View source for Chronic pain

{{Short description|Pain that lasts longer than three months}}
{{More medical citations needed|date=March 2025|references that do not meet [[WP:MEDRS|Wikipedia's guidelines for medical content]], or are excessively dated, are contained in this article}}
{{Infobox medical condition (new)
| name = Chronic pain
| synonym = Chronic pain syndrome
| image = 
| alt = Chronic pain can be caused by [[joint]] or bone damage during heavy and irregular sports.
| caption = Heavy and irregular sports, in a long term, can be the basis of [[joint]] or bone injuries and as a result chronic pain.<ref>{{Cite journal|last=Buckwalter|first=Joseph A.|date=October 2003|title=Sports, joint injury, and posttraumatic osteoarthritis|journal=The Journal of Orthopaedic and Sports Physical Therapy|volume=33|issue=10|pages=578–588|doi=10.2519/jospt.2003.33.10.578|issn=0190-6011|pmid=14620787}}</ref><ref>{{Cite journal|last1=Saxon|first1=L.|last2=Finch|first2=C.|last3=Bass|first3=S.|date=August 1999|title=Sports participation, sports injuries and osteoarthritis: implications for prevention|journal=Sports Medicine|volume=28|issue=2|pages=123–135|doi=10.2165/00007256-199928020-00005|issn=0112-1642|pmid=10492030|s2cid=3087450}}</ref>
| image_size = 295
| specialty = [[Pain management|Pain medicine]], [[neurology]], [[psychology]]
| symptoms = Pain lasts longer than the expected period of recovery.
| onset = All age groups
| causes = [[High blood sugar]], cancer, genetic disorder in neural differentiation, tissue damage, [[neurological disorder]]s, [[viral disease]]s<ref name="Dydyk-2023"/>
| risks = [[Diabetes]], [[cancer]], [[cardiovascular disease|heart disease]]{{citation needed|date=January 2024}}<!-- Empty reference <ref name="McLennan2"/-->
| medication = Non-opioid: [[ibuprofen]], [[acetaminophen]], [[naproxen]], [[non-steroidal anti-inflammatory drug|NSAIDs]], [[olanzapine]]{{citation needed|date=January 2024}}<!-- Empty reference <ref name=":19"/--> {{br}} Opioid: [[morphine]], [[codeine]], [[buprenorphine]]<ref name="Mehan-2018"/>
| differential diagnosis = [[Gastric ulcer]], [[bone fracture]], [[hernia]], [[neoplasia]] of the spinal cord<ref>{{cite web|title=Chronic Pain Syndrome Differential Diagnoses|url=https://emedicine.medscape.com/article/310834-differential|website=emedicine.medscape.com|date=2020-01-14|access-date=2024-01-24|archive-date=2023-12-10|archive-url=https://web.archive.org/web/20231210083050/https://emedicine.medscape.com/article/310834-differential|url-status=live}}</ref>
| frequency = 8% to 55.2% in different countries{{citation needed|date=January 2024}}<!-- Empty reference <ref name=":23"/-->
| duration = At least 3 months
| diagnosis = Based on [[medical history]], [[clinical examination]], questionnaire and [[neuroimaging]]<ref name="Dydyk-2023"/>
}}'''Chronic pain''' is [[pain]] that persists or recurs for longer than 3 months.<ref name="auto">{{cite web | url=https://icd.who.int/browse/2025-01/mms/en#1581976053 | title=ICD-11 for Mortality and Morbidity Statistics }}</ref><ref>{{Cite web|url=https://www.nhs.uk/live-well/pain/how-to-get-nhs-help-for-your-pain/|title=How to get NHS help for your pain|date=Jan 18, 2022|website=nhs.uk}}</ref><ref name="auto1">{{Cite web|url=https://www.nhsinform.scot/illnesses-and-conditions/brain-nerves-and-spinal-cord/chronic-pain/|title=Chronic pain}}</ref> It is also described as burning, electrical, throbbing, or nauseating pain. This type of pain contrasts with acute pain, which is associated with a specific cause, typically resolves when the cause is treated, and decreases over time.<ref name="upmc.com">{{Cite web |title=Acute Pain Causes, Symptoms, and Treatments {{!}} UPMC |url=https://www.upmc.com/services/pain-management/conditions/acute-pain |access-date=2024-01-24 |website=UPMC {{!}} Life Changing Medicine |language=en |archive-date=2024-01-24 |archive-url=https://web.archive.org/web/20240124091335/https://www.upmc.com/services/pain-management/conditions/acute-pain |url-status=live }}</ref> Chronic pain can last for years.<ref name="auto3">{{Cite web|url=https://my.clevelandclinic.org/health/diseases/4798-chronic-pain|title=Does Chronic Pain Ever Go Away?|website=Cleveland Clinic}}</ref> Persistent pain often serves no apparent useful purpose.<ref>{{Cite web|url=https://www.britishpainsociety.org/about/what-is-pain/|title=What is pain? &#124; British Pain Society|website=www.britishpainsociety.org}}</ref> 

The most common types of chronic pain include [[back pain]], severe [[headache]], [[migraine]], and [[facial pain]].  Chronic pain can lead to severe psychological and physical effects that may persist for a lifetime.  Physical complications can include damage to brain [[Neuron|neurons]] (grey matter loss), [[insomnia]] and [[sleep deprivation]], [[Metabolic disorder|metabolic disorders]], [[chronic stress]], [[obesity]], and [[Myocardial infarction|heart attack]]. Mental health consequences may include [[Depression (mood)|depression]] and [[Neurocognitive disorder|neurocognitive disorders]].

A wide range of treatments are  used for chronic pain; [[drug therapy]] including [[opioid]] and non-opioid drugs, [[cognitive behavioral therapy]] and [[physical therapy]] are the most  common interventions. Medications such as [[aspirin]] and [[ibuprofen]] are used for mild pain whereas [[morphine]] and [[codeine]] are prescribed for severe pain.  Non-pharmacological treatments, such as [[Behaviour therapy|behavioral therapy]] and [[Physical therapy|physiotherapy]], are often used as complementary approaches due to their limited effectiveness when used alone. There is currently no definitive cure for chronic pain, and research continues into new management and therapeutic options, such as [[nerve block|nerve blocks]] and [[radiation therapy]].

An average of 8% to 11.2% of people in different countries experience severe chronic pain, with higher incidence in industrialized countries. [[Epidemiology|Epidemiological]] studies show [[prevalence]] in countries varying from 8% to 55.2% (for example 30-40% in the US and 10-20% in Iran and Canada). Chronic pain affects more people than [[diabetes]], [[cancer]], and [[heart disease]]. According to the estimates of the [[American Medical Association]], the costs related to chronic pain in the US are about US$560-635b. 

==Classification==
{{main|Pain#Classification}}

===In medical classification systems===
====ICD-11====
In [[ICD-11]] chronic pain is classified under MG30. It is described as pain that persists or recurs for longer than 3 months. Contributing factors can be multiple, and can include biological, psychological and social factors.<ref name="auto"/>

Subcategories of MG30 are:
* primary (MG 30.0)
* cancer related
* postsurgical or post traumatic
* secondary musculoskeletal
* secondary visceral
* neuropathic
* secondary headache or orofacial
* Other specified
* Unspecified<ref name="auto"/>


Primary chronic pain (MG30.0) has subcategories:
* widespread (diffuse pain in at least 4 of 5 body regions, and is associated with emotional distress or functional disability. This subcategory is an inclusion for [[fibromyalgia]].<ref>{{Cite web |title=ICD-11 for Mortality and Morbidity Statistics |url=https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/849253504 |url-status=live |archive-url=https://archive.today/20180801205234/https://icd.who.int/browse11/l-m/en%23/http://id.who.int/icd/entity/294762853#/http://id.who.int/icd/entity/849253504 |archive-date=1 August 2018 |access-date=2022-04-09 |website=icd.who.int}}</ref>)
* primary musculoskeletal
* primary headache or orofacial
* Complex regional pain syndrome
* Painful bruising syndrome
* Other specified
* Unspecified<ref name="auto"/>

Specific [[List of chronic pain syndromes|pain syndromes]] can be placed in these categories.

====DSM-5====
According to the [[DSM-5]] index, a complication is ''chronic'' when the resulting complication (pain, disorder, and illness) lasts for a period of more than six months (this type of classification does not have any prerequisites such as physical or mental injury).<ref>{{Cite journal|last1=Katz|first1=Joel|last2=Rosenbloom|first2=Brittany N.|last3=Fashler|first3=Samantha|date=April 2015|title=Chronic Pain, Psychopathology, and DSM-5 Somatic Symptom Disorder|journal=Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie|volume=60|issue=4|pages=160–167|doi=10.1177/070674371506000402|issn=0706-7437|pmc=4459242|pmid=26174215}}</ref>

====IASP====
The [[International Association for the Study of Pain]] (IASP) describes pain as chronic if it persists for months or even years, beyond the usual recovery time from an injury or illness.<ref>{{Cite web|url=https://www.iasp-pain.org/resources/topics/chronic-pain/|title=Chronic Pain}}</ref> The IASP uses the terms nociceptive, neuropathic and nociplastic (see below).<ref>{{Cite web|url=https://www.iasp-pain.org/resources/terminology/|title=Terminology &#124; International Association for the Study of Pain}}</ref>

===Other classification approaches===

====Nociceptive/Neuropathic/Nociplastic====
In many cases pain fits into 3 categories;<ref>{{Cite web|url=https://www.ninds.nih.gov/health-information/disorders/pain|title=Pain &#124; National Institute of Neurological Disorders and Stroke|website=www.ninds.nih.gov|access-date=2025-03-12|archive-date=2025-03-04|archive-url=https://web.archive.org/web/20250304174721/https://www.ninds.nih.gov/health-information/disorders/pain|url-status=live}}</ref>

*"[[Nociception|nociceptive]]"; pain caused by [[inflamed]] or damaged tissue that activates special pain sensors called [[nociceptors]].<ref name="Treede-2015">{{Cite journal|last1=Treede|first1=Rolf-Detlef|last2=Rief|first2=Winfried|last3=Barke|first3=Antonia|last4=Aziz|first4=Qasim|last5=Bennett|first5=Michael I.|last6=Benoliel|first6=Rafael|last7=Cohen|first7=Milton|last8=Evers|first8=Stefan|last9=Finnerup|first9=Nanna B.|date=June 2015|title=A classification of chronic pain for ICD-11|journal=Pain|volume=156|issue=6|pages=1003–1007|doi=10.1097/j.pain.0000000000000160|issn=1872-6623|pmc=4450869|pmid=25844555}}</ref> Nociceptive pain can be divided into "superficial," "deep physical" and "deep visceral" pain.<ref>{{cite book|vauthors=Coda BA, Bonica JJ|veditors=Loeser D, Bonica JJ|title=Bonica's management of pain|edition=3|year=2001|publisher=Lippincott Williams & Wilkins|isbn=978-0-443-05683-3|location=Philadelphia|chapter=General considerations of acute pain|chapter-url-access=registration|chapter-url=https://archive.org/details/painmanagementin0000main}}</ref>

*"[[Neuropathic pain|neuropathic]]"; pain caused by damage or malfunction of parts of parts of the nervous system. This can be the [[peripheral nervous system]], the [[central nervous system]] or the [[Somatosensory system|somatosensory nervous system]].<ref>{{cite journal | pmid=32584191 | date=2021 | last1=Finnerup | first1=N. B. | last2=Kuner | first2=R. | last3=Jensen | first3=T. S. | title=Neuropathic Pain: From Mechanisms to Treatment | journal=Physiological Reviews | volume=101 | issue=1 | pages=259–301 | doi=10.1152/physrev.00045.2019 }}</ref><ref name="Treede-2015" /><ref name="Bogduk1994">{{cite book |url=https://archive.org/details/classificationof0000unse_o5f1/page/212 |title=Classification of chronic pain: descriptions of chronic pain syndromes and definitions of pain terms |vauthors=Bogduk N, Merskey H |publisher=IASP Press |year=1994 |isbn=978-0-931092-05-3 |edition=second |location=Seattle |page=[https://archive.org/details/classificationof0000unse_o5f1/page/212 212]}}</ref><ref>{{cite book|title=Diagnostic Methods for Neuropathic Pain: A Review of Diagnostic Accuracy Rapid Response Report: Summary with Critical Appraisal.|publisher=Canadian Agency for Drugs and Technologies in Health|date=April 2015|pmid=26180859}}</ref> [[Peripheral neuropathy|Peripheral neuropathic pain]] is often described as "burning", "tingling", "electrical", "stabbing", or "pins and needles".<ref name="Paice2003">{{cite journal |vauthors=Paice JA |date=Jul–Aug 2003 |title=Mechanisms and management of neuropathic pain in cancer |url=http://www.supportiveoncology.net/journal/articles/0102107.pdf |journal=The Journal of Supportive Oncology |volume=1 |issue=2 |pages=107–120 |pmid=15352654 |archive-url=https://web.archive.org/web/20100107161021/http://www.supportiveoncology.net/journal/articles/0102107.pdf |archive-date=2010-01-07 |access-date=2010-05-03}}</ref>

*"[[nociplastic pain|nociplastic]]"; pain that arises despite no clear evidence of tissue or somatosensory system damage causing the pain.<ref name="L">{{Cite journal |vauthors=Fitzcharles MA, Cohen SP, Clauw DJ, Littlejohn G, Usui C, Häuser W |date=May 2021 |title=Nociplastic pain: towards an understanding of prevalent pain conditions |journal=Lancet |volume=397 |issue=10289 |pages=2098–2110 |doi=10.1016/S0140-6736(21)00392-5 |pmid=34062144 |s2cid=235245552}}</ref>

====By originating body area====
Chronic pain can be classified by origin area as [[neuropathic]], [[musculoskeletal]], [[visceral]], [[Inflammation|inflammatory]] or [[central sensitisation]].<ref name="auto3"/>

====Primary or secondary====
Chronic pain syndromes can be divided between [[List of chronic pain syndromes|primary and secondary]]. Secondary pain results from another disease.

