We’ve all experienced pain, but chronic pain is a uniquely difficult experience. In fact, chronic pain can have profound impacts on almost every aspect of life—physical, mental, social, professional, and even spiritual.

The physical impacts of chronic pain are not limited to the pain itself, as chronic pain is strongly associated with conditions like high blood pressure, fatigue, insomnia, and nausea. Chronic pain can influence our mental health by causing or intensifying depression or anxiety. It frequently harms our relationships by causing irritability, fatigue, and reduced mobility, all of which make it difficult to connect with others. It can change our professional lives by limiting the type of work we can do or how long we can do it. Experiencing any of these challenges can lead us to difficult spiritual or philosophical questions, such as questioning our faith or wondering if life can be meaningful while we are in pain.

The impact of chronic pain is so profound that people often ask two questions: what is chronic pain, and can chronic pain be cured? This article will explore both these questions and more.

What is Chronic Pain?

It’s helpful to think of pain as existing in two forms: acute pain and chronic pain. Acute pain is something we are all familiar with, as it’s the type of pain that comes from short-term illnesses or injuries. Examples of acute pain include a sunburn, food poisoning, sore muscles after a workout, or a broken bone. Acute pain is temporary and lasts until we have received medical care or until the healing process is complete. When the injury or illness is gone, so is the pain.

In chronic pain, however, the pain persists even after treatment and/or sufficient time to heal. Sometimes this is due to a chronic medical condition, like arthritis, lupus, or endometriosis. However, chronic pain may also persist after an illness or injury appears to be physically resolved. For example, a broken bone may appear mended on X-ray imaging but continue to cause pain. It is also possible for chronic pain to develop even when there is no known illness or injury. For people experiencing chronic pain, the pain is persistent, and current medical science is not able to resolve the issue. 

Chronic pain exists on a spectrum of severity and may be mild or severe. Some people have consistent chronic pain that rarely changes, and others may experience fluctuating chronic pain that ebbs and flows. Sometimes chronic pain changes in response to known triggers, such as weather or exercise. Other times, chronic pain may change without an easily understood reason. The quality of pain—such as whether the pain is aching, burning, or pins-and-needles—can also vary by person or change over time. In all its forms, chronic pain disrupts daily life and often feels like it demands to be the center of a person’s life.

What Causes Chronic Pain?

The causes of chronic pain are complex, vary by individual, can vary over time for any given person, and are still being researched by many different types of scientists. However, research so far has identified four broad domains of potential areas of influence that can cause or otherwise impact chronic pain. For many people, a mix of these will be involved in their experience of chronic pain.

1. Biological: Our body’s pain receptors can be activated by many different stimuli, including factors outside our body (such as an injury) or inside the body (such as by disease or genetic conditions). Chronic pain may be caused by injuries or medical conditions that medical science does not treat fully and/or does not understand fully. It may also be caused by dysfunction of our neurological pain processing, which results in our brain perceiving pain even when there is no illness or injury to trigger the pain response. 
   
   
2. Cognitive: Research indicates that the way we think has a profound impact on our physiological experiences. For example, studies have found that chronic pain is more severe for people who believe that chronic pain is a sign of personal weakness. Research also tells us that chronic pain decreases among those who practice radical acceptance by acknowledging their pain and its impact rather than denying or ignoring their pain experience.
   
   
3. Emotional: Our brains process emotional pain and physical pain in similar ways and in overlapping brain regions. Because of this overlap, the presence of one type of pain increases the intensity of the other. For example, research has found that people living with the emotional pain of PTSD experience higher sensitivity to physical pain. This bidirectional relationship between emotional and physical pain is likely also why research has found that treatment of mental health conditions like PTSD and depression can decrease both mental health symptoms and chronic pain symptoms.
   
   
4. Environmental: Some research suggests that stressful childhood experiences, such as childhood physical or sexual abuse, may predispose some people to developing chronic pain. Ongoing stressors in adulthood such as relationship difficulties, work dissatisfaction, or experiences of discrimination such as racism, ableism, or transphobia can also intensify experiences of chronic pain. This is because chronic stress activates our nervous system in ways that can intensify our neurological experience of both acute and chronic physiological pain.

