Pain is a sensation that is transmitted from an area of tissue damage or stress along the sensory nerves to the brain. The brain interprets the information as the sensation of pain.

Substances that decrease pain either interfere with the ability of nerves to conduct messages, or alter the brain’s capacity to receive sensations.

Pain may be a symptom of an underlying pathological condition, such as inflammation. It may also be due to other causes, such as bruising, infection, burns, headaches, and sprains and strains. Use caution when treating pain without understanding its cause—this may delay diagnosis of conditions that could continue to worsen without medical attention.

Symptoms of pain include discomfort that is often worsened by movement or pressure and may be associated with irritability, problems sleeping, and fatigue. People with pain may have uncomfortable sensations described as burning, sharp, stabbing, aching, throbbing, tingling, shooting, dull, heavy, and tight.

What is chronic pain?

Chronic pain is pain that continues after your body has healed from an illness or injury. It is possible there may not be an identifiable physical cause for the persistent pain. Chronic pain can occur anywhere in your body, and can range from mild, annoying pain to severe pain that interferes with your mood and ability to function.

Chronic pain is generally different from acute pain. Acute pain signals are due to actual or impending tissue damage that normally subsides after the injury that caused it. Chronic pain is usually defined as pain that lasts longer than three months. This three-month interval is normally long enough for acute pain to ease completely.

Anyone can develop chronic pain. It commonly occurs in older adults or others with health conditions, such as diabetes, arthritis, or back problems. However, persistent pain is not a normal part of aging and treatment should be sought.

What causes chronic pain? (This topic does not cover cancer-related chronic pain.)

All of the causes of chronic pain are not yet known. However, chronic pain often develops after a major injury or illness such as shingles, back problems, or after a limb has been amputated (phantom limb pain). Chronic pain is common in older adults as they are more likely to suffer from long-term medical conditions linked to on-going pain (such as arthritis).

Chronic pain may also occur without clear-cut injury or illness. Although the reason is not clear, in these cases pain signals are somehow triggered by the nervous system, and continue to fire for months or even years. It is also possible that certain brain chemicals that suppress pain may not work properly.

Pain is caused when the nerves send pain signals through the spinal cord and into the brain. The brain responds with sensations such as sharp, tearing, burning pain and emotions such as a sickening feeling, fright, or depression. Once you have healed from an injury or illness, your nervous system normally stops sending pain signals to your brain. In those with chronic pain, the nervous system continues to send pain signals, resulting in prolonged pain.

What are the symptoms of chronic pain?

Symptoms of chronic pain usually include:
    Mild to severe pain that does not go away.
    Pain that may be described as shooting, burning, or aching.
    Discomfort, soreness, tightness, or stiffness.

Fatigue, depression, withdrawal from social and physical activities, weakened immune system, and sometimes disability may also occur.

How is chronic pain treated?

Your treatment will depend upon the type of pain you have and whether it is mild, moderate, or severe and debilitating. Treatment of chronic pain usually includes behavioral therapy and a combination of medications (such as pain relievers or antidepressants), physical therapy, and exercise. Complementary therapies such as acupuncture or yoga may also be tried. Often chronic pain cannot be cured, but it can be managed well enough to significantly improve the quality of your life.

You may need treatment for conditions related to your chronic pain; for example, professional counseling for depression or better control of blood sugar in diabetes. Several types of health professionals may be involved in your care.

Medications

Medications can often help control chronic pain. There are many different drugs used to treat chronic pain, both prescription and nonprescription. All of these medications can cause side effects and should be taken exactly as they are prescribed. In some cases, it may take several weeks before medications work to reduce pain. It is important to let your doctor know all medications you are taking (including herbal and other complementary medications) to avoid dangerous interactions.

You will probably be given medications with the least significant side effects first (such as acetaminophen), increasing the strength or changing the medications as needed. Older adults are more likely to experience adverse side effects, so medications may be started at lower doses and increased more slowly.

