Chronic pain is the most common chronic condition that physicians diagnose, according to a 2023 study from researchers at the U.S. Centers for Disease Control and Prevention, published in JAMA Network Open. Looking at a year’s worth of data from more than 10,000 American adults, the researchers found that new cases of chronic pain were 16 percent more common than new cases of high blood pressure, triple that of depression, and seven times more than diabetes.
Neglecting chronic pain
Many physicians don’t regard chronic pain as a complex illness, with biological, lifestyle, psychological, and social causes—an illness that requires a range of treatments to address all the contributing factors. Doctors tend to downplay the suffering of patients who have had pain for more than three months (the standard definition of chronic pain). That’s particularly true if pain seems out of proportion to an original injury or if pain lasts longer than the physician expected it to last. Additionally, many people who suffer from chronic pain are seniors, and a doctor may have the mistaken idea that older people are somehow supposed to have chronic pain.
Doctors may undertreat minorities for chronic pain compared to white Americans. Research shows that minority patients are more likely to have their pain underestimated, are less likely to have their pain scores included in the medical record, and are more likely to have their pain untreated.
Problems with painkillers
For most physicians, writing a prescription is the No. 1 way to address a patient’s poor health—including chronic pain. The problem: Pain medications can be ineffective and unsafe for chronic pain. For example, NSAID pain medications are contraindicated for people with chronic kidney disease because they reduce blood flow to the kidneys.
- Opioids. Narcotics such as oxycodone (Percocet, OxyContin) are addictive, make you drowsy, and can cause severe constipation and even bowel obstruction. Plus, they don’t work in the long term. That’s because opioids block pain receptors in the brain, and within weeks (or even days), the brain may respond by activating more pain receptors—increasing pain.
- Nonsteroidal anti-inflammatory drugs (NSAIDs). Regularly taking NSAIDs like ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn) can trigger the same activation of pain receptors as opioids.
- Acetaminophen. Drugs like Tylenol have an additional risk: It can cause liver toxicity, resulting in 56,000 yearly visits to emergency departments, 1,600 cases of acute liver failure (making acetaminophen the most common cause of liver transplantation in the U.S.), and 500 deaths.
NSAIDs also increase the risk for high blood pressure, heart attack, stroke, atrial fibrillation, heart failure, and cardiovascular death.
- Antidepressants. These drugs are sometimes prescribed for chronic pain—but they can’t be prescribed for people already taking them.
Drug-free solutions
There are many effective nondrug modalities for chronic pain, and they work most effectively when two or more modalities are combined. Talk to your physician about which of these modalities are best for you:
- Physical therapy (PT). Physical therapy is often the most helpful treatment for chronic pain (as long as the physician has confirmed the patient is free to move and exercise without worsening a pain-causing injury). A physical therapist can work with a patient on pain-relieving movements and exercises targeted to specific joints (knee, hip, neck, etc.) to improve balance, flexibility, strength, posture, and the ability to walk.
- Occupational therapy (OT). Occupational therapists specialize in rehabilitating upper-extremity injuries to the hand, elbow, and shoulder. The therapist shows patients how to improve functional ability in daily life, like brushing teeth, showering, and getting dressed.
- Aquatic therapy. Moving and exercising in the weightlessness of water can take the pressure off painful joints and provide significant relief. For example, people who are unable to walk may find they can walk in the water. Many pools used for aquatic therapy are heated to 90 to 95º F, providing even more relief. Like physical and occupational therapy, aquatic therapy is usually covered by insurance.
- Acupuncture. This technique from traditional Chinese medicine uses tiny, thin needles to stimulate points that unblock and increase the flow of energy (qi) in the body. Thousands of studies show that acupuncture works—with the American College of Physicians recommending the technique as an effective treatment for low back pain. The treatment is typically weekly or biweekly. However, acupuncture is costly, and may not be covered by insurance. (Call your insurance company to find out.) Acupuncture for chronic pain is covered by a flexible spending account (FSA), health care spending account (HSA), and health reimbursement arrangement (HRA). If you find you can’t afford the ongoing treatments, look for a community acupuncture center or an acupuncture school, both of which may offer discounted rates.
- Medical massage. Medical massage uses techniques that reduce stress and release tight muscle groups called trigger points, increasing circulation, and reducing inflammation and pain. It is usually covered by workers’ compensation and sometimes by insurance.
- Icing and heating. Icing is usually preferred for an acute injury, to reduce inflammation and swelling. But for chronic pain—use what feels best, whether it’s a heating pad or an ice pack.
- Hypnosis. Hypnosis helps you enter a state of deep relaxation in which you are open and responsive to hypnotic suggestions like, “Your pain will no longer be debilitating,” or “You can walk without pain.”
This is an excellent method if you are a “suggestible” person—someone who is responsive to hypnotic suggestions and commands. To find out, use the Reveri app, which has a free exercise to determine whether or not you’re suggestible (www.reveri.com). Insurance covers some of the cost of hypnosis, and it is covered under Medicare.
- Psychological support. Chronic pain often causes depression and anxiety—which worsen chronic pain. A person with chronic pain needs to learn to regulate their emotions rather than be overwhelmed by them. Techniques that can help include meditation (like mindfulness-based stress reduction), visualization (for example, picturing yourself in a relaxed, pain-free state, like lounging on a warm beach), and cognitive behavioral therapy (CBT), which helps overcome so-called “distorted thinking,” like ignoring the good things that have happened to you and emphasizing the bad.
- Herbal supplements. Three herbs that research shows can reduce inflammation and pain as well as (or better than) NSAIDs are curcumin (500 milligrams [mg] twice a day), ashwagandha (200 to 500 mg per day), and ginger (250 mg three or four times a day.)
If you haven’t seen improvement in your symptoms after four to six weeks of use, discontinue the supplement. And if you’re on a significant number of medications for other health conditions, consult with your doctor before using any herbal supplement.
Breakthrough therapies
There are several new, nondrug therapies that show promise in the relief of chronic pain.
- Scrambler therapy. This FDA-approved therapy transmits impulses into nerve fibers that “scramble” pain messages, reducing pain. It’s most effective in chronic nerve pain (neuropathy).
- Radiofrequency ablation. This procedure temporarily disrupts pain signals from arthritic joints to the brain, and the benefits can last for six months or more. It’s very helpful for neck, midback, and sacroiliac (low back) pain.
- Regenerative medicine. This type of therapy focuses on repairing, replacing, or regenerating damaged or diseased tissues and organs. The most popular and effective regenerative therapy for chronic pain is platelet-rich plasma (PRP) therapy, which uses injections of the platelet-rich portion of a patient’s blood to target chronic pain, usually in a joint or tendon.
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