== Etiology ==
Chronic pain has many [[Pathophysiology|pathophysiological]] and environmental causes and can occur in cases such as [[Peripheral neuropathy|neuropathy]] of the central nervous system, after cerebral hemorrhage, tissue damage such as extensive burns, inflammation, autoimmune disorders such as rheumatoid arthritis, psychological stress such as headache, migraine or abdominal pain (caused by emotional, psychological or behavioral) and mechanical pain caused by tissue wear and tear such as arthritis.<ref name="Dydyk-2023">{{Cite journal|last1=Dydyk|first1=Alexander M|last2=Till|first2=Conermann|date=June 2023|editor-last=Abrazo Central Campus|title=Chronic Pain|url=https://www.ncbi.nlm.nih.gov/books/NBK553030/|journal=StatPearls [Internet]|publisher=StatPearls Publishing|pmid=31971706|archive-date=2024-03-06|access-date=2024-01-24|archive-url=https://web.archive.org/web/20240306101622/https://www.ncbi.nlm.nih.gov/books/NBK553030/|url-status=live}}</ref> In some cases, chronic pain can be caused by genetic factors which interfere with neuronal differentiation, leading to a permanently lowered threshold for pain.<ref>{{cite journal |vauthors=Rusanescu G, Mao J |date=October 2014 |title=Notch3 is necessary for neuronal differentiation and maturation in the adult spinal cord |journal=Journal of Cellular and Molecular Medicine |volume=18 |issue=10 |pages=2103–16 |doi=10.1111/jcmm.12362 |pmc=4244024 |pmid=25164209}}</ref>

The pathophysiological [[etiology]] of chronic pain remains unclear. Many theories of chronic pain<ref>{{cite journal |vauthors=((Apkarian, A. V.)), ((Baliki, M. N.)), ((Geha, P. Y.)) |date=February 2009 |title=Towards a theory of chronic pain |journal=Progress in Neurobiology |volume=87 |issue=2 |pages=81–97 |doi=10.1016/j.pneurobio.2008.09.018 |pmc=2650821 |pmid=18952143}}</ref><ref>{{cite book |title=Sciatica and Chronic Pain |vauthors=((Baloh, R. W.)) |date=2019 |publisher=Springer International Publishing |isbn=978-3-319-93903-2 |pages=71–88 |chapter=Why does pain persist in so many cases? |doi=10.1007/978-3-319-93904-9_7 |s2cid=56824408}}</ref> fail to clearly explain why the same pathological conditions do not invariably result in chronic pain. Patients' anatomical predisposition to proximal neural compression (in particular of peripheral nerves) may be the answer to this conundrum. Proximal neural lesion at the level of the [[dorsal root ganglion]] (DRG) may drive a [https://www.frontiersin.org/files/Articles/1037376/fpain-04-1037376-HTML-r1/image_m/fpain-04-1037376-g002.jpg vicious cycle of chronic pain] by causing postural protection of the painful site and consequent neural compression in the same spinal region. Difficulties in diagnosing proximal neural lesion<ref>{{Cite journal |last1=Hendler |first1=N.H. |last2=Kozikowski |first2=J.G. |date=November 1993 |title=Overlooked Physical Diagnoses in Chronic Pain Patients Involved in Litigation |url=https://linkinghub.elsevier.com/retrieve/pii/S003331829371823X |journal=Psychosomatics |language=en |volume=34 |issue=6 |pages=494–501 |doi=10.1016/S0033-3182(93)71823-X|pmid=8284339 |url-access=subscription }}</ref> may account for the theoretical perplexity of chronic pain.

=== Pathophysiology ===
[[File:Discogenic Pain.png|thumb|Continuous pressure on the spine can destroy the [[intervertebral disc]] and cause the [[sciatic nerve]] to actively produce pain.]]
The mechanism of continuous activation and transmission of pain messages, leads the body to an activity to relieve pain (a [[Mechanism (biology)|mechanism]] to prevent damage in the body), this action causes the release of [[prostaglandin]] and increase the sensitivity of that part to [[stimulation]]; Prostaglandin secretion causes unbearable and chronic pain.<ref name="Panahi-2018">{{Cite book |last1=Neuroscience |first1=Association |title=Brain facts |last2=Panahi |first2=Reza |last3=Soor |first3=Behnam |last4=Shahbazi |first4=Ali |last5=Haqparest |first5=Abbas |date=2018 |publisher=Satish Hasti Publishing House |isbn=978-622-6445-63-4 |location=Tehran.Iran |page=113}}</ref> Under persistent activation, the transmission of pain signals to the [[Posterior horn of spinal cord|dorsal horn]] may produce a [[pain wind-up]] phenomenon. This triggers changes that lower the threshold for pain signals to be transmitted. In addition, it may cause non-nociceptive nerve fibers to respond to, generate, and transmit pain signals.<ref name="Hansson-1998">{{cite book |title=Nociceptive and neurogenic pain |vauthors=Hansson P |publisher=Pharmacia & Upjon AB |year=1998 |pages=52–63}}</ref><ref name="Jena-2015">{{Cite journal|last1=Jena|first1=Monalisa|last2=Mishra|first2=Swati Mishra|last3=Pradhan|first3=Sarita|last4=Jena|first4=Swetalina|last5=Mishra|first5=Sudhansu Sekhar|date=2015-09-01|title=Chronic pain, its management and psychological issues: A review|url=https://innovareacademics.in/journals/index.php/ajpcr/article/view/7403|journal=Asian Journal of Pharmaceutical and Clinical Research|language=en|pages=42–47|issn=2455-3891|archive-date=2021-08-02|access-date=2024-01-24|archive-url=https://web.archive.org/web/20210802223143/https://innovareacademics.in/journals/index.php/ajpcr/article/view/7403|url-status=live}}</ref> Researchers believe that the nerve fibers that cause this type of pain are [[group C nerve fiber]]s; these fibers are not [[myelinated]] (have low transmission speed) and cause long-term pain.<ref name="Jena-2015"/><ref name="Dickenson-2002">{{Cite journal|last1=Dickenson|first1=Anthony H.|last2=Matthews|first2=Elizabeth A.|last3=Suzuki|first3=Rie|date=2002|title=Neurobiology of neuropathic pain: mode of action of anticonvulsants|url=https://onlinelibrary.wiley.com/doi/abs/10.1053/eujp.2001.0323|journal=European Journal of Pain|language=en|volume=6|issue=SA|pages=51–60|doi=10.1053/eujp.2001.0323|pmid=11888242|s2cid=31591435|issn=1532-2149|archive-date=2021-10-18|access-date=2024-01-24|archive-url=https://web.archive.org/web/20211018135400/https://onlinelibrary.wiley.com/doi/abs/10.1053/eujp.2001.0323|url-status=live|url-access=subscription}}</ref>

These changes in neural structure can be explained by [[neuroplasticity]].<ref name="Dickenson-2002" /> When there is chronic pain, the [[somatotopic arrangement]] of the body (the distribution view of nerve cells) is abnormally changed due to continuous stimulation and can cause [[allodynia]] or [[hyperalgesia]].{{Efn|The continuous sending of messages from one body part causes its somatotopic area to become larger than the normal state, and the brain of the area attaches more and abnormal energy and importance to the tissue stimuli of that part of the body.<ref name="Jensen, M.P. 20092">{{cite journal|vauthors=Jensen MP, Sherlin LH, Hakiman S, Fregni F|year=2009|title=Neuromodulatory approaches for chronic pain management: research findings and clinical implications|journal=Journal of Neurotherapy|volume=13|issue=4|pages=196–213|doi=10.1080/10874200903334371|doi-access=free}}</ref>}} In chronic pain, this process is difficult to reverse or stop once established.<ref name="Vadivelu N, Sinatra R.">{{cite journal |vauthors=Vadivelu N, Sinatra R |date=October 2005 |title=Recent advances in elucidating pain mechanisms |journal=Current Opinion in Anesthesiology |volume=18 |issue=5 |pages=540–7 |doi=10.1097/01.aco.0000183109.27297.75 |pmid=16534290 |s2cid=22012269}}</ref> [[EEG]] of people with chronic pain showed that brain activity and [[synaptic plasticity]] change as a result of pain, and specifically, the relative activity of [[beta wave]] increases and [[Alpha wave|alpha]] and [[theta wave]]s decrease.<ref name="Jensen, M.P. 20092"/>

Inefficient management of [[dopamine]] secretion in the brain can act as a common mechanism between chronic pain, [[insomnia]] and [[major depressive disorder]] and cause its unpleasant side effects.<ref>{{Cite journal|last1=Finan|first1=Patrick H.|last2=Smith|first2=Michael T.|date=June 2013|title=The comorbidity of insomnia, chronic pain, and depression: dopamine as a putative mechanism|journal=Sleep Medicine Reviews|volume=17|issue=3|pages=173–183|doi=10.1016/j.smrv.2012.03.003|issn=1532-2955|pmc=3519938|pmid=22748562}}</ref> [[Astrocytes]], [[microglia]] and [[satellite glial cell]]s also lose their effective function in chronic pain. Increasing the activity of microglia, changing microglia networks, and increasing the production of [[chemokine]]s and [[cytokine]]s by microglia may exacerbate chronic pain.<ref name="Panahi-2018" /><ref name="Ji-2013">{{Cite journal|last1=Ji|first1=Ru-Rong|last2=Berta|first2=Temugin|last3=Nedergaard|first3=Maiken|date=December 2013|title=Glia and pain: is chronic pain a gliopathy?|journal=Pain|volume=154|issue=Suppl 1 |pages=S10–S28|doi=10.1016/j.pain.2013.06.022|issn=1872-6623|pmc=3858488|pmid=23792284}}</ref> It has also been observed that astrocytes lose their ability to regulate the [[Electron mobility|excitability of neurons]] and increase the spontaneous activity of neurons in pain circuits.<ref name="Ji-2013" />

==Disease associations==
Some diseases such as [[diabetes]], [[shingles]], [[phantom limb pain]], [[hypertension]], and [[stroke]] play a role in the formation of chronic pain.

Chronic pain is associated with [[fibromyalgia]].

== Prognosis and outcomes==

Complete, longterm [[Remission (medicine)|remission]] of many types of chronic pain is rare.<ref name="chronic low back pain.">{{cite journal | vauthors = Chou R, Huffman LH | title = Medications for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline | journal = Annals of Internal Medicine | volume = 147 | issue = 7 | pages = 505–514 | date = October 2007 | pmid = 17909211 | doi = 10.7326/0003-4819-147-7-200710020-00008 | s2cid = 32719708 | doi-access =  }}</ref> Chronic pain is often difficult to treat.<ref name="Andrews-2018">{{cite journal |vauthors=Andrews P, Steultjens M, Riskowski J |date=January 2018 |title=Chronic widespread pain prevalence in the general population: A systematic review |journal=European Journal of Pain |volume=22 |issue=1 |pages=5–18 |doi=10.1002/ejp.1090 |pmid=28815801 |doi-access=free}}</ref>

Chronic pain can significantly reduce individuals' quality of life, productivity, and wages, worsen existing health issues, and provoke the onset of new conditions like [[Major depressive disorder|major depression]], [[anxiety disorder]]s, and [[substance use disorder]]s.<ref name="Dydyk-2023" /> 