Medications used to treat chronic pain include the following:
    Acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed for mild to moderate pain and reduce inflammation.
    Antidepressants (such as tricyclic antidepressants) may be used to treat chronic pain, although not all antidepressants are effective at reducing pain.
    Corticosteroids, such as prednisone, are used to reduce inflammation and pain.
    Oral medicines that act like a local anesthetic (such as mexiletine [for example, Mexitil]).
    Anticonvulsants, such as gabapentin (Neurontin), may reduce pain with fewer side effects than tricyclic antidepressants. Anticonvulsants such as carbamazepine (Tegretol) may help control the episodes of facial pain seen in trigeminal neuralgia. If you take Tegretol daily, you should be checked periodically to be sure you don't develop intolerable or serious side effects (such as allergic reaction or liver problems).
    Topical analgesics such as EMLA cream can penetrate the skin and dull pain. Lidocaine is now available as a patch (Lidoderm).
    Capsaicin, a naturally occurring substance found in chile peppers and used to make certain creams, may affect the pain signals in the skin, blocking pain without blocking other sensations. Capsaicin may cause burning when first applied.
    Opioid analgesics may relieve moderate to severe pain, especially if you have continuous pain.2 There are guidelines on prescribing and long-term use of opioids that may influence whether or not these medications are an option for you.
    Patient-controlled analgesia (PCA). This means you give yourself an injection of an opioid on a predetermined schedule using a computerized pump.
    Nerve block therapy. An anesthetic is injected into the affected nerve to relieve pain. The anesthetic may relieve pain for several days but the pain often returns. Although nerve blocks do not cure chronic pain, they may allow you to begin physical therapy and to improve range of motion that has decreased from long-term inactivity due to pain.
    Epidural steroid injections (injecting steroids around the base of the spine). Although they have been used for many years and may provide relief for low back pain, their effectiveness has not yet been proven.
    Trigger point injections may relieve pain by injecting a local anesthetic into trigger points (or specific tender areas) associated with chronic facial pain or fibromyalgia. For many people, nerve blocks or other injections can result in persistent relief. However, the exact mechanism of these treatments is still poorly understood and it is not clear who will benefit from injections and who will not.

Medications can reduce or provide temporary relief of chronic pain. You may initially be given medications with the fewest side effects, increasing the strength or changing the type of medication as needed. Medication works best when used in combination with other types of treatment, such as physical therapy and counseling, to address the different causes of chronic pain.

In general, avoid alcohol or using doses in excess of those prescribed when taking any medication for chronic pain.

Medication taken daily can be an effective part of a long-term regimen for chronic pain. However, sometimes medication loses some or all of its effectiveness when used daily over long periods of time (tolerance).

Surgery

Surgery is not often used to treat chronic pain. The decision to have surgery depends on your condition and the cause of pain. Surgery is usually considered only after other treatments have failed, unless the cause of your chronic pain is mechanical, such as a disc irritating a nerve or scar tissue obstructing the bowel.

Surgery may bring pain relief, but also may permanently damage other sensations (such as light touch and temperature sensation), or cause a different pain.

Implanted pain control devices may be an option if you have severe chronic pain. These devices deliver drugs or mild electrical current to the spinal cord.

The two most common pain control systems must be surgically implanted. Both have been used effectively to treat chronic pain.
    Intrathecal drug delivery injects a medication (such as morphine) into the spinal fluid through a small adjustable, implanted pump.
    Spinal cord stimulation administers a small electrical current to the spinal cord from an implanted power source. The electrical current can be adjusted with an external control device.

Surgery is not commonly used to treat chronic pain. It may not always control chronic pain in the long run, and it can lead to other problems that can complicate or sometimes worsen chronic pain.

Other Treatment

In addition to medication or surgery, other treatments can be helpful in reducing chronic pain. Additional treatments for chronic pain may include:
    Chronic pain management clinics.
    Physical therapy, including hot and cold therapy to relieve painful areas of the body, or stretching and range-of-motion exercises to maintain strength, flexibility, and mobility.
    Transcutaneous electrical nerve stimulation (TENS), (applying brief pulses of electricity to nerve endings in the skin), a type of device used to relieve chronic pain.
    Professional counseling (such as cognitive-behavioral therapy) that focuses on your mental health and such conditions as stress and depression, which can accompany and worsen chronic pain. It is important to be healthy emotionally as well as physically to recover from chronic pain.
    Radiofrequency lesioning, which may be used to try to block nerve signals, after a diagnostic nerve block helps pinpoint specific nerves as causing your pain.

