidemic, but the solution isnt as simple as no longer prescribing them. There was abuse, but as doctors attempted to restrict access, pain patients who were doing well on opioids found themselves forcefully tapered and accused of being addicts, says Dr. Mackey. On the other hand, theres a greater awareness that physicians were prescribing, in general, too many opioids, he says. As clinicians, we needed to reevaluate for whom we were prescribing opioids and in what circumstances and recognize that in most cases, opioids are not a first-line treatment for chronic pain.
If theres a silver lining to the opioid epidemic, its that it brought greater attention to innovative and non-pharmacological treatments. Physicians are having more conversations with patients about alternative options, for which insurance coverage is increasing, and new treatments are being studied.
One that looks promising is spinal cord stimulation, in which a small insulated wire or lead is placed along the spinal cord above the area where the pain is generated. For example, if you have pain in your legs, those signals come into the lumbar spine, so the leads are placed in the thoracic spine and you can modulate the signal before it gets to your brain, where you process it, says Dr. Malhotra. In some cases, he says, the modulation could be something you would feel, like warmth or a buzzing sensation that replaces the pain, or it could be at a high frequency that blocked the pain signal, meaning you wouldnt feel anything.
Another option thats gaining steam is virtual reality (VR). In one study, when hospitalized patients used VR goggles to access relaxation experiences, they reported less pain than patients who watched yoga and meditation videos on their hospital televisions. Other research suggests that VR therapy could help relieve the phantom-limb pain from which amputees often suffer. With the therapy, you could be skiing down a mountain and doing activities using your legs even after an amputation, tricking your brain to suppress symptoms of pain, explains Leena Mathew, M.D., a professor of anesthesiology and director of the Pain Medicine Fellowship at Columbia University Medical Center in New York City.
New medications are in the works too, one of which was inspired by congenital insensitivity to pain (CIPA), a condition that prevents people from feeling pain (not a good thingif you cant feel that a stove is hot, you might rest your arm on it). In people with CIPA, says Dr. Malhotra, often there is a mutation in a particular sodium channel throughout the body, so there are some medications that are targeted toward purposely inactivating this channel more specifically to treat painful areas. Another subset of medicines is aimed at a protein involved in pain transmission and inflammation in the brain and spinal cord.
Of course, these are just a few treatment optionsthere are plenty of other procedures, medications, and alternative therapies out there. But no matter what path you decide to take, remember that chronic pain is similar to conditions like diabetes and asthma: It often cant be cured, but there are tools to help mitigate it. Go in with a mindset that you need to work hand in hand with your clinician, and the solution may involve a degree of management of your pain to help you be more functional and have a better quality of life, Dr. Mackey says.
As much progress as weve made with pain treatment, not everyone has equal access to it. Not only is good insurance coverage a luxury in the U.S., but insurance is not the only barrier. People cant always afford to take time away from work or caregiving to go to physical therapy twice a week or cook healthy meals regularly. Plus, research shows that women are more likely than men to report having painful conditions, but women and people of color are less likely to have their pain taken seriously by health care providers than are men or white people. These issues are the result of an incredibly complex and unfair health care system, but by raising concerns with doctors, we can start to move the needle. At the very least, we all have to acknowledge that disparities exist, says Dr. Mathew. Try using the strategies below to advocate for yourself.
Seeking pain care can be a frustrating endeavor, admits Driscoll. But the more you can pinpoint how pain affects you and what aspects of your life you want to improve, she says, the easier it is to identify treatments. For example, if pain has led you to give up activities or dampens your mood, an intervention like CBT may help. If its affecting your ability to walk, then PT, yoga, or even a treatment such as pain injections might be key. Some literature suggests that when a woman comes in with fibromyalgia, providers may assume whats bothering her most is painand that may be true for some women, but in many cases its fatigue, says Driscoll. So if the provider is treating the pain or thinks pain is the biggest problem, then the woman walks out with a treatment plan thats not really addressing whats bothering her the most. Being clear with providers about how pain interferes with your life is essential.
If you have a diagnosis, reach out to patient advocacy organizations that focus on the condition and see if they have educational resources. Im not asking people to try to train to be doctorsthats not the message, says Dr. Mackey. But learn as much as you can, because that will make you more empowered to advocate for yourself.
This can be tough, especially if you live in a rural area or have an insurance plan with few in-network providers, but its impor tant. You need to find a clinician with whom you can establish a good partnership, somebody whos going to validate whats going on, says Dr. Mackey. If theres no one nearby, he suggests asking whether your insurance covers telemedicine.
