Chronic pain management and tips

Managing chronic pain every day can be challenging. When you hurt all the time, it’s easy to feel isolated. You may think that other people don’t understand what you’re going through. But in fact, over 51 million adults in the U.S. have chronic pain. It’s one of the most common reasons adults seek medical care, according to the Centers for Disease Control and Prevention.¹

Chronic pain can happen because of medical conditions or a past injury. It’s defined as persistent pain lasting longer than 3 months. It can persist for years, even after you’ve recovered. In some cases, pain can be fueled by ongoing medical conditions like cancer. In others (like irritable bowel syndrome or low back pain) it can occur without past injury or illness. 

Chronic pain can affect you emotionally as well as physically. It can get in the way of daily routines and can even lead to depression and anxiety. The American Chronic Pain Association (ACPA) and the Stanford University Division of Pain Medicine recommends the biopsychosocial approach to treatment. That means it addresses the emotional, mental, and social aspects of pain along with the physical.²

“Chronic pain is a problem that affects the mind, the body and social functioning,” says Efrat Hedges Eichenbaum, Ph.D., a clinical psychologist based in Phoenix. “To get the most out of your treatment, I urge both providers and patients to seek an integrated approach.”

Holistic medicine treats the whole person. It includes medical and mental health remedies as well as non-drug therapies. Let’s look at how some of these strategies may help with chronic pain.

Pain cognitive behavioral therapy (Pain-CBT) is a type of cognitive behavioral therapy which is a goal-oriented psychological treatment that targets the behavioral aspects of pain. CBT for chronic pain explores how thought patterns, emotions and actions impact pain. It teaches skills, such as relaxation techniques, that people can use to manage pain. Pain-CBT is the best-studied psychological treatment for pain. There are decades of research showing its usefulness for people living with chronic pain, according to the ACPA and Stanford Pain Medicine.²

A key CBT skill is learning to find negative thought patterns and behaviors that worsen pain. CBT helps form more helpful thought patterns and behaviors that can reduce stress and tension.

Depression and anxiety are common when people have a chronic condition. That’s true whether it’s chronic pain or chronic conditions like cancer, heart disease or diabetes, says Jeffrey Lackner, Psy.D., a health psychologist and professor in the department of medicine at the University at Buffalo School of Medicine, SUNY. Up to 60% of people with chronic pain have depression.³

“Chronic pain is stressful. It can take so much away from a person’s life," notes Eichenbaum. “Treating depression or anxiety can improve quality of life and day-to-day functioning. And that puts people in a better place to cope with chronic pain.”

If you think you might be experiencing depression or anxiety, talk to your doctor.⁴ Treatment options may include medication and talk therapy.

The stress of chronic pain can trigger the "fight, flight or freeze" response, which can make pain worse. “When this happens, your sympathetic nervous system – part of the central nervous system – becomes activated,” says Eichenbaum. “And when it’s consistently activated by chronic pain, it makes it very hard to function.”

The good news is that you may be able to help counteract this with the relaxation response. “To help balance your central nervous system, you can activate the parasympathetic nervous system. That’s our relaxation response,” says Eichenbaum. 

Ways to do this include meditation, mindfulness, biofeedback, box breathing and progressive muscle relaxation, Eichenbaum says.

Biofeedback is a mind-body technique. It uses monitoring devices to build conscious control over bodily functions that are normally automatic. Progressive muscle relaxation is when you concentrate on slowly tensing and relaxing each muscle group. It makes you focus on the physical sensation.

“Relaxation strategies can play a major role in managing the physical and emotional stress of pain,” she says.

Staying physically active when you’re in pain can be a challenge. “Because it hurts to move, a lot of people with chronic pain really decrease their activity level,” says Eichenbaum. This can leave people in a weakened state, which then makes movement even more difficult.

But according to the ACPA and Stanford Pain Medicine, regular exercise can lower chronic pain symptoms. These include pain, stiffness and inflammation.² Exercise can also help you improve strength, range of motion and balance. Low-impact options include aquatic exercise, tai chi, qigong, yoga and Pilates.

Moving more can make it much easier to go about your day in a way that’s not so painful. Exercising regularly can also have a major positive effect on mood. Before starting any exercise regimen, remember to check with your doctor.⁵

Depending on the type and source of your pain, your doctor may suggest medicine. Acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) are common over-the-counter options used by some. Sometimes antidepressants are used for pain relief. And anticonvulsants can also help manage some kinds of pain, such as nerve pain. (Anticonvulsants work by reducing the transmission of pain signals sent from damaged or overly sensitized nerves.)

Doctors are less likely to prescribe opioids or narcotics because of their addiction potential. They can even raise pain sensitivity for some conditions. But if your doctor thinks you would benefit from a narcotic, make sure to take it exactly as directed and only for as long as recommended.

Whatever your situation, remember that you have options. There are steps you can take that may help improve chronic pain and get you back to doing the things you love.