Complementary Therapies

Complementary therapies may reduce pain, help you cope with stress, and improve your emotional and physical well-being. These include:
    Acupuncture.
    Aromatherapy.
    Biofeedback.
    Chiropractic therapy.
    Guided imagery.
    Healing touch.
    Homeopathy.
    Hydrotherapy.
    Hypnosis.
    Magnet therapy.
    Massage.
    Meditation.
    Naturopathy.
    Yoga.

If you decide to try one or more of these complementary therapies to treat your chronic pain, find a health professional who has special training and, whenever possible, certification in the particular therapy you are interested in. You may get a referral from someone you trust such as your doctor, family, or friends. Make sure all of your health professionals know every type of treatment you are using to reduce chronic pain.

Many people are uncomfortable with the idea of taking a pill regularly for pain relief. Here are some alternatives.

According to the American Pain Foundation, there are more than 50 million Americans suffering from chronic pain, or 25 million experiencing acute pain as a result of injury or surgery. Worldwide, 2 million people were taking Vioxx at the time of the recall.

If you're a pain sufferer, here's some good news: Plenty of options exist to ease aches, and many of them don't come in pill form. After all, Vioxx only entered the market in 1999, and arthritis, menstrual cramps, post-surgery pain, and other aches and pains soothed by the drug have been around and managed for a much longer time period. A big part of pain management is feeling like you have to regain control of your life, because the pain has taken over.

There are dozens, if not hundreds, of pain relief approaches out there. Before trying any pain relief approaches, it is important to talk with your doctor. Some therapies may not be safe or appropriate for you, even if they are of the non-pharmaceutical kind. Different factors need to be considered before undergoing any treatment, including your medical condition and history. Also keep in mind that none of the resources available are perfect pain remedies. They may not provide complete pain relief. They do not work the same for everyone. You may have to try a number of different strategies and combine some of them before finding an acceptable level of pain relief. As with any treatment, there may also be risks and side effects. A benefit of trying out alternative therapies is that you may find a pain relief option that works for you. We all know how priceless pain relief can be. So don't give up on finding respite for your suffering.

Pain Relief With Physical Therapy

One expert says physical therapy is highly effective. Physical therapists teach people how to take care of themselves. "If you give a man a fish, he eats for a day. If you teach him how to fish, he eats for the rest of his life”. Physical therapists are like fishing instructors. In the case of arthritis, therapists show people how to deal with pain in day-to-day life. They show people how to build up strength and improve range of motion, and how to make sensible decisions about activities to prevent arthritic flare-ups.

Yet physical therapy is far from a panacea. In patients with severe rheumatoid arthritis, a condition that can shave 10 to 15 years off life. Immune-modulating drugs is a first choice of treatment, and physical therapy is an adjunct. In patients with osteoarthritis, the condition could worsen if swelling isn't fully addressed. Physical therapy does decrease inflammation to a certain extent, but the most dramatic changes to inflammation are made pharmacologically (with medicine).

Pain Relief With Acupuncture

Easing pain with needles may sound agonizing, but acupuncture is an ancient form of pain relief.

Acupuncture originated in China thousands of years ago. In traditional practice, needles are pierced through the skin in specific areas to improve the flow of energy throughout the body. Western scientists suspect the practice may stimulate the release of chemicals, which can either soothe pain, or prompt the body's natural healing systems. The National Institutes of Health has sponsored a number of studies on acupuncture, including its affect on arthritis, inflammation, and chronic pain.

Acupuncture is not recommended for people who are taking blood thinners, or for those with a bleeding disorder. Risks of the procedure involve dangers inherent in needle use, including spread of an infectious disease, piercing of organs, minor bleeding, and broken or forgotten needles.

Pain Relief With Stress Management

Stress is a big psychological factor that can intensify the perception of pain. When people are distressed, their muscles tend to become tense and may arouse already tender tissues. On an emotional level, the pressure may amplify their perception of pain. Emotional arousal or stress may lead them to interpret their situation as being more difficult, and may make them avoid certain types of activities, because they're afraid it's going to make their pain worse.

To alleviate the pressure, try to change the source of stress. For instance, if you find yourself always arguing with your spouse, it may help to find a way to communicate with him or her instead. If it is not possible to change the source of tension, try distracting yourself with enjoyable activities such as spending time with friends, watching a movie, or listening to music. Participating in something pleasurable may shift focus away from pain.