It is important to note that the idea that pain is “all in our head” is often used to dismiss the experience of those living with chronic pain. This type of minimization is ableist, harmful, and anti-scientific. After all, neuroscience tells us that all our experiences—such as feeling joy, tasting chocolate, experiencing heartbreak, remembering a fond memory, and suffering from a broken bone—are also “all in our head” because it is our brain that processes these experiences. The involvement of our biology and psychology does not make chronic pain any less real, any less life-altering, or any less deserving of the best available healthcare.

Who Experiences Chronic Pain?

Chronic pain is very common: it impacts 1 in 5 Americans! However, it is more common among certain groups of people. For example, chronic pain is more common among women than among men, among military veterans than among civilians, and chronic pain is also found at higher rates among Indigenous Americans and Alaskan Native adults than other racial/ethnic groups. 

Chronic pain is also especially common among those with disabilities and chronic illness. This is because chronic pain can be part of a chronic illness or existing medical condition, such as arthritis, endometriosis, or hypermobile Ehlers-Danlos Syndrome. Another reason chronic pain is more common in these groups is that they also experience higher rates of trauma, discrimination, and mental health conditions, all of which are associated with intensified experiences of chronic pain. 

In other cases, chronic pain develops after an injury, such as broken bone, muscle strain, ligament tear, or disc-related problem. For this reason, chronic pain is also more common among athletes and those who work physically-demanding jobs, such as firefighters, farmers, construction workers, and other laborers. 

However, chronic pain doesn’t always have a known cause. Many people who experience chronic pain may not have an identified illness or injury they know is the cause or a contributing factor to their pain. For these individuals, chronic pain is even more likely to result in a sense of isolation, helplessness, and confusion, and they may be more likely to experience minimization or dismissal of their pain by friends, family, and healthcare providers. 

Can Chronic Pain Be Cured?

Unfortunately, medical science has not yet developed a cure for chronic pain itself. 

Fortunately, chronic pain can be cured if the cause of the chronic pain can be identified and cured. For example, if the cause of chronic pain is determined to be osteoarthritis, successful treatment for osteoarthritis can sometimes stop the associated chronic joint pain. 

However, sometimes the identified cause of chronic pain does not have a medical treatment that can eliminate associated chronic pain. This is often the case for genetic and autoimmune disorders. In other instances, the cause of the chronic pain is not known, and therefore treatment is both more complicated and less likely to stop the pain entirely. In these instances, chronic pain can be treated in a variety of ways, even if there is not currently a cure that can totally eliminate it. 

How Is Chronic Pain Treated?

Treatment for chronic pain varies widely based on the cause of the pain, the nature of the pain itself, and the goals, needs, abilities, and preferences of the person experiencing chronic pain. Even if two patients have the same underlying cause of chronic pain, their treatment plans may look radically different from each other based on their unique experiences. Additionally, treatment plans often evolve over time due. This is because patient experiences of pain change over time, but also because the available treatments evolve over time. Because the treatment is ongoing and dynamic, it is often described as “chronic pain management." 

Broadly speaking, common approaches to managing chronic pain include:

• Lifestyle changes, such as making adjustments to our physical activity, diet, or habits like substance use
  
  
• Medications, like NSAIDs, muscle relaxers, and opioids
  
  
• Medical procedures which may include surgeries, injections, or the use of devices like TENS units
   
• Physical or occupational therapy
  
  
• Complementary and alternative medicine approaches, such as massage, biofeedback, or acupuncture
  
  
• Assistive devices like canes, wheelchairs, braces, and heating pads
  
  
• Psychological interventions, including cognitive-behavioral therapy, mindfulness-based therapy
  
  

Most people who experience chronic pain develop a unique pain management plan that integrates multiple forms of the interventions above. There is no “one size fits all” approach to chronic pain management. 

