Most pain subsides after an injury heals or an illness runs its course. But with chronic pain syndrome, pain can last for months and even years after the body heals. It can even occur when there’s no known trigger for the pain. According to the National Center for Complementary and Integrative Health, chronic pain is defined as lasting anywhere from 3 to 6 months, and it affects some 25 million Americans.

Chronic pain syndrome takes a toll on both your physical and mental health. While the pain can be near-constant, there may be flares of more intense pain due to increases in stress or activity. Symptoms include:

  • joint pain
  • muscle aches
  • burning pain
  • fatigue
  • sleep problems
  • loss of stamina and flexibility, due to decreased activity
  • mood problems, including depression, anxiety, and irritability

In one study published in the journal Pain, 60.8 percent of the subjects who reported chronic pain also had depression, most of them with “severe” level symptoms.

Conditions that cause widespread and long-lasting pain are, not surprisingly, often linked to chronic pain syndrome. Some of these conditions include:

  • Osteoarthritis. This type of arthritis is generally the result of wear and tear on the body and occurs when the protective cartilage between bones wears away.
  • Rheumatoid arthritis. This is an autoimmune disease that causes painful inflammation in the joints.
  • Back pain. This pain may stem from muscle strains, nerve compression, or arthritis of the spine (called spinal stenosis).
  • Fibromyalgia. This is a neurological condition that causes pain and tenderness in various parts of the body (known as trigger points).
  • Inflammatory bowel disease. This condition causes chronic inflammation of the digestive tract and can produce intestinal pain and cramping.
  • Surgical trauma.
  • Advanced cancer.

Even when these conditions improve (via medications or therapies), some people can still experience chronic pain. This type of pain is generally caused by a miscommunication between the brain and nervous system. (For unexplained reasons, some people can encounter this kind of pain without any known triggers.)

Chronic pain can change the way neurons (nerve cells in the brain that transmit and process sensory input) behave, making them hypersensitive to pain messages. For example, according to the Arthritis Foundation, 20 percent of people with osteoarthritis who get their knees replaced (and presumably have no more painful joint issues) will still report chronic pain.

Risk factors

Research shows that some people are more susceptible to chronic pain syndrome than others. They are:

  • Those with chronic and painful conditions, such as arthritis.
  • Those who are depressed. Experts aren’t exactly sure why this is, but one theory is that depression changes the way the brain receives and interprets messages from the nervous system.
  • Those who smoke. As of yet there are no definitive answers, but experts are exploring why smoking seems to make pain worse in those with arthritis, fibromyalgia, and other chronic pain disorders. According to the Cleveland Clinic, smokers make up 50 percent of those who seek treatment for pain relief.
  • Those who are obese. According to research, 50 percent of those who seek treatment for obesity report mild to severe pain. Experts aren’t sure if this is due to the stress extra weight puts on the body or if it’s due to the complex way obesity interplays with the body’s hormones and metabolism.
  • Those who are female. Women tend to have more sensitivity to pain. Researchers theorize that may be due to hormones or differences in the density of female versus male nerve fibers.
  • Those who are older than 65. As you age, you’re more prone to all kinds of conditions that can produce chronic pain.

While chronic pain syndrome and fibromyalgia often coexist, they are two different disorders. Chronic pain syndrome often has an identifiable trigger, such as arthritis or injury from a broken bone that doesn’t heal properly.

Fibromyalgia — a disorder of the nervous system characterized by muscle and joint pain and fatigue — often arises without a known cause. If you looked at an X-ray, you wouldn’t find tissue or nerve damage. Fibromyalgia does, however, impact the way nerves sense and relay pain messages. Even when treated, the pain of fibromyalgia can still be chronic (thus leading to chronic pain syndrome).

The first thing your doctor will do is take a thorough medical history. You’ll be asked things like:

  • when your pain started
  • what it feels like (for example, burning and sharp or dull and aching)
  • where it’s located
  • if anything makes it better or worse

Because certain conditions can lead to chronic pain syndrome, your doctor may order imaging tests to determine if there is joint or tissue damage that may explain your pain. For example, your doctor may order an MRI to determine if your pain is stemming from a herniated disk, an X-ray to see if you have osteoarthritis, or a blood test to check for rheumatoid arthritis.

Without being able to find a direct cause of your pain — or if they think the pain is disproportionate to the trigger — some doctors will dismiss your symptoms or tell you they are “all in your head.” It’s hard to be proactive when you don’t feel well, but keep investigating alternatives. If need be, talk to your doctor about what you think is causing your pain and ask for the appropriate tests and treatments. Working as a team is your best shot at finding relief.

Chronic pain can be perplexing, but it is treatable. Some options include:

Medical

  • Drugs to relieve pain. These can be anti-inflammatories, steroids, muscle relaxers, antidepressants that also have pain-relieving qualities and, in severe cases, opioids (this is a last resort).
  • Physical therapy to increase flexibility and range of motion.
  • Nerve blocks to interrupt pain signals.
  • Psychological/behavior therapy. While they may not have a big impact on pain, some psychological therapies can have a positive effect on mood. For example, cognitive behavior therapy (a type of talk therapy that helps you reframe negative thinking) has been shown to be effective in boosting mood, even up to a year after treatment ends. In another study, biofeedback was beneficial in reducing muscle tension and depression and improving coping with chronic pain. Biofeedback is a type of therapy which teaches you to use your mind to control bodily reactions, like rapid breathing.

Alternative

  • Acupuncture. According to an analysis of studies, acupuncture reduced pain levels in 50 percent of those who tried it, compared with a 30 percent pain reduction in those who did not receive acupuncture.
  • Hypnosis. Research reports that 71 percent of subjects with irritable bowel syndrome (IBS) reported much-improved symptoms after a course of hypnosis. These effects extended up to five years post treatment.
  • Yoga. Because it helps to relax muscles, encourages deep, restorative breathing and increases mindfulness, research shows that yoga can be beneficial in reducing the depression and anxiety that comes with chronic pain, thus improving your quality of life.

When you don’t feel well, managing chronic pain can be difficult. Emotional stress can make pain even worse. It can be hard to work, and you may consider the possibility of receiving disability benefits. However, research this carefully. The Social Security Administration has very specific requirements you must meet before benefits are paid out.

In the meantime, the American Psychological Association suggests these tips for dealing with chronic pain:

  • Focus on what’s positive in your life.
  • Be engaged. Don’t retreat from family and friends or activities you enjoy and can still perform.
  • Participate in support groups. Your doctor or local hospital may be able to refer you to one.
  • Seek help, both psychological and physical. And remember, if you feel your doctors are dismissive of your pain, keep searching. Compassionate health professionals are out there. Ask friends for recommendations and contact support groups, health organizations dedicated to a particular disorder, and local hospitals for referrals.