Another strategy is to unwind. Relaxation techniques include deep breathing, progressive muscle relaxation, meditation, visualization, massage, yoga, and Tai Chi. These practices have been proven to be effective.

Some people have found stress relief by joining support groups or by getting individual counseling on how to best cope with their stress or ailment. For the most part, many of these stress-management strategies have been proven to be effective. Yet not everyone can benefit from each of the techniques. Different methods work for different people. For instance, there is good evidence that people who go to support groups experience pain reduction and dramatic improvements in their physical and emotional functioning. Nonetheless, a person who doesn't want to talk about their ailment would not be a good candidate for a support group.

Pain Relief With Exercise

Many people in pain often avoid exercise because movement hurts too much. Yet their inactivity may actually worsen their condition.

The human body was designed to be in motion no matter what state of health you're in. If you let your body become inactive, then you will let your body degenerate. Muscle degeneration can lead to other problems such as diminishing bone density, depression, and a weakened heart. In contrast, regular exercise can help keep joints flexible and strong, and better able to deal with arthritic pain. Besides, physical activity promotes the release of mood-enhancing chemicals in the body that can help diminish the perception of pain.

There are three types of exercise recommended for arthritis patients. The first, flexibility workouts, involve stretches that can help enhance range of motion. The second, cardiovascular or aerobic workouts, includes walking, water exercises, and cycling. The third, strength conditioning, includes isometric or isotonic workouts. Isometric workouts are static exercises that involve applying resistance without moving the joint. For example, if you stand up against the wall and press your hands against it, you are working out your chest muscle. On the other hand, isotonic workouts use the full range of motion. They include bicep curls and leg extensions.

To decrease pain and prevent further injury, it is important to apply appropriate effort in proper form. Not all exercises are right for everyone. If one type of exercise does not work for you, there are always other options. Before starting a fitness program, make sure to consult with your doctor and with a trained fitness professional.

Pain Relief With Diet

Here's extra incentive if you've been thinking about losing weight: Shedding excess pounds could help reduce the risk of pain.

If you're overweight and de-conditioned, your joints take a major hit, because of the increased poundage that your joints have to carry. There are plenty of weight loss programs available, but keep in mind that regular physical activity and a nutritious, well-balanced diet are proven methods for weight loss.

On the other extreme, being underweight or weight loss with a poor diet and inactivity can exacerbate pain. "Your hormone levels are off," explains Lisa Dorfman, MSRD, a sports nutritionist and spokeswoman for the American Dietetic Association (ADA). Normal flow of hormones can help the body combat aches, and activate the body's own healing systems. Dorfman says people need not become vegetarians for pain relief. She suggests limiting intake of animal protein and saturated fat, and beefing up on foods rich in omega-3 fatty acids, antioxidants, vitamins, and minerals.

Pain Relief With Dietary Supplements

There is promising evidence that two types of dietary supplements -- Chondroitin sulfate and glucosamine -- may help relieve pain associated with osteoarthritis. Yet more research needs to be done on their long-term safety and effectiveness.

Side effects of chondroitin are rare, but could include headache, motor uneasiness, euphoria, hives, rash, photosensitivity, hair loss, and breathing difficulties. People with bleeding disorders or those taking blood thinners should consult with their doctor before taking the supplement.

Side effects of glucosamine include upset stomach, drowsiness, insomnia, headache, skin reactions, sun sensitivity, and nail toughening. Some glucosamine products may be made with shellfish, and may cause adverse reaction in people with shellfish allergies.

Bioelectric Therapy

Some arthritis patients may find some pain relief with bioelectric therapy. In bioelectric therapy, a dose of electric current is applied to the skin to help distract the brain from sensing pain. The therapy tries to overload the brain with sensations to divert its focus on the original source of pain.

There may be skin irritation and redness as a result of bioelectric therapy. This strategy is not recommended for people who have a pacemaker, are pregnant, have blood clots in the arms and legs, and have a bacterial infection.

Live a Healthy Life

In some cases, your physician may suggest combining non-medicinal options with drug therapy. Try not to rule out medication altogether. The ideal goal of pain relief treatment, after all, is not just to alleviate suffering, but also to keep you alive and healthy.