Many of the often-used medications for chronic pain carry risks for side effects and complications. For example, chronic use of opioids is associated with decreased life expectancy and increased mortality of patients relative to non-users.<ref>{{Cite journal|last1=Cavalcante|first1=Alexandre N.|last2=Sprung|first2=Juraj|last3=Schroeder|first3=Darrell R.|last4=Weingarten|first4=Toby N.|date=July 2017|title=Multimodal Analgesic Therapy With Gabapentin and Its Association With Postoperative Respiratory Depression|journal=Anesthesia and Analgesia|volume=125|issue=1|pages=141–146|doi=10.1213/ANE.0000000000001719|issn=1526-7598|pmid=27984223|s2cid=11637917}}</ref><ref>{{Cite journal|last1=Gomes|first1=Tara|last2=Greaves|first2=Simon|last3=van den Brink|first3=Wim|last4=Antoniou|first4=Tony|last5=Mamdani|first5=Muhammad M.|last6=Paterson|first6=J. Michael|last7=Martins|first7=Diana|last8=Juurlink|first8=David N.|date=2018-11-20|title=Pregabalin and the Risk for Opioid-Related Death: A Nested Case-Control Study|journal=Annals of Internal Medicine|volume=169|issue=10|pages=732–734|doi=10.7326/M18-1136|issn=1539-3704|pmid=30140853}}</ref> [[Acetaminophen]], a frequently used drug in chronic pain management, can cause [[hepatotoxicity]] when taken in excess of four grams per day,<ref>{{Cite journal|last1=Watkins|first1=Paul B.|last2=Kaplowitz|first2=Neil|last3=Slattery|first3=John T.|last4=Colonese|first4=Connie R.|last5=Colucci|first5=Salvatore V.|last6=Stewart|first6=Paul W.|last7=Harris|first7=Stephen C.|date=2006-07-05|title=Aminotransferase elevations in healthy adults receiving 4 grams of acetaminophen daily: a randomized controlled trial|journal=JAMA|volume=296|issue=1|pages=87–93|doi=10.1001/jama.296.1.87|issn=1538-3598|pmid=16820551}}</ref><ref>{{Cite journal|last1=Holubek|first1=William J.|last2=Kalman|first2=Susanne|last3=Hoffman|first3=Robert S.|date=April 2004|title=Acetaminophen-induced acute liver failure: results of a United States multicenter, prospective study|journal=Hepatology|volume=43|issue=4|pages=880; author reply 882|doi=10.1002/hep.21106|issn=0270-9139|pmid=16557558}}</ref> and even therapeutic doses administered to pain patients with [[chronic liver disease]] may cause hepatotoxicity.<ref>{{Cite journal|last1=Jalan|first1=Rajiv|last2=Williams|first2=Roger|last3=Bernuau|first3=Jacques|date=2006-12-23|title=Paracetamol: are therapeutic doses entirely safe?|journal=Lancet|volume=368|issue=9554|pages=2195–2196|doi=10.1016/S0140-6736(06)69874-7|issn=1474-547X|pmid=17189017|s2cid=40299987}}</ref> Long-term risks and side effects of opioids, another class of analgesic, include [[constipation]], [[drug tolerance]] and [[Drug dependence|dependence]], [[nausea]], [[indigestion]], [[arrhythmia]] (e.g., [[QT prolongation]] during [[methadone treatment]]), [[endocrine gland]] disruptions promoting [[amenorrhea]], [[erectile dysfunction]], and [[gynecomastia]], and fatigue. A major [[public health]] and clinical concern in and since the 2010s has been [[opioid overdose]], especially in the context of an [[opioid epidemic in the United States]].<ref name="Dydyk-2023" /><ref>{{Cite journal|last1=Lee|first1=Marion|last2=Silverman|first2=Sanford M.|last3=Hansen|first3=Hans|last4=Patel|first4=Vikram B.|last5=Manchikanti|first5=Laxmaiah|date=2011|title=A comprehensive review of opioid-induced hyperalgesia|journal=Pain Physician|volume=14|issue=2|pages=145–161|doi=10.36076/ppj.2011/14/145|issn=2150-1149|pmid=21412369}}</ref>

As of 2011, drug treatments for chronic non-cancer pain reduced pain by 30%, although effectiveness varied widely by modality, diagnosis, and population studied.<ref>{{Cite journal|last1=Turk|first1=Dennis C.|last2=Wilson|first2=Hilary D.|last3=Cahana|first3=Alex|date=2011-06-25|title=Treatment of chronic non-cancer pain|journal=Lancet|volume=377|issue=9784|pages=2226–2235|doi=10.1016/S0140-6736(11)60402-9|issn=1474-547X|pmid=21704872|s2cid=24727112}}</ref> This reduction in pain can significantly improve patients' performance and quality of life. However, the general and long-term prognosis of chronic pain shows decreased function and quality of life.<ref>{{Cite journal|last1=Farrar|first1=John T.|last2=Young|first2=James P.|last3=LaMoreaux|first3=Linda|last4=Werth|first4=John L.|last5=Poole|first5=Michael R.|date=November 2001|title=Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale|journal=Pain|volume=94|issue=2|pages=149–158|doi=10.1016/S0304-3959(01)00349-9|issn=0304-3959|pmid=11690728|s2cid=11875257}}</ref> Also, this disease causes many complications and increases the possibility of death of patients and suffering from other chronic diseases and [[obesity]].<ref name="Dydyk-2023" /> Similarly, patients with chronic pain who require opioids often develop drug tolerance over time, and this increase in the amount of the dose taken to be effective increases the risk of side effects and death.<ref name="Dydyk-2023" />

Mental disorders can amplify pain signals and make symptoms more severe.<ref>{{Cite journal|last=Price|first=D. D.|date=2000-06-09|title=Psychological and neural mechanisms of the affective dimension of pain|journal=Science|volume=288|issue=5472|pages=1769–1772|doi=10.1126/science.288.5472.1769|issn=0036-8075|pmid=10846154|bibcode=2000Sci...288.1769P}}</ref> In addition, comorbid psychiatric disorders, such as major depressive disorder, can significantly delay the diagnosis of pain disorders.<ref>{{Cite journal|last1=Clark|first1=Lauren|last2=Jones|first2=Katherine|last3=Pennington|first3=Karen|date=November 2004|title=Pain assessment practices with nursing home residents|journal=Western Journal of Nursing Research|volume=26|issue=7|pages=733–750|doi=10.1177/0193945904267734|issn=0193-9459|pmid=15466611|s2cid=42887748}}</ref> Major depressive disorder and generalized anxiety disorder are the most common comorbidities associated with chronic pain. Patients with underlying pain and comorbid mental disorders receive twice as much medication from doctors annually as compared to patients who do not have such co-morbidities.<ref name="Closs-2002">{{Cite journal|last1=Closs|first1=S. José|last2=Briggs|first2=Michelle|date=July 2002|title=Patients' verbal descriptions of pain and discomfort following orthopaedic surgery|journal=International Journal of Nursing Studies|volume=39|issue=5|pages=563–572|doi=10.1016/s0020-7489(01)00067-0|issn=0020-7489|pmid=11996877}}</ref> Studies have shown that when coexisting diseases exist along with chronic pain, the treatment and improvement of one of these disorders can be effective in the improvement of the other.<ref name="Tang-2006">{{Cite journal|last1=Tang|first1=Nicole K. Y.|last2=Crane|first2=Catherine|date=May 2006|title=Suicidality in chronic pain: a review of the prevalence, risk factors and psychological links|journal=Psychological Medicine|volume=36|issue=5|pages=575–586|doi=10.1017/S0033291705006859|issn=0033-2917|pmid=16420727|s2cid=30586505}}</ref><ref name="Petrosky-2018">{{Cite journal|last1=Petrosky|first1=Emiko|last2=Harpaz|first2=Rafael|last3=Fowler|first3=Katherine A.|last4=Bohm|first4=Michele K.|last5=Helmick|first5=Charles G.|last6=Yuan|first6=Keming|last7=Betz|first7=Carter J.|date=2018-10-02|title=Chronic Pain Among Suicide Decedents, 2003 to 2014: Findings From the National Violent Death Reporting System|journal=Annals of Internal Medicine|volume=169|issue=7|pages=448–455|doi=10.7326/M18-0830|issn=1539-3704|pmc=6913029|pmid=30208405}}</ref> 

Patients with chronic pain are at higher risk for [[suicide]] and [[suicidal thought]]s. Research has shown approximately 20% of people with suicidal thoughts, and between 5 and 14% of patients with chronic pain commit suicide.<ref name="Tang-2006" /> Of patients who attempted suicide, 53.6% died of gunshot wounds, and 16.2% died of opioid overdose.<ref name="Petrosky-2018" />

Sleep disturbance, and [[insomnia]] due to medication and illness symptoms are often experienced by those with chronic pain.<ref>{{Cite book |vauthors=Ferini-Strambi L |chapter=Sleep disorders in multiple sclerosis |title=Sleep Disorders: Sleep disorders in multiple sclerosis |series=Handbook of Clinical Neurology |volume=99 |pages=1139–1146 |year=2011 |pmid=21056246 |doi=10.1016/B978-0-444-52007-4.00025-4 |isbn=978-0-444-52007-4}}</ref> These conditions can be difficult to treat due to the high potential of medication interactions, especially when the conditions are treated by different doctors.<ref>{{Cite journal |last=Research |first=Center for Drug Evaluation and |date=2020-03-17 |title=Drug Interactions: What You Should Know |url=https://www.fda.gov/drugs/resources-drugs/drug-interactions-what-you-should-know |journal=FDA |language=en}}</ref>

Severe chronic pain is associated with increased risk of death over a ten-year period, particularly from heart disease and respiratory disease.<ref name=pmid19726210>{{cite journal | vauthors = Torrance N, Elliott AM, Lee AJ, Smith BH | title = Severe chronic pain is associated with increased 10 year mortality. A cohort record linkage study | journal = European Journal of Pain | volume = 14 | issue = 4 | pages = 380–386 | date = April 2010 | pmid = 19726210 | doi = 10.1016/j.ejpain.2009.07.006 | s2cid = 22222751 }}</ref> Several mechanisms have been proposed for this increase, such as an abnormal [[Fight-or-flight response|stress response]] in the body's [[endocrine system]].<ref>{{cite journal | vauthors = McBeth J, Chiu YH, Silman AJ, Ray D, Morriss R, Dickens C, Gupta A, Macfarlane GJ | display-authors = 6 | title = Hypothalamic-pituitary-adrenal stress axis function and the relationship with chronic widespread pain and its antecedents | journal = Arthritis Research & Therapy | volume = 7 | issue = 5 | pages = R992–R1000 | year = 2005 | article-number = R992 | pmid = 16207340 | pmc = 1257426 | doi = 10.1186/ar1772 | doi-access = free }}</ref> Additionally, chronic stress seems to affect risks to heart and lung ([[cardiovascular]]) health by increasing how quickly plaque can build up on artery walls ([[arteriosclerosis]]). However, further research is needed to clarify the relationship between severe chronic pain, stress and cardiovascular health.<ref name=pmid19726210/>

People with chronic pain tend to have higher rates of depression<ref>{{cite journal |display-authors=6 |vauthors=IsHak WW, Wen RY, Naghdechi L, Vanle B, Dang J, Knosp M, Dascal J, Marcia L, Gohar Y, Eskander L, Yadegar J, Hanna S, Sadek A, Aguilar-Hernandez L, Danovitch I, Louy C |date=2018 |title=Pain and Depression: A Systematic Review |journal=Harvard Review of Psychiatry |volume=26 |issue=6 |pages=352–363 |doi=10.1097/HRP.0000000000000198 |pmid=30407234 |s2cid=53212649}}</ref> and although the exact connection between the comorbidities is unclear, a 2017 study on neuroplasticity found that "injury sensory pathways of body pains have been shown to share the same brain regions involved in mood management."<ref>{{cite journal |vauthors=Sheng J, Liu S, Wang Y, Cui R, Zhang X |date=2017-06-19 |title=The Link between Depression and Chronic Pain: Neural Mechanisms in the Brain |journal=Neural Plasticity |volume=2017 |article-number=9724371 |doi=10.1155/2017/9724371 |pmc=5494581 |pmid=28706741 |doi-access=free}}</ref> Chronic pain can contribute to decreased physical activity due to fear of making the pain worse. Pain intensity, pain control, and resilience to pain can be influenced by different levels and types of [[social support]] that a person with chronic pain receives, and are also influenced by the person's [[socioeconomic status]].<ref>{{cite news |date=2019-09-20 |title=Effective Coping of Chronic Pain Varies With Psychosocial Resource Profiles |url=https://www.apa.org/pubs/highlights/spotlight/issue-154 |archive-url=https://web.archive.org/web/20200609040106/https://www.apa.org/pubs/highlights/spotlight/issue-154 |archive-date=2020-06-09 |access-date=2021-02-15 |work=APA Journals Article Spotlight |publisher=American Psychological Association}}</ref>

In a study, [[Mendelian randomization]] was used to identify [[Causality|causal relationships]] between chronic pain and certain psychiatric, cardiovascular, and inflammatory conditions that were initially thought to be unrelated to pain. It was found that exposure to [[Depression (mood)|depression]] increases the likelihood of reporting pain, but not the other way around. Exposure to [[Coronary artery disease|coronary diseases]] increases the risk of developing chronic pain, and vice versa. An increase in [[body mass index]] modestly raises the likelihood of experiencing pain, while high blood [[High-density lipoprotein|HDL]] levels reduce the probability of suffering from chronic pain. Regarding inflammatory traits, exposure to [[asthma]] increases the likelihood of experiencing pain, and vice versa.<ref>{{Cite journal |last1=Mocci |first1=Evelina |last2=Ward |first2=Kathryn |last3=Perry |first3=James A. |last4=Starkweather |first4=Angela |last5=Stone |first5=Laura S. |last6=Schabrun |first6=Siobhan M. |last7=Renn |first7=Cynthia |last8=Dorsey |first8=Susan G. |last9=Ament |first9=Seth A. |date=2023-10-16 |title=Genome wide association joint analysis reveals 99 risk loci for pain susceptibility and pleiotropic relationships with psychiatric, metabolic, and immunological traits |journal=PLOS Genetics |language=en |volume=19 |issue=10 |article-number=e1010977 |doi=10.1371/journal.pgen.1010977 |doi-access=free |issn=1553-7404 |pmc=10602383 |pmid=37844115}}</ref>