A lot of my success in practice with patients is actually when theyre patient, so to speak, says Trahan. Healing takes time. Be willing to work with your doctor to try different approaches and put in the time to let them be effective.
Try these drug-free strategies for combating common pain points.
If neck tension or bad posture is causing your pain, try to sit up straight and gently bring your chin toward your chest. Slowly bring your chin back up and repeat several times. This lubricates the facet joints in the neck, which can help decrease stiffness and reduce pain, Trahan explains. You can also put a drop of lavender essential oil on each thumb, then use your thumbs to massage the soft tissue behind your ears. The combo of aromatherapy and massage should relax your neck muscles.
With pain in this area, you have to look at what youre doing throughout the day, says Trahan. Instead of crossing your legs when you sit, keep your knees hip-width apart. Rather than leaning on one hip when you stand, put equal weight on both legs. It might feel unnatural at first, but you get used to that posture and then start experiencing less hip pain because youre not overusing the muscles and tendons and ligaments of that joint, Trahan says. If you have osteoarthritis in your hips, she also suggests that you perform hip stretches, such as lying on your back with your knees bent and windshield-wipering your legs from side to side a few times a day. This motion helps wash out inflammatory proteins and the extra fluid in the hips while stretching and expanding the ligaments, she says.
Not sure whats causing your back to ache? Trahan suggests strengthening your core, because it works in tandem with and supports back muscles. A few exercises established by back expert Stuart McGill, Ph.D., can help you build a strong core for injury prevention and rehabilitation, including curl-ups: Lie on your back with one leg out straight and the other knee bent, foot on the floor. Place one or both hands under the curve of your low back and slowly raise your shoulders, chest, neck, and head a couple of inches off the floor in a straight line. Pause for a few deep breaths, then lower your body again.
Depending on the source of your pain, you may want to mention to your doc these science-backed non-pharmacological options.
During acupuncture, very thin needles are inserted into certain parts of the body. It can be viewed through the Eastern lens, which considers meridians or pathways in the body, says Dr. Malhotra, or the Western lens, which theorizes that the needles activate new nerve endings, taking your attention away from the original pain and telling your brain it was a false signal.
Physical therapy is a movement-based intervention in which a practitioner guides a person through specific exercises that can, when done repeatedly, help lessen pain. One 2021 study found that patients with lower-back pain who were prescribed PT in the emergency room had greater improvement in functioning and used fewer high-risk medications in the following three months compared with those with similar pain who received the usual care in the ER.
The idea of this therapy is not to imply that the pain is all in your headit is very real. But since pain can influence your emotional well-being (and vice versa), psychological treatments like cognitive behavioral therapy for chronic pain (CBT-CP) can help. CBT-CP gives you tools to recognize pain and cope with it in a more useful way. For example, pain is a stressor, which can lead to muscle tension, and when muscles are tight, that can make the underlying pain worse, says Driscoll. CBT-CP teaches people to recognize that this process is going on in the body and encourages use of a relaxation strategy like deep breathing or visualization to reduce the pain. Learning to pace yourself is another tool Driscoll says is often taught during CBT-CP, to help you recognize the impulse to push through activities that may lead to pain flares. Once youre aware of these impulses, CBT-CP helps you identify ways to accomplish tasks with less pain.
Yoga combines the benefits of movement with the perks of a mindfulness and relaxation practice. The key is to find an instructor who has experience and training in working with your conditionstart with one-on-one sessions if youre new to yoga. The instructor can give you modifications and tips on how to adapt the poses to your needs.
Your body cant function well if you dont provide it with all the nutrients it needs to do its job, preferably through a healthy, well-rounded eating plan. If your diet is deficient in certain nutrients, you might need to supplement, says Sarah Trahan, N.M.D., a staff physician at Southwest College of Naturopathic Medicine & Health Sciences in Tempe, AZ, who focuses on acute and chronic pain management using regenerative medicine. Common vitamins and minerals can be helpful in preventing or reducing pain, but research also supports the use of turmeric, omega-3 fatty acids, and cannabidiol (CBD). Therapeutic doses of these supplements can be just as effective as some analgesic meds, but make sure to talk to your doctor before taking any.
Studies have linked various lifestyle factorsincluding a high-fat diet, unmanaged stress, inadequate sleep, and smokingto increased pain. That means regardless of the approach to pain relief you and your physician decide on, its going to be a lot harder to feel a difference if you have a foundation of unhealthy habits. As Trahan says, You can fertilize the garden, but if you never water it, the fertilizer was just wasted money.
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