When you strain your back or burn your arm, receptor cells send messages along your nerve pathways to your brain. This results in a feeling of pain, a signal from your body that you must tend to it; when you get better, the pain should subside. But for an estimated one in five American adults, pain remains a constant companion. Chronic pain is defined as pain that lasts at least three months, often persisting well after any original injury has resolved. In some cases the pain comes on without a known cause. “Chronic pain is a physical and an emotional response not only to actual tissue damage but also to perceived tissue damage,” says Leena Mathew, M.D., a pain management specialist at Columbia University Medical Center.
Where it shows up
Arthritis, migraines, and nervous system issues are common causes, but chronic pain can also be the result of long-term inflammation (a common symptom of, for example, long COVID). And in 2016 the International Association for the Study of Pain recognized a new type of chronic pain, nociplastic pain, that arises from abnormal processing of pain signals by the nervous system when there is no evidence of tissue damage or injury, says Shana Johnson, M.D., a physical medicine and rehabilitation specialist in Scottsdale, AZ. Depression and anxiety can also contribute to chronic pain—and being in constant pain increases your risk for those conditions as well.
How it’s treated
In-the-moment treatments can vary depending on the location and cause of the pain (see below); however, the following methods are key to managing any type of chronic pain.
Pain medications
While opioids are often prescribed for acute pain, they are now generally not recommended for chronic pain, says Dr. Mathew (opioids are a leading cause of drug overdoses in the U.S.). Beyond nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen, prescription anticonvulsants including gabapentin and pregabalin can reduce overactive pain signals being transmitted to the brain. A recently approved medication for acute pain called suzetrigine, which blocks specific sodium channels in pain pathways, offers promise as a treatment for some kinds of chronic pain as well.
Cognitive behavioral therapy
This form of talk therapy helps change negative thought patterns and has been found to be effective in helping those with chronic pain develop a more positive attitude and cope better, says Dr. Mathew.
Antidepressants
The brain relies on neurochemicals such as serotonin, norepinephrine, and dopamine in its natural pain-suppression pathways, and when there’s a deficiency of these chemical messengers, its ability to dampen pain signals is impaired. This is why antidepressants that boost these neurotransmitters can be effective for management of chronic pain even in patients without depression, says Dr. Mathew. A 2023 meta-study found that the most effective antidepressant for chronic pain was duloxetine (Cymbalta), though you should discuss your options with your doctor.
Sleep
While pain can cause sleepless nights, the reverse is also true. “If you have poor sleep, your threshold for pain would be much lower than that of someone who is getting the appropriate amount of sleep,” says Dr. Mathew.
Exercise
Physical activity stimulates the release of endorphins (natural painkillers) and promotes the production of anti-inflammatory compounds that help reduce inflammation. Exercise also combats pain by reducing muscle stiffness, enhancing flexibility and range of motion, and strengthening supportive muscles and connective tissues.
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