Chronic pain of different causes has been characterized as a disease that affects brain structure and function. [[Magnetic resonance imaging|MRI]] studies have shown abnormal anatomical<ref name="geha">{{cite journal |vauthors=Geha PY, Baliki MN, Harden RN, Bauer WR, Parrish TB, Apkarian AV |date=November 2008 |title=The brain in chronic CRPS pain: abnormal gray-white matter interactions in emotional and autonomic regions |journal=Neuron |volume=60 |issue=4 |pages=570–81 |doi=10.1016/j.neuron.2008.08.022 |pmc=2637446 |pmid=19038215}}</ref> and functional connectivity, even during rest<ref name="baliki">{{cite journal |vauthors=Baliki MN, Geha PY, Apkarian AV, Chialvo DR |date=February 2008 |title=Beyond feeling: chronic pain hurts the brain, disrupting the default-mode network dynamics |journal=The Journal of Neuroscience |volume=28 |issue=6 |pages=1398–403 |doi=10.1523/JNEUROSCI.4123-07.2008 |pmc=6671589 |pmid=18256259}}</ref><ref name="taglia">{{cite journal |vauthors=Tagliazucchi E, Balenzuela P, Fraiman D, Chialvo DR |date=November 2010 |title=Brain resting state is disrupted in chronic back pain patients |journal=Neuroscience Letters |volume=485 |issue=1 |pages=26–31 |doi=10.1016/j.neulet.2010.08.053 |pmc=2954131 |pmid=20800649}}</ref> involving areas related to the processing of pain. Also, persistent pain has been shown to cause [[grey matter]] loss, which is reversible once the pain has resolved.<ref name="may">{{cite journal |vauthors=May A |date=July 2008 |title=Chronic pain may change the structure of the brain |journal=Pain |volume=137 |issue=1 |pages=7–15 |doi=10.1016/j.pain.2008.02.034 |pmid=18410991 |s2cid=45515001}}</ref><ref name="seminowicz">{{cite journal |display-authors=6 |vauthors=Seminowicz DA, Wideman TH, Naso L, Hatami-Khoroushahi Z, Fallatah S, Ware MA, Jarzem P, Bushnell MC, Shir Y, Ouellet JA, Stone LS |date=May 2011 |title=Effective treatment of chronic low back pain in humans reverses abnormal brain anatomy and function |journal=The Journal of Neuroscience |volume=31 |issue=20 |pages=7540–50 |doi=10.1523/JNEUROSCI.5280-10.2011 |pmc=6622603 |pmid=21593339}}</ref>

One approach to predicting a person's experience of chronic pain is the [[biopsychosocial model]], according to which an individual's experience of chronic pain may be affected by a complex mixture of their biology, psychology, and their social environment.<ref name="Hochwarter-2010">{{Cite journal |vauthors=Hochwarter W, Byrne ZS |date=2010 |title=The Interactive Effects of Chronic Pain, Guilt, and Perfectionism on Work Outcomes |journal=Journal of Applied Social Psychology |language=en |volume=40 |issue=1 |pages=76–100 |doi=10.1111/j.1559-1816.2009.00564.x}}</ref>

Chronic pain may be an important contributor to [[suicide]].<ref>{{Cite journal|title=Chronic Pain Among Suicide Decedents, 2003 to 2014: Findings From the National Violent Death Reporting System - PMC|date=2018 |pmc=6913029 |last1=Petrosky |first1=E. |last2=Harpaz |first2=R. |last3=Fowler|journal=Annals of Internal Medicine |volume=169 |issue=7 |pages=448–455 |doi=10.7326/M18-0830 |pmid=30208405 }}</ref> 

==Management==
{{main|Pain management}}

===Overview===
[[Pain management]] is a branch of medicine that uses an interdisciplinary approach. The combined knowledge of various medical professions and [[allied health professions]] is used to ease [[pain]] and improve the [[quality of life]] of those living with pain.<ref>{{cite book | vauthors = Hardy PA |title= Chronic pain management: the essentials |year= 1997 |publisher= Greenwich Medical Media |location= UK|isbn= 978-1-900151-85-6 |url= https://archive.org/details/chronicpainmanag0000hard|url-access= registration |page= [https://archive.org/details/chronicpainmanag0000hard/page/10 10] |quote= the reduction of suffering and enhanced quality of life . }}</ref> The typical pain management team includes [[medical practitioner]]s (particularly anesthesiologists), [[Rehabilitation psychology|rehabilitation psychologists]], [[physiotherapist]]s, [[occupational therapist]]s, [[physician assistants]], and [[nurse practitioner]]s.<ref>{{cite book | vauthors = Main CJ, Spanswick CC |title= Pain management: an interdisciplinary approach |year= 2000 |publisher= Churchill Livingstone |isbn= 978-0-443-05683-3 |url-access= registration |url= https://archive.org/details/painmanagementin0000main }}</ref> [[Acute pain]] usually resolves with the efforts of one practitioner; however, the management of chronic pain frequently requires the coordinated efforts of a treatment team.<ref>{{cite book | vauthors = Thienhaus O, Cole BE | veditors = Weiner RS | title= Pain management: A practical guide for clinicians|chapter-url = https://books.google.com/books?id=L2CSdeiMZi4C&q=%22chronic%20pain%20frequently%20requires%20the%20coordinated%20efforts%20of%20a%20broadly%20based%20treatment%20team%22&pg=PA27 |year= 2002 |publisher= CRC Press |isbn= 978-0-8493-0926-7|page= 29 |chapter= The classification of pain}}</ref><ref name="Henningsen P, Zipfel S.">{{cite journal | vauthors = Henningsen P, Zipfel S, Herzog W | title = Management of functional somatic syndromes | journal = Lancet | volume = 369 | issue = 9565 | pages = 946–55 | date = March 2007 | pmid = 17368156 | doi = 10.1016/S0140-6736(07)60159-7 | s2cid = 24730085 }}</ref><ref name="Stanos S, Houle TT.">{{cite journal | vauthors = Stanos S, Houle TT | title = Multidisciplinary and interdisciplinary management of chronic pain | journal = Physical Medicine and Rehabilitation Clinics of North America | volume = 17 | issue = 2 | pages = 435–450, vii | date = May 2006 | pmid = 16616276 | doi = 10.1016/j.pmr.2005.12.004 }}</ref>

A multimodal treatment approach is essential for better pain control and outcomes, as well as minimizing the need for high-risk treatments such as opioid medications. Managing comorbid depression and anxiety is critical in reducing chronic pain.<ref name="Dydyk-2023" /><ref name="Tang-2006" /> Patients with chronic pain should be carefully monitored for severe depression and any suicidal thoughts and plans.<ref name="Dydyk-2023" /><ref name="Petrosky-2018" /> Periodic referral of the patient to the doctor for physical examination and to check the effectiveness of treatment too is necessary, and the rapid and correct treatment and management of chronic pain can prevent the occurrence of potential negative consequences on the patient's life and increase in healthcare costs.<ref name="Dydyk-2023" />

As of 2024, the patient is encouraged to play a major role in the management of their pain.<ref>{{Cite journal|url=https://www.bmj.com/content/384/bmj-2022-072362|title=Chronic pain: supported self-management|first1=Youngjoo|last1=Kang|first2=Louise|last2=Trewern|first3=John|last3=Jackman|first4=Anushka Irani (nee|last4=Soni)|first5=David|last5=McCartney|date=January 2, 2024|journal=BMJ|volume=384|article-number=e072362|via=www.bmj.com|doi=10.1136/bmj-2022-072362|pmid=38167273|url-access=subscription}}</ref>

===Medications===
Various [[Nonopiod analgesics|non-opioid]] medicines are initially recommended to treat chronic pain, depending on whether the pain is due to tissue damage or is [[Peripheral neuropathy|neuropathic]].<ref name="Tauben2015">{{cite journal |vauthors=Tauben D |date=May 2015 |title=Nonopioid medications for pain |journal=Physical Medicine and Rehabilitation Clinics of North America |volume=26 |issue=2 |pages=219–248 |doi=10.1016/j.pmr.2015.01.005 |pmid=25952062}}</ref><ref name="Welsch2015">{{cite journal |vauthors=Welsch P, Sommer C, Schiltenwolf M, Häuser W |date=February 2015 |title=[Opioids in chronic noncancer pain-are opioids superior to nonopioid analgesics? A systematic review and meta-analysis of efficacy, tolerability and safety in randomized head-to-head comparisons of opioids versus nonopioid analgesics of at least four week's duration] |journal=Schmerz |language=de |volume=29 |issue=1 |pages=85–95 |doi=10.1007/s00482-014-1436-0 |pmid=25376546}}</ref> 

Some people with chronic pain may benefit from [[opioid]] treatment while others can be harmed by it.<ref name="Reuben2015" /><ref>{{cite journal |display-authors=6 |vauthors=Chou R, Turner JA, Devine EB, Hansen RN, Sullivan SD, Blazina I, Dana T, Bougatsos C, Deyo RA |date=February 2015 |title=The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention Workshop |journal=Annals of Internal Medicine |volume=162 |issue=4 |pages=276–286 |doi=10.7326/M14-2559 |pmid=25581257 |s2cid=207538295 |doi-access=}}</ref> 

People with non-cancer pain who have not been helped by non-opioid medicines might be recommended to try opioids if there is no history of [[substance use disorder]] and no current [[mental illness]].<ref name="Bus2017" />

A 2023 review said that future chronic pain diagnosis and treatment would be more personalized and precision based.<ref>{{Cite journal|title=Clinical Diagnosis and Treatment of Chronic Pain|first1=Sadiq|last1=Rahman|first2=Ali|last2=Kidwai|first3=Emiliya|last3=Rakhamimova|first4=Murad|last4=Elias|first5=William|last5=Caldwell|first6=Sergio D.|last6=Bergese|date=December 18, 2023|journal=Diagnostics (Basel, Switzerland)|volume=13|issue=24|page=3689|doi=10.3390/diagnostics13243689|doi-access=free |pmid=38132273|pmc=10743062}}</ref> 

====Nonopioids====
Initially recommended efforts are [[Analgesic|non-opioid]] based therapies.<ref name=Bus2017>{{cite journal | vauthors = Busse JW, Craigie S, Juurlink DN, Buckley DN, Wang L, Couban RJ, Agoritsas T, Akl EA, Carrasco-Labra A, Cooper L, Cull C, da Costa BR, Frank JW, Grant G, Iorio A, Persaud N, Stern S, Tugwell P, Vandvik PO, Guyatt GH | display-authors = 6 | title = Guideline for opioid therapy and chronic noncancer pain | journal = CMAJ | volume = 189 | issue = 18 | pages = E659–E666 | date = May 2017 | pmid = 28483845 | pmc = 5422149 | doi = 10.1503/cmaj.170363 }}</ref> Non-opioid treatment of chronic pain with pharmaceutical medicines might include [[Acetaminophen|acetaminophen (paracetamol)]]<ref>{{Cite web|title=Acetaminophen Monograph for Professionals|url=https://www.drugs.com/monograph/acetaminophen.html|access-date=2020-06-30|website=Drugs.com|language=en|archive-date=2016-06-05|archive-url=https://web.archive.org/web/20160605063136/http://www.drugs.com/monograph/acetaminophen.html|url-status=live}}</ref> or [[Nonsteroidal anti-inflammatory drug|NSAIDs]].<ref>{{cite journal | vauthors = Conaghan PG | title = A turbulent decade for NSAIDs: update on current concepts of classification, epidemiology, comparative efficacy, and toxicity | journal = Rheumatology International | volume = 32 | issue = 6 | pages = 1491–502 | date = June 2012 | pmid = 22193214 | pmc = 3364420 | doi = 10.1007/s00296-011-2263-6 }}</ref>

Various other nonopioid medicines can be used, depending on whether the pain is a result of tissue damage or is [[neuropathic]] (pain caused by a damaged or dysfunctional nervous system). 

There is limited evidence that [[cancer pain]] or chronic pain from tissue damage as a result of a conditions (e.g. [[rheumatoid arthritis]]) is best treated with opioids. 