Remember: The simplest -- yet often the most challenging -- strategy for pain relief involves eating right, sleeping enough, exercising, and managing stress.

Whoever coined the term "necessary evil" might have been thinking of pain. No one wants it, yet it's the body's way of getting your attention when something is wrong. You're probably sufficiently in tune with your body to know when the pain is just a bother, perhaps the result of moving furniture a day or two before or eating that third enchilada. It's when pain might signal something more serious that the internal dialogue begins.

You need to understand which pains you must not ignore -- and why.

No. 1: Worst Headache of Your Life

Get medical attention immediately. If you have a cold, it could be a sinus headache. But you could have a brain hemorrhage or brain tumor. With any pain, unless you're sure of what caused it, get it checked out.

When someone says they have the worst headache of their life, what we learned in medical training was that was a classic sign of a brain aneurysm. Go immediately to the ER.

No. 2: Pain or Discomfort in the Chest, Throat, Jaw, Shoulder, Arm, or Abdomen

Chest pain could be pneumonia or a heart attack. But be aware that heart conditions typically appear as discomfort, not pain. Don't wait for pain. Heart patients talk about pressure. They'll clench their fist and put it over their chest or say it's like an elephant sitting on their chest.

The discomfort associated with heart disease could also be in the upper chest, throat, jaw, left shoulder or arm, or abdomen and might be accompanied by nausea. Too often people delay because they misinterpret it as heartburn or GI distress. Call 911 or get to an emergency room or physician's office. If it turns out to be something else, that's great.

Intermittent discomfort should be taken seriously as well. There might be a pattern, such as discomfort related to excitement, emotional upset, or exertion. For example, if you experience it when you're gardening, but it goes away when you sit down, that's angina. It's usually worse in cold or hot weather.

A woman's discomfort signs can be more subtle. Heart disease can masquerade as GI symptoms, such as bloating, GI distress, or discomfort in the abdomen. It's also associated with feeling tired. Risk for heart disease increases dramatically after menopause. It kills more women than men even though men are at higher risk at any age. Women and their physicians need to be on their toes.

No. 3: Pain in Lower Back or Between Shoulder Blades

Most often it's arthritis. Other possibilities include a heart attack or abdominal problems. One danger is aortic dissection, which can appear as either a nagging or sudden pain. People who are at risk have conditions that can change the integrity of the vessel wall. These would include high blood pressure, a history of circulation problems, smoking, and diabetes.

No. 4: Severe Abdominal Pain

Still have your appendix? Don't flirt with the possibility of a rupture. Gallbladder and pancreas problems, stomach ulcers, and intestinal blockages are some other possible causes of abdominal pain that need attention.

No 5: Calf Pain

One of the lesser known dangers is deep vein thrombosis (DVT), a blood clot that can occur in the leg's deep veins. It affects 2 million Americans a year, and it can be life-threatening. The danger is that a piece of the clot could break loose and cause pulmonary embolism [a clot in the lungs], which could be fatal. Cancer, obesity, immobility due to prolonged bed rest or long-distance travel, pregnancy, and advanced age are among the risk factors.

Sometimes there's just swelling without pain. If you have swelling and pain in your calf muscles, see a doctor immediately.

No. 6: Burning Feet or Legs

Nearly one-third of the 20 million Americans who have diabetes are undiagnosed, according to the American Diabetes Association. In some people who don't know they have diabetes, peripheral neuropathy could be one of the first signs. It's a burning or pins-and-needles sensation in the feet or legs that can indicate nerve damage.

No 7: Vague, Combined, or Medically Unexplained Pains

Various painful, physical symptoms are common in depression. Patients will have vague complaints of headaches, abdominal pain, or limb pain, sometimes in combination.
Because the pain might be chronic and not terribly debilitating, depressed people, their families, and health care professionals might dismiss the symptoms. Furthermore, the more depressed you are, the more difficulty you have describing your feelings. All of this can lead the clinician astray.

Other symptoms must be present before a diagnosis of depression can be made. Get help when you've lost interest in activities, you're unable to work or think effectively, and you can't get along with people. And don't suffer silently when you're hurting. It has to be treated aggressively before it causes structural changes in the brain.