How Therapy Can Help with Chronic Pain

You may have been surprised to see psychological interventions like therapy on the list of strategies to manage a medical condition like chronic pain. Therapy can be a helpful treatment because our physical experiences both impact and are impacted by our psychological experiences, and the reverse is also true. As such, psychological interventions like therapy are effective treatments for many conditions we may think of as primarily medical or physical, such as insomnia and chronic pain.

Two forms of therapy have strong research support to indicate that they can result in significant improvements in the lives of people experiencing chronic pain. While they have much in common, they offer distinct approaches to therapy, and each type is customized to an individual’s unique experiences, needs, goals, abilities, and preferences. 

The first form of therapy is called Cognitive Behavioral Therapy, or CBT for short. CBT is a broad category of therapy, and many well-known types of therapy (such as CPT for PTSD or ERP for OCD) fall within this category. However, CBT can also refer to specific types of therapy that have been developed for many specific conditions. 

CBT for chronic pain, sometimes called CBT-CP, is one such approach, and research shows it is effective in helping people learn to manage chronic pain as effectively as possible and to enhance their quality of life even while experiencing pain. CBT-CP explores the way our thoughts, emotions, and behaviors are related to our experiences of chronic pain. It teaches strategies for working with our bodies—including both its physical and psychological aspects—to reduce the impact of chronic pain on daily life. CBT-CP teaches strategies like relaxation training, pacing techniques to reduce recurrent experiences of “overdoing it,” and methods of improving mood and sleep. This type of therapy is structured, practical, and often short-term. In fact, it can be completed in as few as three months of weekly appointments. 

The second form of therapy that has strong research support for managing chronic pain is called Acceptance and Commitment Therapy, or ACT for short. ACT is a type of cognitive behavioral  therapy. However, instead of emphasizing specific coping skills for pain management, ACT focuses more on helping people with chronic pain build a rich, meaningful life even while pain is present. ACT helps people identify their personal values and build a life that feels consistent with those values. ACT emphasizes learning to accept rather than struggle with thoughts and emotions that can keep us feeling stuck, dissatisfied, or hopeless. ACT for chronic pain is about choosing to take valued actions, no matter how big or small, even while pain is present. 

Starting Therapy for Chronic Pain

Psychologists at Aviva Psychology Services are trained in both CBT for chronic pain and ACT for chronic pain. In conjunction with the treatment plan you’ve developed with your medical team, adding one of these therapies can enrich your pain management plan and enrich your quality of life. You can get connected with a psychologist who has expertise in chronic pain by filling out the Request an Appointment form.

Selected References and Additional Reading:

1. McCracken, L. M., Yu, L., & Vowles, K. E. (2022). New generation psychological treatments in chronic pain. The BMJ, 376, Article e057212. https://doi.org/10.1136/bmj-2021-057212
   
   
2. Perry G. Fine, Long-Term Consequences of Chronic Pain: Mounting Evidence for Pain as a Neurological Disease and Parallels with Other Chronic Disease States, Pain Medicine, Volume 12, Issue 7, July 2011, Pages 996–1004, https://doi.org/10.1111/j.1526-4637.2011.01187.x
   
   
3. Wall, D. (2021, February 28). Chronic Pain | Fact Sheet - ABCT - Association for Behavioral and Cognitive Therapies. ABCT - Association for Behavioral and Cognitive Therapies. https://www.abct.org/fact-sheets/chronic-pain/
   
   
4. Ward, A. (Host). (2022, November 10). Dolorology (PAIN) with Dr. Rachel Zoffness. Episode 228. Ologies with Allie Ward. https://www.alieward.com/ologies/dolorology
   
   
5. Wetherell, J. L., Afari, N., Rutledge, T., Sorrell, J. T., Stoddard, J. A., Petkus, A. J., ... & Atkinson, J. H. (2011). A randomized, controlled trial of acceptance and commitment therapy and cognitive-behavioral therapy for chronic pain. Pain, 152(9), 2098-2107.