For [[neuropathic pain]] other drugs may be more effective than opioids,<ref name="Tauben2015" /><ref name="Welsch2015" /><ref>{{cite journal | vauthors = Vardy J, Agar M | title = Nonopioid drugs in the treatment of cancer pain | journal = Journal of Clinical Oncology | volume = 32 | issue = 16 | pages = 1677–1690 | date = June 2014 | pmid = 24799483 | doi = 10.1200/JCO.2013.52.8356 | hdl-access = free | hdl = 10453/115544 }}</ref><ref>{{cite journal | vauthors = Elomrani F, Berrada N, L'annaz S, Ouziane I, Mrabti H, Errihani H | title = Pain and Cancer: A systematic review | journal = The Gulf Journal of Oncology | volume = 1 | issue = 18 | pages = 32–37 | date = May 2015 | pmid = 26003103 }}</ref> such as [[tricyclic antidepressants]],<ref name="Moore2015">{{cite journal | vauthors = Moore RA, Derry S, Aldington D, Cole P, Wiffen PJ | title = Amitriptyline for neuropathic pain in adults | journal = The Cochrane Database of Systematic Reviews | volume = 7 | issue = 7 | article-number = CD008242 | date = July 2015 | pmid = 26146793 | pmc = 6447238 | doi = 10.1002/14651858.CD008242.pub3 }}</ref> [[serotonin-norepinephrine reuptake inhibitors]],<ref name="Gilron2015">{{cite journal | vauthors = Gilron I, Baron R, Jensen T | title = Neuropathic pain: principles of diagnosis and treatment | journal = Mayo Clinic Proceedings | volume = 90 | issue = 4 | pages = 532–545 | date = April 2015 | pmid = 25841257 | doi = 10.1016/j.mayocp.2015.01.018 | doi-access = free }}</ref> and [[anticonvulsants]].<ref name=Gilron2015/> 

Some atypical antipsychotics, such as [[olanzapine]], may also be effective, but the evidence to support this is in very early stages.<ref>{{cite journal | vauthors = Jimenez XF, Sundararajan T, Covington EC | title = A Systematic Review of Atypical Antipsychotics in Chronic Pain Management: Olanzapine Demonstrates Potential in Central Sensitization, Fibromyalgia, and Headache/Migraine | journal = The Clinical Journal of Pain | volume = 34 | issue = 6 | pages = 585–591 | date = June 2018 | pmid = 29077621 | doi = 10.1097/AJP.0000000000000567 | s2cid = 699847 }}</ref> In women with chronic pain, hormonal medications such as oral contraceptive pills ("the pill") might be helpful.<ref>{{cite journal | vauthors = Carey ET, Till SR, As-Sanie S | title = Pharmacological Management of Chronic Pelvic Pain in Women | journal = Drugs | volume = 77 | issue = 3 | pages = 285–301 | date = March 2017 | pmid = 28074359 | doi = 10.1007/s40265-016-0687-8 | s2cid = 35809874 }}</ref> When there is no evidence of a single best fit, doctors may need to look for a treatment that works for the individual person.<ref name=Moore2015/>

[[Nefopam]] may be used when common alternatives are contraindicated or ineffective, or as an add-on therapy. However it is associated with adverse drug reactions and is toxic in overdose.<ref>{{Cite web|url=https://www.sps.nhs.uk/articles/use-of-nefopam-for-chronic-pain/|title=Use of nefopam for chronic pain|date=January 5, 2024|website=SPS - Specialist Pharmacy Service}}</ref>

====Opioids====
In those who have not benefited from other measures and have no history of either [[mental illness]] or [[substance use disorder]] treatment with opioids may be tried.<ref name=Bus2017/> If significant benefit does not occur it is recommended that they be stopped.<ref name=Bus2017/> In those on opioids, stopping or decreasing their use may improve outcomes including pain.<ref>{{cite journal | vauthors = Frank JW, Lovejoy TI, Becker WC, Morasco BJ, Koenig CJ, Hoffecker L, Dischinger HR, Dobscha SK, Krebs EE | display-authors = 6 | title = Patient Outcomes in Dose Reduction or Discontinuation of Long-Term Opioid Therapy: A Systematic Review | journal = Annals of Internal Medicine | volume = 167 | issue = 3 | pages = 181–191 | date = August 2017 | pmid = 28715848 | doi = 10.7326/m17-0598 | doi-access = free }}</ref>

Some people with chronic pain benefit from [[opioid]] treatment and others do not; some are harmed by the treatment.<ref name=Reuben2015/> Possible harms include reduced sex hormone production, [[hypogonadism]], infertility, impaired immune system, falls and fractures in older adults, [[neonatal abstinence syndrome]], heart problems, sleep-disordered breathing, [[physical dependence]], addiction, abuse, and overdose.<ref name=Neurology2014>{{cite journal | vauthors = Franklin GM | title = Opioids for chronic noncancer pain: a position paper of the American Academy of Neurology | journal = Neurology | volume = 83 | issue = 14 | pages = 1277–1284 | date = September 2014 | pmid = 25267983 | doi = 10.1212/wnl.0000000000000839 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Higgins C, Smith BH, Matthews K | title = Incidence of iatrogenic opioid dependence or abuse in patients with pain who were exposed to opioid analgesic therapy: a systematic review and meta-analysis | journal = British Journal of Anaesthesia | volume = 120 | issue = 6 | pages = 1335–1344 | date = June 2018 | pmid = 29793599 | doi = 10.1016/j.bja.2018.03.009 | doi-access = free }}</ref>

It is difficult for doctors to predict who will use opioids just for pain management and who will go on to develop an addiction. It is also challenging for doctors to know which patients ask for opioids because they are living with an opioid addiction. Withholding, interrupting or withdrawing opioid treatment in people who benefit from it can cause harm.<ref name=Reuben2015>{{cite journal | vauthors = Reuben DB, Alvanzo AA, Ashikaga T, Bogat GA, Callahan CM, Ruffing V, Steffens DC | title = National Institutes of Health Pathways to Prevention Workshop: the role of opioids in the treatment of chronic pain | journal = Annals of Internal Medicine | volume = 162 | issue = 4 | pages = 295–300 | date = February 2015 | pmid = 25581341 | doi = 10.7326/M14-2775 | doi-access = free }}</ref>

===Psychological treatments===
Psychological treatments, including [[cognitive behavioral therapy]]<ref name="pmid23091394">{{cite journal | vauthors = Sveinsdottir V, Eriksen HR, Reme SE | title = Assessing the role of cognitive behavioral therapy in the management of chronic nonspecific back pain | journal = Journal of Pain Research | volume = 5 | pages = 371–380 | year = 2012 | pmid = 23091394 | pmc = 3474159 | doi = 10.2147/JPR.S25330 | doi-access = free }}</ref><ref name="pmid23175199">{{cite journal | vauthors = Castro MM, Daltro C, Kraychete DC, Lopes J | title = The cognitive behavioral therapy causes an improvement in quality of life in patients with chronic musculoskeletal pain | journal = Arquivos de Neuro-Psiquiatria | volume = 70 | issue = 11 | pages = 864–868 | date = November 2012 | pmid = 23175199 | doi = 10.1590/s0004-282x2012001100008 | doi-access = free }}</ref> and [[acceptance and commitment therapy]]<ref name="pmid23090719">{{cite journal | vauthors = Wicksell RK, Kemani M, Jensen K, Kosek E, Kadetoff D, Sorjonen K, Ingvar M, Olsson GL | display-authors = 6 | title = Acceptance and commitment therapy for fibromyalgia: a randomized controlled trial | journal = European Journal of Pain | volume = 17 | issue = 4 | pages = 599–611 | date = April 2013 | pmid = 23090719 | doi = 10.1002/j.1532-2149.2012.00224.x | hdl-access = free | s2cid = 32151525 | hdl = 10616/44579 }}</ref><ref>{{cite journal | vauthors = Veehof MM, Trompetter HR, Bohlmeijer ET, Schreurs KM | title = Acceptance- and mindfulness-based interventions for the treatment of chronic pain: a meta-analytic review | journal = Cognitive Behaviour Therapy | volume = 45 | issue = 1 | pages = 5–31 | year = 2016 | pmid = 26818413 | doi = 10.1080/16506073.2015.1098724 | url = https://research.utwente.nl/en/publications/acceptance-and-mindfulnessbased-interventions-for-the-treatment-of-chronic-pain-a-metaanalytic-review(f2f3c3c2-58a3-4458-a179-659f6990dedd).html | doi-access = free | archive-date = 2021-08-28 | access-date = 2025-03-17 | archive-url = https://web.archive.org/web/20210828035518/https://research.utwente.nl/en/publications/acceptance-and-mindfulness-based-interventions-for-the-treatment- | url-status = live }}</ref> can be helpful for improving quality of life and reducing pain interference. Brief mindfulness-based treatment approaches have been used, but they are not yet recommended as a first-line treatment.<ref>{{cite journal | vauthors = McClintock AS, McCarrick SM, Garland EL, Zeidan F, Zgierska AE | title = Brief Mindfulness-Based Interventions for Acute and Chronic Pain: A Systematic Review | journal = Journal of Alternative and Complementary Medicine | volume = 25 | issue = 3 | pages = 265–278 | date = March 2019 | pmid = 30523705 | pmc = 6437625 | doi = 10.1089/acm.2018.0351 }}</ref> The effectiveness of [[mindfulness-based pain management]] (MBPM) has been supported by a range of studies.<ref name="Mehan-2018">{{Cite journal| vauthors = Mehan S, Morris J |date=2018|title=A literature review of Breathworks and mindfulness intervention|journal=British Journal of Healthcare Management|volume=24|issue=5|pages=235–241|doi=10.12968/bjhc.2018.24.5.235|issn=1358-0574}}</ref><ref name="Long-2016">{{cite journal | vauthors = Long J, Briggs M, Long A, Astin F | title = Starting where I am: a grounded theory exploration of mindfulness as a facilitator of transition in living with a long-term condition | journal = Journal of Advanced Nursing | volume = 72 | issue = 10 | pages = 2445–2456 | date = October 2016 | pmid = 27174075 | doi = 10.1111/jan.12998 | s2cid = 4917280 | url = http://eprints.whiterose.ac.uk/111569/3/LongStarting%20where%20I%20am.pdf | archive-date = 2020-12-01 | access-date = 2020-09-06 | archive-url = https://web.archive.org/web/20201201155250/http://eprints.whiterose.ac.uk/111569/3/LongStarting%20where%20I%20am.pdf | url-status = live }}</ref><ref name="Brown-2013">{{cite journal | vauthors = Brown CA, Jones AK | title = Psychobiological correlates of improved mental health in patients with musculoskeletal pain after a mindfulness-based pain management program | journal = The Clinical Journal of Pain | volume = 29 | issue = 3 | pages = 233–244 | date = March 2013 | pmid = 22874090 | doi = 10.1097/AJP.0b013e31824c5d9f | s2cid = 33688569 }}</ref>

Among older adults psychological interventions can help reduce pain and improve [[self-efficacy]] for pain management.<ref>{{cite journal | vauthors = Niknejad B, Bolier R, Henderson CR, Delgado D, Kozlov E, Löckenhoff CE, Reid MC | title = Association Between Psychological Interventions and Chronic Pain Outcomes in Older Adults: A Systematic Review and Meta-analysis | journal = JAMA Internal Medicine | volume = 178 | issue = 6 | pages = 830–839 | date = June 2018 | pmid = 29801109 | pmc = 6145761 | doi = 10.1001/jamainternmed.2018.0756 }}</ref> Psychological treatments have also been shown to be effective in children and teens with chronic headache or mixed chronic pain conditions.<ref>{{cite journal | vauthors = Fisher E, Law E, Dudeney J, Palermo TM, Stewart G, Eccleston C | title = Psychological therapies for the management of chronic and recurrent pain in children and adolescents | journal = The Cochrane Database of Systematic Reviews | volume = 9 | article-number = CD003968 | date = September 2018 | issue = 9 | pmid = 30270423 | pmc = 6257251 | doi = 10.1002/14651858.CD003968.pub5 | collaboration = Cochrane Pain, Palliative and Supportive Care Group }}</ref>

===Exercise===
While exercise has been offered as a method to lessen chronic pain and there is some evidence of benefit, this evidence is tentative.<ref name="Geneen-2017">{{cite journal | vauthors = Geneen LJ, Moore RA, Clarke C, Martin D, Colvin LA, Smith BH | title = Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews | journal = The Cochrane Database of Systematic Reviews | volume = 4 | article-number = CD011279 | date = April 2017 | issue = 2 | pmid = 28436583 | pmc = 5461882 | doi = 10.1002/14651858.CD011279.pub3 }}</ref> For people living with chronic pain, exercise results in few side effects.<ref name="Geneen-2017" />

===Other interventions===

[[Interventional pain management]] may be appropriate, including techniques such as [[Myofascial trigger point#Trigger point injection|trigger point injections]], [[neurolytic block]]s, and [[radiotherapy]]. While there is no high quality evidence to support [[Therapeutic ultrasound|ultrasound]], it has been found to have a small effect on improving function in non-specific chronic low back pain.<ref>{{cite journal | vauthors = Ebadi S, Henschke N, Forogh B, Nakhostin Ansari N, van Tulder MW, Babaei-Ghazani A, Fallah E | title = Therapeutic ultrasound for chronic low back pain | journal = The Cochrane Database of Systematic Reviews | volume = 2020 | article-number = CD009169 | date = July 2020 | issue = 7 | pmid = 32623724 | pmc = 7390505 | doi = 10.1002/14651858.CD009169.pub3 }}</ref>

===Alternative medicine===
Alternative medicine refers to health practices or products that are used to treat pain or illness that are not necessarily considered a part of conventional medicine.<ref name="Lee-2011">{{cite journal | vauthors = Lee FH, Raja SN | title = Complementary and alternative medicine in chronic pain | journal = Pain | volume = 152 | issue = 1 | pages = 28–30 | date = January 2011 | pmid = 20933330 | doi = 10.1016/j.pain.2010.09.023 | s2cid = 6632695 }}</ref> When dealing with chronic pain, these practices generally fall into the following four categories: biological, mind-body, manipulative body, and energy medicine.<ref name="Lee-2011" />

