Chronic Pain

Pain is an uncomfortable feeling that starts in the nervous system. Acute pain lets you know that you may be injured or have a problem you needs to be addressed. Acute pain is a normal sensation triggered in the nervous system to alert you to possible injury and the need to take care of yourself, chronic pain is different. Chronic pain is different than acute pain. In this case, the pain signals last for weeks, months, or even years. The original cause may have been an injury or infection, or a chronic condition or disease, such as arthritis or cancer, may be the source of pain. Problems that cause chronic pain include headache, low back strain, or nerve damage.

Chronic pain usually cannot be cured, but treatments can help. They include medicines, acupuncture, electrical stimulation, and surgery. Other treatments include psychotherapy, relaxation and meditation therapy, biofeedback, and behavior modification.

A person may have 2 or more co-existing chronic pain conditions such as chronic fatigue syndrome, endometriosis, fibromyalgia, inflammatory bowel disease, interstitial cystitis, temporomandibular joint dysfunction, and vulvodynia. It is not known whether these disorders share a common cause.

The causes of chronic pain are complex and poorly understood. Various neuromuscular, reproductive, gastrointestinal, and urologic disorders may cause or contribute to chronic pain. Sometimes multiple contributing factors may be present in a single patient.

Musculoskeletal disorders commonly associated with chronic pain include the following:

• Osteoarthritis/degenerative joint disease/spondylosis
• Rheumatoid arthritis
• Lyme disease
• Reiter syndrome
• Disk herniation/facet osteoarthropathy
• Fractures/compression fracture of lumbar vertebrae
• Faulty or poor posture
• Fibromyalgia
• Polymyalgia rheumatica
• Mechanical low back pain
• Chronic coccygeal pain
• Muscular strains and sprains
• Pelvic floor myalgia (levator ani spasm)
• Piriformis syndrome (see the image below)
• Rectus tendon strain
• Hernias (eg, obturator, sciatic, inguinal, femoral, spigelian, perineal, umbilical)
• Abdominal wall myofascial pain (trigger points)
• Chronic overuse syndromes (eg, tendonitis, bursitis)

Neurologic disorders associated with chronic pain include the following:

• Brachial plexus traction injury
• Cervical radiculopathy
• Thoracic outlet syndrome
• Spinal stenosis
• Arachnoiditis
• Metabolic deficiency myalgias
• Polymyositis
• Neoplasia of spinal cord or sacral nerve
• Cutaneous nerve entrapment in surgical scar
• Postherpetic neuralgia (shingles)
• Neuralgia (eg, iliohypogastric, ilioinguinal, or genitofemoral nerves)
• Polyneuropathies
• Polyradiculoneuropathies
• Mononeuritis multiplex
• Chronic daily headaches
• Muscle tension headaches
• Migraine headaches
• Temporomandibular joint dysfunction
• Temporalis tendonitis
• Sinusitis
• Atypical facial pain
• Trigeminal neuralgia
• Glossopharyngeal neuralgia
• Nervus intermedius neuralgia
• Sphenopalatine neuralgia
• Referred dental or temporomandibular joint pain
• Abdominal epilepsy
• Abdominal migraine
• Stroke (central poststroke pain)

Urologic disorders associated with chronic pain include the following:

• Bladder neoplasm
• Chronic urinary tract infection
• Interstitial cystitis
• Radiation cystitis
• Recurrent cystitis
• Recurrent urethritis
• Urolithiasis
• Uninhibited bladder contractions (detrusor-sphincter dyssynergia)
• Urethral diverticulum
• Chronic urethral syndrome
• Urethral carbuncle
• Prostatitis
• Urethral stricture
• Testicular torsion
• Peyronie disease

Gastrointestinal disorders associated with chronic pain include the following:

• Chronic visceral pain syndrome
• Gastroesophageal reflux
• Peptic ulcer disease
• Pancreatitis
• Chronic intermittent bowel obstruction
• Colitis
• Chronic constipation
• Diverticular disease
• Inflammatory bowel disease
• Irritable bowel syndrome

Female reproductive disorders associated with chronic pain include the following:

• Endometriosis
• Adhesions
• Adnexal cysts
• Chronic ectopic pregnancy
• Chlamydial endometritis or salpingitis
• Endosalpingiosis
• Ovarian retention syndrome (residual ovary syndrome)
• Ovarian remnant syndrome
• Ovarian dystrophy or ovulatory pain
• Pelvic congestion syndrome
• Postoperative peritoneal cysts
• Residual accessory ovary
• Subacute salpingo-oophoritis
• Tuberculous salpingitis
• Adenomyosis
• Chronic endometritis
• Atypical dysmenorrhea or ovulatory pain
• Cervical stenosis
• Endometrial or cervical polyps
• Intrauterine contraceptive devices
• Leiomyomata
• Symptomatic pelvic relaxation (genital prolapse)

Psychological disorders associated with chronic pain include the following:

• Bipolar personality disorders
• Depression
• Porphyria
• Sleep disturbances

The following disorders can also be associated with chronic pain:

• Cardiovascular disease (eg, angina)
• Peripheral vascular disease
• Chemotherapeutic, radiation, or surgical complications

Talk with your doctor if pain lasts more than a few weeks, limits daily life, or affects your mood or sleep. A care plan can help, and call or text 988 if pain leaves you feeling hopeless or having thoughts of self-harm.