Implementing dietary changes, which is considered a biological-based alternative medicine practice, has been shown to help improve symptoms of chronic pain over time.<ref name="Lee-2011" /> Adding supplements to one's diet is a common dietary change when trying to relieve chronic pain, with some of the most studied supplements being: [[Acetyl L Carnitine|acetyl-<small>L</small>-carnitine]], [[alpha-lipoic acid]], and [[vitamin E]].<ref name="Lee-2011" /><ref>{{Cite journal| vauthors = Gupta A |date=2019-10-15|title=What are the benefits and harms of acetyl-L-carnitine for treatment of diabetic peripheral neuropathy (DPN)? |journal=Cochrane Clinical Answers|doi=10.1002/cca.2721|s2cid=208452418 |issn=2050-4217}}</ref><ref>{{cite journal | vauthors = Ziegler D | title = Painful diabetic neuropathy: advantage of novel drugs over old drugs? | journal = Diabetes Care | volume = 32 | issue = suppl_2 | pages = S414–419 | date = November 2009 | pmid = 19875591 | pmc = 2811478 | doi = 10.2337/dc09-s350 | doi-access = free }}</ref><ref name="Argyriou-2006">{{cite journal | vauthors = Argyriou AA, Chroni E, Koutras A, Iconomou G, Papapetropoulos S, Polychronopoulos P, Kalofonos HP | title = Preventing paclitaxel-induced peripheral neuropathy: a phase II trial of vitamin E supplementation | journal = Journal of Pain and Symptom Management | volume = 32 | issue = 3 | pages = 237–244 | date = September 2006 | pmid = 16939848 | doi = 10.1016/j.jpainsymman.2006.03.013 | doi-access = free }}</ref> Vitamin E is perhaps the most studied out of the three, with strong evidence that it helps lower [[neurotoxicity]] in those with cancer, multiple sclerosis, and cardiovascular diseases.<ref name="Argyriou-2006" />

[[Hypnosis]], including [[self-hypnosis]], has tentative evidence.<ref name="pmid22655332">{{cite journal | vauthors = Elkins G, Johnson A, Fisher W | title = Cognitive hypnotherapy for pain management | journal = The American Journal of Clinical Hypnosis | volume = 54 | issue = 4 | pages = 294–310 | date = April 2012 | pmid = 22655332 | doi = 10.1080/00029157.2011.654284 | s2cid = 40604946 }}</ref> Hypnosis, specifically, can offer pain relief for most people and may be a safe alternative to pharmaceutical medication.<ref>{{cite journal | vauthors = Thompson T, Terhune DB, Oram C, Sharangparni J, Rouf R, Solmi M, Veronese N, Stubbs B | display-authors = 6 | title = The effectiveness of hypnosis for pain relief: A systematic review and meta-analysis of 85 controlled experimental trials | journal = Neuroscience and Biobehavioral Reviews | volume = 99 | pages = 298–310 | date = April 2019 | pmid = 30790634 | doi = 10.1016/j.neubiorev.2019.02.013 | url = http://gala.gre.ac.uk/id/eprint/23018/7/23108%20THOMPSON_The_Effectiveness_of_Hypnosis_for_Pain_Relief_2019.pdf | s2cid = 72334198 | archive-date = 2021-04-13 | access-date = 2020-09-06 | archive-url = https://web.archive.org/web/20210413213427/https://gala.gre.ac.uk/id/eprint/23018/7/23108%20THOMPSON_The_Effectiveness_of_Hypnosis_for_Pain_Relief_2019.pdf | url-status = live }}</ref> Evidence does not support hypnosis for chronic pain due to a spinal cord injury.<ref>{{cite journal | vauthors = Boldt I, Eriks-Hoogland I, Brinkhof MW, de Bie R, Joggi D, von Elm E | title = Non-pharmacological interventions for chronic pain in people with spinal cord injury | journal = The Cochrane Database of Systematic Reviews | volume = 2014 | issue = 11 | article-number = CD009177 | date = November 2014 | pmid = 25432061 | doi = 10.1002/14651858.CD009177.pub2 | doi-access =  | pmc = 11329868 }}</ref>

Preliminary studies have found [[medical marijuana]] to be beneficial in treating neuropathic pain, but not other kinds of long term pain.<ref>{{cite journal | vauthors = Nugent SM, Morasco BJ, O'Neil ME, Freeman M, Low A, Kondo K, Elven C, Zakher B, Motu'apuaka M, Paynter R, Kansagara D | display-authors = 6 | title = The Effects of Cannabis Among Adults With Chronic Pain and an Overview of General Harms: A Systematic Review | journal = Annals of Internal Medicine | volume = 167 | issue = 5 | pages = 319–331 | date = September 2017 | pmid = 28806817 | doi = 10.7326/M17-0155 | doi-access = free }}</ref> {{as of|2018}}, the evidence for its efficacy in treating neuropathic pain or pain associated with rheumatic diseases is not strong for any benefit and further research is needed.<ref>{{cite journal | vauthors = Ciccone CD | title = Medical Marijuana: Just the Beginning of a Long, Strange Trip? | journal = Physical Therapy | volume = 97 | issue = 2 | pages = 239–248 | date = February 2017 | pmid = 27660328 | doi = 10.2522/ptj.20160367 | doi-access = free }}</ref><ref>{{cite web |title=[115] Cannabinoids for Chronic Pain {{!}} Therapeutics Initiative |url=https://www.ti.ubc.ca/2018/11/22/115-cannabinoids-for-chronic-pain/ |website=Therapeutics Initiative |date=23 November 2018 |access-date=17 March 2025 |archive-date=16 April 2021 |archive-url=https://web.archive.org/web/20210416090837/https://www.ti.ubc.ca/2018/11/22/115-cannabinoids-for-chronic-pain/ |url-status=live }}</ref><ref name="Hauser-2018">{{cite journal | vauthors = Häuser W, Petzke F, Fitzcharles MA | title = Efficacy, tolerability and safety of cannabis-based medicines for chronic pain management – An overview of systematic reviews | journal = European Journal of Pain | volume = 22 | issue = 3 | pages = 455–470 | date = March 2018 | pmid = 29034533 | doi = 10.1002/ejp.1118 | s2cid = 3443248 }}</ref> For chronic non-cancer pain, a recent study concluded that it is unlikely that [[cannabinoid]]s are highly effective.<ref>{{cite journal | vauthors = Stockings E, Campbell G, Hall WD, Nielsen S, Zagic D, Rahman R, Murnion B, Farrell M, Weier M, Degenhardt L | display-authors = 6 | title = Cannabis and cannabinoids for the treatment of people with chronic noncancer pain conditions: a systematic review and meta-analysis of controlled and observational studies | journal = Pain | volume = 159 | issue = 10 | pages = 1932–1954 | date = October 2018 | pmid = 29847469 | doi = 10.1097/j.pain.0000000000001293 | s2cid = 44165877 | hdl = 1959.4/unsworks_51404 | url = https://unsworks.unsw.edu.au/bitstreams/67ef786b-3067-44ca-8874-de776ef82975/download | hdl-access = free }}</ref> However, more rigorous research into cannabis or cannabis-based medicines is needed.<ref name="Hauser-2018" />

[[Tai chi]] has been shown to improve pain, stiffness, and quality of life in chronic conditions such as osteoarthritis, low back pain, and osteoporosis.<ref>{{cite journal | vauthors = Chen YW, Hunt MA, Campbell KL, Peill K, Reid WD | title = The effect of Tai Chi on four chronic conditions-cancer, osteoarthritis, heart failure and chronic obstructive pulmonary disease: a systematic review and meta-analyses | journal = British Journal of Sports Medicine | volume = 50 | issue = 7 | pages = 397–407 | date = April 2016 | pmid = 26383108 | doi = 10.1136/bjsports-2014-094388 | url = http://bjsm.bmj.com/cgi/content/short/50/7/397 | doi-access = free | archive-date = 2021-08-28 | access-date = 2019-07-07 | archive-url = https://web.archive.org/web/20210828035500/https://bjsm.bmj.com/content/50/7/397 | url-status = live | url-access = subscription }}</ref><ref>{{cite journal | vauthors = Kong LJ, Lauche R, Klose P, Bu JH, Yang XC, Guo CQ, Dobos G, Cheng YW | display-authors = 6 | title = Tai Chi for Chronic Pain Conditions: A Systematic Review and Meta-analysis of Randomized Controlled Trials | journal = Scientific Reports | volume = 6 | article-number = 25325 | date = April 2016 | pmid = 27125299 | pmc = 4850460 | doi = 10.1038/srep25325 | bibcode = 2016NatSR...625325K }}</ref> [[Acupuncture]] has also been found to be an effective and safe treatment in reducing pain and improving quality of life in chronic pain including [[Chronic prostatitis/chronic pelvic pain syndrome|chronic pelvic pain syndrome]].<ref>{{cite journal | vauthors = Vickers AJ, Vertosick EA, Lewith G, MacPherson H, Foster NE, Sherman KJ, Irnich D, Witt CM, Linde K | display-authors = 6 | title = Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis | journal = The Journal of Pain | volume = 19 | issue = 5 | pages = 455–474 | date = May 2018 | pmid = 29198932 | pmc = 5927830 | doi = 10.1016/j.jpain.2017.11.005 }}</ref><ref>{{cite journal | vauthors = Liu BP, Wang YT, Chen SD | title = Effect of acupuncture on clinical symptoms and laboratory indicators for chronic prostatitis/chronic pelvic pain syndrome: a systematic review and meta-analysis | journal = International Urology and Nephrology | volume = 48 | issue = 12 | pages = 1977–1991 | date = December 2016 | pmid = 27590134 | doi = 10.1007/s11255-016-1403-z | s2cid = 12344832 }}</ref>

[[Transcranial magnetic stimulation]] for reduction of chronic pain is not supported by high quality evidence, and the demonstrated effects are small and short-term.<ref>{{cite journal | vauthors = O'Connell NE, Marston L, Spencer S, DeSouza LH, Wand BM | title = Non-invasive brain stimulation techniques for chronic pain | journal = The Cochrane Database of Systematic Reviews | volume = 4 | article-number = CD008208 | date = April 2018 | issue = 8 | pmid = 29652088 | pmc = 6494527 | doi = 10.1002/14651858.CD008208.pub5 }}</ref>

Spa therapy could potentially improve pain in patients with chronic lower back pain, but more studies are needed to provide stronger evidence of this.<ref>{{cite journal | vauthors = Bai R, Li C, Xiao Y, Sharma M, Zhang F, Zhao Y | title = Effectiveness of spa therapy for patients with chronic low back pain: An updated systematic review and meta-analysis | journal = Medicine | volume = 98 | issue = 37 | article-number = e17092 | date = September 2019 | pmid = 31517832 | pmc = 6750337 | doi = 10.1097/MD.0000000000017092 }}</ref>

While some studies have investigated the efficacy of St John's Wort or nutmeg for treating neuropathic (nerve) pain, their findings have raised serious concerns about the accuracy of their results.<ref>{{cite journal | vauthors = Boyd A, Bleakley C, Hurley DA, Gill C, Hannon-Fletcher M, Bell P, McDonough S | title = Herbal medicinal products or preparations for neuropathic pain | journal = The Cochrane Database of Systematic Reviews | volume = 4 | article-number = CD010528 | date = April 2019 | issue = 5 | pmid = 30938843 | pmc = 6445324 | doi = 10.1002/14651858.CD010528.pub4 }}</ref>

[[KT tape|Kinesio tape]] has not been shown to be effective in managing chronic non-specific low-back pain.<ref>{{cite journal | vauthors = Luz Júnior MA, Almeida MO, Santos RS, Civile VT, Costa LO | title = Effectiveness of Kinesio Taping in Patients With Chronic Nonspecific Low Back Pain: A Systematic Review With Meta-analysis | journal = Spine | volume = 44 | issue = 1 | pages = 68–78 | date = January 2019 | pmid = 29952880 | doi = 10.1097/BRS.0000000000002756 | s2cid = 49486200 }}</ref>

[[Myofascial release]] has been used in some cases of [[fibromyalgia]], chronic [[low back pain]], and [[tennis elbow]] but there is not enough evidence to support this as method of treatment.<ref>{{cite journal | vauthors = Laimi K, Mäkilä A, Bärlund E, Katajapuu N, Oksanen A, Seikkula V, Karppinen J, Saltychev M | display-authors = 6 | title = Effectiveness of myofascial release in treatment of chronic musculoskeletal pain: a systematic review | journal = Clinical Rehabilitation | volume = 32 | issue = 4 | pages = 440–450 | date = April 2018 | pmid = 28956477 | doi = 10.1177/0269215517732820 | s2cid = 206486404 }}</ref>

==Epidemiology==
Chronic pain is common.
*Epidemiological studies have found that 8–11.2% of people in various countries have chronic widespread pain.<ref name="Andrews-2018"/> Chronic pain varies in different countries affecting anywhere from 8% to 55% of the population. It affects women at a higher rate than men, and chronic pain uses a large amount of healthcare resources around the globe.<ref name="Harstall2003">{{cite journal|vauthors=Harstall C, Ospina M|date=June 2003|title=How Prevalent Is Chronic Pain?|url=http://iasp.files.cms-plus.com/Content/ContentFolders/Publications2/PainClinicalUpdates/Archives/PCU03-2_1390265045864_38.pdf|journal=Pain Clinical Updates|publisher=International Association for the Study of Pain|volume=XI|issue=2|pages=1–4|archive-url=https://web.archive.org/web/20170623013705/http://iasp.files.cms-plus.com/content/contentfolders/publications2/painclinicalupdates/archives/pcu03-2_1390265045864_38.pdf|archive-date=2017-06-23}}</ref><ref name="Andrews-2018" />
*A large-scale telephone survey of 15 European countries and Israel found that 19% of respondents over 18 years of age had suffered pain for more than 6 months, including the last month, and more than twice in the last week, with pain intensity of 5 or more for the last episode, on a scale of 1 (no pain) to 10 (worst imaginable). 4839 of these respondents with chronic pain were interviewed in-depth. Sixty-six percent scored their pain intensity at moderate (5–7), and 34% at severe (8–10); 46% had constant pain, 56% intermittent; 49% had suffered pain for 2–15 years; and 21% had been diagnosed with depression due to the pain. Sixty-one percent were unable or less able to work outside the home, 19% had lost a job, and 13% had changed jobs due to their pain. Forty percent had inadequate pain management and less than 2% were seeing a pain management specialist.<ref>{{cite journal | vauthors = Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D | title = Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment | journal = European Journal of Pain | volume = 10 | issue = 4 | pages = 287–333 | date = May 2006 | pmid = 16095934 | doi = 10.1016/j.ejpain.2005.06.009 | url = https://archive-ouverte.unige.ch/unige:126435 | s2cid = 22834242 | archive-date = 2021-04-16 | access-date = 2021-02-23 | archive-url = https://web.archive.org/web/20210416081034/https://archive-ouverte.unige.ch/unige:126435 | url-status = live | url-access = subscription }}</ref>
*In the United States, chronic pain has been estimated to occur in approximately 35% of the population, with approximately 50 million Americans experiencing partial or total disability as a consequence.<ref>{{Cite journal|url=https://emedicine.medscape.com/article/310834-overview|title=Chronic Pain Syndrome: Practice Essentials, Etiology, Patient Education|date=February 18, 2022|website=eMedicine|archive-date=March 16, 2024|access-date=March 5, 2022|archive-url=https://web.archive.org/web/20240316083415/https://emedicine.medscape.com/article/310834-overview?form=fpf|url-status=live}}</ref> According to the [[Institute of Medicine]], there are about 116 million Americans living with chronic pain, which suggests that approximately half of American adults have some chronic pain condition.<ref name="painreview">{{cite journal | vauthors = Debono DJ, Hoeksema LJ, Hobbs RD | title = Caring for patients with chronic pain: pearls and pitfalls | journal = The Journal of the American Osteopathic Association | volume = 113 | issue = 8 | pages = 620–627 | date = August 2013 | pmid = 23918913 | doi = 10.7556/jaoa.2013.023 | doi-access = free }}</ref><ref>{{cite book | title=Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research | publisher=The National Academies Press | location=Washington DC | year=2011 | last=Institute of Medicine of the National Academies Report}}</ref> The Mayday Fund estimate of 70 million Americans with chronic pain is slightly more conservative.<ref>{{cite book | title=A Call to Revolutionize Chronic Pain Care in America: An Opportunity in Health Care Reform | publisher=The Mayday Fund | year=2009 }}</ref> In an internet study, the prevalence of chronic pain in the United States was calculated to be 30.7% of the population: 34.3% for women and 26.7% for men.<ref name="pmid20797916">{{cite journal | vauthors = Johannes CB, Le TK, Zhou X, Johnston JA, Dworkin RH | title = The prevalence of chronic pain in United States adults: results of an Internet-based survey | journal = The Journal of Pain | volume = 11 | issue = 11 | pages = 1230–1239 | date = November 2010 | pmid = 20797916 | doi = 10.1016/j.jpain.2010.07.002 | s2cid = 27177431 | doi-access = free }}</ref> A 2021 survey found chronic pain sufferers were 55% female.<ref>{{Cite journal|url=https://www.cdc.gov/mmwr/volumes/72/wr/mm7215a1.htm|title=Chronic Pain Among Adults — United States, 2019–2021|first=S. Michaela|last=Rikard|date=March 12, 2023|journal=MMWR. Morbidity and Mortality Weekly Report|volume=72|issue=15|pages=379–385|via=www.cdc.gov|doi=10.15585/mmwr.mm7215a1|pmid=37053114|pmc=10121254|archive-date=February 28, 2025|access-date=March 12, 2025|archive-url=https://web.archive.org/web/20250228131805/https://www.cdc.gov/mmwr/volumes/72/wr/mm7215a1.htm|url-status=live}}</ref>
*In Canada it is estimated that approximately 1 in 5 Canadians live with chronic pain and half of those people have lived with chronic pain for 10 years or longer.<ref name="Health Canada-2019">{{Cite web|author=Health Canada|date=2019-08-08|title=Canadian Pain Task Force Report: June 2019|url=https://www.canada.ca/en/health-canada/corporate/about-health-canada/public-engagement/external-advisory-bodies/canadian-pain-task-force/report-2019.html|access-date=2020-06-30|website=aem|archive-date=2020-07-02|archive-url=https://web.archive.org/web/20200702172916/https://www.canada.ca/en/health-canada/corporate/about-health-canada/public-engagement/external-advisory-bodies/canadian-pain-task-force/report-2019.html|url-status=live}}</ref> Chronic pain in Canada also occurs more and is more severe in women and Canada's [[Indigenous peoples in Canada|Indigenous communities]].<ref name="Health Canada-2019" />
*In the UK chronic pain affects 13–50% of adults.<ref name="auto2">{{Cite journal|title=Chronic pain: a review of its epidemiology and associated factors in population-based studies|first1=Sarah E. E.|last1=Mills|first2=Karen P.|last2=Nicolson|first3=Blair H.|last3=Smith|date=Aug 6, 2019|journal=British Journal of Anaesthesia|volume=123|issue=2|pages=e273–e283|doi=10.1016/j.bja.2019.03.023|pmid=31079836|pmc=6676152}}</ref><ref name="auto1"/>10.4–14.3% of people with chronic pain have moderate-to-severe disabling chronic pain.<ref name="auto2"/>

==Psychological aspects==

===Personality===
Two of the most frequent personality profiles found in people with chronic pain by the [[Minnesota Multiphasic Personality Inventory]] (MMPI) are the ''conversion V'' and the ''neurotic triad''. The conversion V personality expresses exaggerated concern over body feelings, develops bodily symptoms in response to stress, and often fails to recognize their own emotional state, including depression. The neurotic triad personality also expresses exaggerated concern over body feelings and develops bodily symptoms in response to stress, but is demanding and complaining.<ref>{{cite book |title=Clinical manual of pain management in psychiatry | vauthors = Leo R |year=2007 |publisher=American Psychiatric Publishing |location=Washington, DC |isbn=978-1-58562-275-7  |page=58}}</ref>

Some investigators have argued that it is this [[neuroticism]] that causes acute pain to turn chronic, but clinical evidence points the other way, to chronic pain causing neuroticism. When long term pain is relieved by therapeutic intervention, scores on the neurotic triad and [[anxiety]] fall, often to normal levels.<ref name="pmid17112364">{{cite journal | vauthors = Fishbain DA, Cole B, Cutler RB, Lewis J, Rosomoff HL, Rosomoff RS | title = Chronic pain and the measurement of personality: do states influence traits? | journal = Pain Medicine | volume = 7 | issue = 6 | pages = 509–529 | date = 1 November 2006 | pmid = 17112364 | doi = 10.1111/j.1526-4637.2006.00239.x | doi-access = free }}</ref><ref name="pmid9648998">{{cite journal | vauthors = Jess P, Jess T, Beck H, Bech P | title = Neuroticism in relation to recovery and persisting pain after laparoscopic cholecystectomy | journal = Scandinavian Journal of Gastroenterology | volume = 33 | issue = 5 | pages = 550–553 | date = May 1998 | pmid = 9648998 | doi = 10.1080/00365529850172151 }}</ref><ref name="pmid7846260">{{cite journal | vauthors = Jess P, Bech P | title = The validity of Eysenck's neuroticism dimension within the Minnesota Multiphasic Personality Inventory in patients with duodenal ulcer. The Hvidovre Ulcer Project Group | journal = Psychotherapy and Psychosomatics | volume = 62 | issue = 3–4 | pages = 168–175 | year = 1994 | pmid = 7846260 | doi = 10.1159/000288919 | url = http://www.hopkinsguides.com/hopkins/ub/citation/7846260/The_validity_of_Eysenck%27s_neuroticism_dimension_within_the_Minnesota_Multiphasic_Personality_Inventory_in_patients_with_duodenal_ulcer__The_Hvidovre_Ulcer_Project_Group_ | archive-date = 2021-04-28 | access-date = 2011-09-26 | archive-url = https://web.archive.org/web/20210428140128/https://www.hopkinsguides.com/hopkins/ub/citation/7846260/The_validity_of_Eysenck%27s_neuroticism_dimension_within_the_Minnesota_Multiphasic_Personality_Inventory_in_patients_with_duodenal_ulcer__The_Hvidovre_Ulcer_Project_Group_ | url-status = live | url-access = subscription }}</ref><ref name=Melzack_Wall_1996_31-32>{{cite book | vauthors = Melzack R, Wall PD | date = 1996 | title = The Challenge of Pain | edition = 2nd | location = London | publisher = Penguin | pages = 31–32 | isbn = 0-14-025670-9 }}</ref> Self-esteem, often low in people with chronic pain, also shows improvement once pain has resolved.<ref name="Melzack_Wall_1996_31-32"/>

It has been suggested that [[Pain catastrophizing|catastrophizing]] might play a role in the experience of pain. ''Pain catastrophizing'' is the tendency to describe a pain experience in more exaggerated terms than the average person, to think a great deal more about the pain when it occurs, or to feel more helpless about the experience.<ref name="Damme">{{cite journal | vauthors = Van Damme S, Crombez G, Bijttebier P, Goubert L, Van Houdenhove B | title = A confirmatory factor analysis of the Pain Catastrophizing Scale: invariant factor structure across clinical and non-clinical populations | journal = Pain | volume = 96 | issue = 3 | pages = 319–324 | date = April 2002 | pmid = 11973004 | doi = 10.1016/S0304-3959(01)00463-8 | s2cid = 19059827 }}</ref> People who score highly on measures of catastrophization are likely to rate a pain experience as more intense than those who score low on such measures. It is often reasoned that the tendency to catastrophize ''causes'' the person to experience the pain as more intense. One suggestion is that catastrophizing influences pain perception through altering attention and anticipation, and heightening emotional responses to pain.<ref name="Grace">{{cite journal | vauthors = Gracely RH, Geisser ME, Giesecke T, Grant MA, Petzke F, Williams DA, Clauw DJ | title = Pain catastrophizing and neural responses to pain among persons with fibromyalgia | journal = Brain | volume = 127 | issue = Pt 4 | pages = 835–843 | date = April 2004 | pmid = 14960499 | doi = 10.1093/brain/awh098 | doi-access =  }}</ref> However, at least some aspects of catastrophization may be the ''product'' of an intense pain experience, rather than its cause. That is, the more intense the pain feels to the person, the more likely they are to have thoughts about it that fit the definition of catastrophization.<ref>{{cite journal | vauthors = Severeijns R, van den Hout MA, Vlaeyen JW | title = The causal status of pain catastrophizing: an experimental test with healthy participants | journal = European Journal of Pain | volume = 9 | issue = 3 | pages = 257–265 | date = June 2005 | pmid = 15862475 | doi = 10.1016/j.ejpain.2004.07.005 | s2cid = 43047540 }}</ref>

=== Comorbidity with trauma ===
Individuals with post-traumatic stress disorder (PTSD) have a high comorbidity with chronic pain.<ref>{{cite journal | vauthors = Fishbain DA, Pulikal A, Lewis JE, Gao J | title = Chronic Pain Types Differ in Their Reported Prevalence of Post–Traumatic Stress Disorder (PTSD) and There Is Consistent Evidence That Chronic Pain Is Associated with PTSD: An Evidence-Based Structured Systematic Review | journal = Pain Medicine | volume = 18 | issue = 4 | pages = 711–735 | date = April 2017 | pmid = 27188666 | doi = 10.1093/pm/pnw065 | url = https://academic.oup.com/painmedicine/article-lookup/doi/10.1093/pm/pnw065 | s2cid = 205291405 | url-access = subscription }}</ref> Patients with both PTSD and chronic pain report higher severity of pain than those who do not have a PTSD comorbidity.<ref>{{cite journal | vauthors = Morasco BJ, Lovejoy TI, Lu M, Turk DC, Lewis L, Dobscha SK | title = The relationship between PTSD and chronic pain: mediating role of coping strategies and depression | journal = Pain | volume = 154 | issue = 4 | pages = 609–616 | date = April 2013 | pmid = 23398939 | pmc = 3609886 | doi = 10.1016/j.pain.2013.01.001 }}</ref><ref>{{cite journal | vauthors = Siqveland J, Ruud T, Hauff E | title = Post-traumatic stress disorder moderates the relationship between trauma exposure and chronic pain | journal = European Journal of Psychotraumatology | volume = 8 | issue = 1 | article-number = 1375337 | date = January 2017 | pmid = 29038680 | pmc = 5632777 | doi = 10.1080/20008198.2017.1375337 }}</ref>

=== Comorbidity with depression ===
People with chronic pain may also have symptoms of depression.<ref>{{Cite journal |last1=Sheng |first1=Jiyao |last2=Liu |first2=Shui |last3=Wang |first3=Yicun |last4=Cui |first4=Ranji |last5=Zhang |first5=Xuewen |date=2017 |title=The Link between Depression and Chronic Pain: Neural Mechanisms in the Brain |journal=Neural Plasticity |volume=2017 |article-number=9724371 |doi=10.1155/2017/9724371 |issn=2090-5904 |pmc=5494581 |pmid=28706741 |doi-access=free }}</ref><ref>{{Cite journal |vauthors=Surah A, Baranidharan G, Dip PG, Morley S |title=Chronic pain and depression|journal=British Journal of Anaesthesia|date=1 April 2014 |volume=14|issue=2|pages=85–9|doi=10.1093/bjaceaccp/mkt046|url=https://www.bjaed.org/article/S1743-1816(17)30112-9/fulltext|doi-access=free}}</ref> In 2017, the British Medical Association found that 49% of people with chronic pain had depression.<ref>{{Cite web |publisher=British Medical Association |date=2017 |title=Chronic pain: supporting safer prescribing of analgesics |url=https://www.bma.org.uk/media/2100/analgesics-chronic-pain.pdf |access-date=2023-10-24 |archive-date=2024-01-19 |archive-url=https://web.archive.org/web/20240119191256/https://www.bma.org.uk/media/2100/analgesics-chronic-pain.pdf |url-status=live }}</ref>

===Effect on cognition===
Chronic pain's impact on cognition is an under-researched area, but several tentative conclusions have been published. Most people with chronic pain complain of [[cognitive impairment]], such as forgetfulness, difficulty with attention, and difficulty completing tasks. Objective testing has found that people in chronic pain tend to experience impairment in attention, memory, mental flexibility, verbal ability, speed of response in a cognitive task, and speed in executing structured tasks.<ref>{{cite journal | vauthors = Kreitler S, Niv D | year = 2007 | title = Cognitive impairment in chronic pain | journal = Pain: Clinical Updates | volume = XV | issue = 4 | pages = 1–4 | url = https://www.iasp-pain.org/PublicationsNews/NewsletterIssue.aspx?ItemNumber=2111 | format = pdf | access-date = 2019-01-06 | archive-date = 2018-10-30 | archive-url = https://web.archive.org/web/20181030233831/http://www.iasp-pain.org/PublicationsNews/NewsletterIssue.aspx?ItemNumber=2111 }}</ref> A review of studies in 2018 reports a relationship between people in chronic pain and abnormal results in test of memory, attention, and processing speed.<ref>{{cite journal | vauthors = Higgins DM, Martin AM, Baker DG, Vasterling JJ, Risbrough V | title = The Relationship Between Chronic Pain and Neurocognitive Function: A Systematic Review | journal = The Clinical Journal of Pain | volume = 34 | issue = 3 | pages = 262–275 | date = March 2018 | pmid = 28719507 | pmc = 5771985 | doi = 10.1097/AJP.0000000000000536 }}</ref>

==Social and personal impacts==

===Social support===
[[Social support]] has important consequences for individuals with chronic pain. In particular, pain intensity, pain control, and resiliency to pain have been implicated as outcomes influenced by different levels and types of social support. Much of this research has focused on emotional, instrumental, tangible and informational social support. People with persistent pain conditions tend to rely on their social support as a coping mechanism and therefore have better outcomes when they are a part of larger more supportive social networks. Across a majority of studies investigated, there was a direct significant association between social activities or social support and pain. Higher levels of pain were associated with a decrease in social activities, lower levels of social support, and reduced social functioning.<ref>{{cite journal | vauthors = Molton IR, Terrill AL | title = Overview of persistent pain in older adults | journal = The American Psychologist | volume = 69 | issue = 2 | pages = 197–207 | date = 2014 | pmid = 24547805 | doi = 10.1037/a0035794 }}</ref><ref>{{cite journal | vauthors = Zaza C, Baine N | title = Cancer pain and psychosocial factors: a critical review of the literature | journal = Journal of Pain and Symptom Management | volume = 24 | issue = 5 | pages = 526–542 | date = November 2002 | pmid = 12547052 | doi = 10.1016/s0885-3924(02)00497-9 | doi-access = free }}</ref>

===Racial disparities===
Evidence exists for unconscious biases and negative stereotyping against [[racial minority|racial minorities]] requesting pain treatment, although clinical decision making was not affected, according to one 2017 review.<ref name="dehon">{{cite journal | vauthors = Dehon E, Weiss N, Jones J, Faulconer W, Hinton E, Sterling S | title = A Systematic Review of the Impact of Physician Implicit Racial Bias on Clinical Decision Making | journal = Academic Emergency Medicine | volume = 24 | issue = 8 | pages = 895–904 | date = August 2017 | pmid = 28472533 | doi = 10.1111/acem.13214 | s2cid = 32634889 | veditors = Choo EK | doi-access = free }}</ref> Minorities may be denied diagnoses for pain and pain medications, and are more likely to go through [[substance abuse]] assessment, and are less likely to transfer for pain specialist referral.<ref name="tait">{{cite journal | vauthors = Tait RC, Chibnall JT | title = Racial/ethnic disparities in the assessment and treatment of pain: psychosocial perspectives | journal = The American Psychologist | volume = 69 | issue = 2 | pages = 131–141 | year = 2014 | pmid = 24547799 | doi = 10.1037/a0035204 }}</ref> A 2010 University of Michigan Health study found that black patients in pain clinics received 50% of the amount of drugs that patients who were white received.<ref>{{Cite news |title=4 Ways Racism in Health Care Is Still a Problem Today |work=ThoughtCo |url=https://www.thoughtco.com/racism-in-health-care-still-a-problem-2834530 |access-date=May 12, 2018 |archive-date=May 13, 2018 |archive-url=https://web.archive.org/web/20180513081117/https://www.thoughtco.com/racism-in-health-care-still-a-problem-2834530 |url-status=live }}</ref> Preliminary research showed that health providers might have less empathy for black patients and underestimated their pain levels, resulting in treatment delays.<ref name=dehon/><ref name=tait/> Minorities may experience a [[language barrier]], limiting the high level of engagement between the person with pain and health providers for treatment.<ref name=tait/>

===Perceptions of injustice===
Similar to the damaging effects seen with catastrophizing, perceived injustice is thought to contribute to the severity and duration of chronic pain.<ref>{{cite journal | vauthors = Sullivan MJ, Yakobov E, Scott W, Tait R |title=Perceived Injustice and Adverse Recovery Outcomes |journal=Psychological Injury and Law |date=1 November 2014 |volume=7 |issue=4 |pages=325–334 |doi=10.1007/s12207-014-9209-8|s2cid=143450160 }}</ref> Pain-related injustice perception has been conceptualized as a cognitive appraisal reflecting the severity and irreparability of pain- or injury-related loss (e.g., "I just want my life back"), and externalizing blame and unfairness ("I am suffering because of someone else's negligence.").<ref>{{cite journal |vauthors = Sullivan MJ, Adams H, Horan S, Maher D, Boland D, Gross R | title = The role of perceived injustice in the experience of chronic pain and disability: scale development and validation |journal = Journal of Occupational Rehabilitation | volume = 18 | issue = 3 |pages = 249–261 |date = September 2008 |pmid = 18536983 | doi = 10.1007/s10926-008-9140-5 |s2cid = 23897737}}</ref> It has been suggested that understanding problems with top down processing/cognitive appraisals can be used to better understand and treat this problem.<ref>{{cite journal |vauthors = Bissell DA, Ziadni MS, Sturgeon JA | title = Perceived injustice in chronic pain: an examination through the lens of predictive processing | journal = Pain Management | volume = 8 | issue = 2 | pages = 129–138 | date = March 2018 | pmid = 29451429 | pmc = 6123883 | doi = 10.2217/pmt-2017-0051 }}</ref>

===Chronic pain and COVID-19===
[[COVID-19]] disrupted the lives of many, leading to major physical, psychological and socioeconomic impacts in the general population.<ref name="doi.org">{{cite journal | vauthors = Dassieu L, Pagé MG, Lacasse A, Laflamme M, Perron V, Janelle-Montcalm A, Hudspith M, Moor G, Sutton K, Thompson JM, Choinière M | display-authors = 6 | title = Chronic pain experience and health inequities during the COVID-19 pandemic in Canada: qualitative findings from the chronic pain & COVID-19 pan-Canadian study | journal = International Journal for Equity in Health | volume = 20 | issue = 1 | article-number = 147 | date = June 2021 | pmid = 34162393 | doi = 10.1186/s12939-021-01496-1 | pmc = 8220113 | doi-access = free }}</ref> Social distancing practices defining the response to the pandemic altered familiar patterns of social interaction, creating the conditions for what some psychologists described as a period of collective grief.<ref>{{cite journal |vauthors=Weir K |title=Grieving Life and Loss |journal=Monitor on Psychology |date=June 2020 |volume=51 |issue=4 |url=https://www.apa.org/monitor/2020/06/covid-grieving-life |archive-date=2024-03-16 |access-date=2021-08-22 |archive-url=https://web.archive.org/web/20240316081303/https://www.apa.org/monitor/2020/06/covid-grieving-life |url-status=live }}</ref> 

With a large proportion of the global population enduring prolonged periods of social isolation and distress, one study found that people with chronic pain from COVID-19 experienced more empathy towards their suffering during the pandemic.<ref name="doi.org"/>

===Relationship with conventional medicine===
Individuals with chronic pain tend to embody an ambiguous status, at times expressing that their type of suffering places them between and outside of conventional medicine.<ref>{{cite journal |vauthors=Jackson JE |title=Stigma, Liminality, and Chronic Pain: Mind-Body Borderlands |journal=American Ethnologist |date=2005 |volume=32 |issue=3 |pages=332–353 |doi=10.1525/ae.2005.32.3.332 |jstor=3805289 |issn=0094-0496 }}</ref>

=== Effect of chronic pain in the workplace ===
In the workplace, chronic pain conditions are a significant problem for both the person with the condition and the organization; a problem only expected to increase in many countries due to an aging workforce. In light of this, it may be helpful for organizations to consider the social environment of their workplace, and how it may be working to ease or worsen chronic pain issues for employees. As an example of how the social environment can affect chronic pain, some research has found that high levels of socially prescribed perfectionism (perfectionism induced by external pressure from others, such as a supervisor) can interact with the guilt felt by a person with chronic pain, thereby increasing job tension, and decreasing job satisfaction.<ref name="Hochwarter-2010" />

A 2025 Swedish cohort study of over 10,000 patients receiving treatment for high-impact chronic pain found that about one-quarter had sickness absence lasting more than 180 days within three years. The study identified previous sickness absence as the strongest risk factor of future long-term absence, followed by comorbid neurological disorders, lower self-rated work ability and confidence in recovery, female sex, longer pain duration, and household income.<ref>{{Cite journal |last1=Larsson |first1=Robin |last2=Guta |first2=Enisa |last3=Äng |first3=Björn |last4=LoMartire |first4=Riccardo |date=2 October 2025 |title=Risk factors for long-term sickness absence in patients with high-impact chronic pain – A scoping review and Swedish register-based cohort study |url=https://linkinghub.elsevier.com/retrieve/pii/S1526590025007977 |journal=The Journal of Pain |language=en |volume=37 |article-number=105570 |doi=10.1016/j.jpain.2025.105570 |pmid=41046109 |doi-access=free }}</ref>

== See also ==
* [[List of chronic pain syndromes]]
* [[Childhood chronic pain]]
* [[Dopaminergic pathways]]
* [[List of investigational analgesics]]
* [[Neurodegeneration]]
* [[Neuroinflammation]]
* [[Neurotherapy]]

== Notes==
{{reflist|group=lower-alpha}}

== References ==
{{reflist|30em|refs=

<!-- <ref name="Turk1">{{cite book |title=Bonica's Management of Pain |vauthors=Turk DC, Okifuji A |publisher=Lippincott Williams & Wilkins |year=2001 |isbn={{Format ISBN|978-0683304626}} |veditors=Loeser D, Butler SH, Chapman JJ, Turk DC |edition=3rd |pages=18–25 |chapter=Pain terms and taxonomies |chapter-url=https://books.google.com/books?id=TyNEicOiJqQC&q=Pain+terms+and+taxonomies&pg=RA1-PA18}}</ref> -->

}}

== Further reading ==
* {{cite journal | vauthors = Dowell D, Haegerich TM, Chou R | title = CDC Guideline for Prescribing Opioids for Chronic Pain{{snd}}United States, 2016 | journal = JAMA | volume = 315 | issue = 15 | pages = 1624–1645 | date = April 2016 | pmid = 26977696 | pmc = 6390846 | doi = 10.1001/jama.2016.1464 | ref = none }}
*{{Cite news |last=Kahn |first=Jennifer |date=2025-01-12 |title=Chronic Pain Is a Hidden Epidemic. It's Time for a Revolution. |url=https://www.nytimes.com/2025/01/12/magazine/chronic-pain.html |access-date=2025-02-27 |work=The New York Times |language=en-US}}

== External links ==
* [https://www.iasp-pain.org/index.aspx International Association for the Study of Pain] {{Webarchive|url=https://web.archive.org/web/20210501224152/https://www.iasp-pain.org/index.aspx |date=2021-05-01 }}
* {{commons-inline|Category:Pain|pain}}
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{{Pain}}
{{General symptoms and signs}}

[[Category:Chronic pain syndromes| ]]
[[Category:Nociception]]
[[Category:Pain management]]