What causes it?

Pain is a signal in your nervous system that something may be wrong.

Pain warns you that something is not quite right in your body and can cause you to take certain actions and avoid others. Pain can significantly impact your quality of life—by adversely affecting your physical and emotional well-being; upsetting relationships with family, coworkers, and friends; and limiting your mobility and participation in daily activities.¹

Hundreds of pain syndromes or disorders make up the spectrum of pain. For example, there is the pain of childbirth, the pain of a heart attack, the pain of a headache or backache, and the pain that can follow amputation of a limb. There is also pain that accompanies cancer and the pain that follows severe trauma, such as head and spinal cord injuries.

Pain is often a debilitating symptom of many diseases and is considered a disease itself when it persists beyond recovery from an injury or illness. There are two types of pain.

• Acute pain usually results from a specific injury, disease, and/or inflammation. It generally comes on suddenly, for example, after physical trauma or surgery, and can be accompanied by anxiety or emotional distress. Normally, acute pain is a protective response to tissue damage resulting from injury, disease, overuse, or environmental stressors. The cause of acute pain can be diagnosed and treated. The pain is self-limiting, meaning it is confined to a given period of time and severity. Acute pain, however, can become chronic.
• Chronic pain lasts 3 months or more and can be caused by a disease or injury, medical treatment (such as surgery), inflammation, or a problem in the nervous system, or the cause may be unknown.³ Chronic pain persists over a long period and can be challenging to manage. People with chronic pain often suffer from more than one painful condition. They also have an increased risk for developing problems with physical functioning, cognition, and emotional reactions.¹

The most common types of chronic pain include:

• musculoskeletal pain (e.g., chronic low back pain, neck pain, arthritis pain)
• neuropathic pain (e.g., peripheral neuropathy, trigeminal neuralgia)
• functional pain syndromes (e.g., fibromyalgia, chronic migraine, chronic pelvic pain)
• chronic pain after surgery
• complex regional pain syndrome
• cancer pain⁴

How does acute pain transition to chronic pain? It is thought that after three months of persistent pain in a local body region, changes in the central nervous system (brain and spinal cord) begin to occur. These changes involve rewiring of the neural pathways to compensate for the ongoing pain, and many studies have shown evidence of brain changes in individuals with chronic pain compared to healthy pain-free individuals. As this occurs, even if the local site of pain has healed or is treated, the rewired central nervous system could enable the experience of pain to continue and become chronic.⁴

Once pain becomes chronic it is much more difficult to treat, and this may be because reversing the rewiring of the central nervous system is more difficult than improving physiology at the site of pain. Pain that is found to be associated with an ongoing disease in the body is best addressed by specifically treating the effects and associated symptoms of the disease to reduce the impact of pain and prevent rewiring of the central nervous system neural pathways.⁴

For the biological events that occur when you experience pain, read more here.

What are the symptoms?

According to the National Institutes of Health, pain can be very mild, almost unnoticeable, or explosive. You may experience pain as pricking, tingling, stinging, burning, shooting, aching, or electric sensations.

Prevention

The best way to prevent acute pain is follow guidelines to avoid injury (such as wearing a bike helmet or proper eye/ear protection while operating machinery). To reduce the chance of developing chronic pain, maintaining a healthful lifestyle is a strong intervention:

• Maintain a healthful diet and weight
• Exercise regularly
• Eliminate unhealthy practices such as excessive alcohol use and smoking
• Work and rest in a variety of healthy postures
• Manage stress with deep breaths using the diaphragm muscles, participating in enjoyable activities, reducing sources of unnecessary stress whenever possible
• Seek counsel or psychological/behavioral therapy whenever needed⁴

Diagnosis

There is no way to objectively measure pain. Only the person experiencing pain can describe how much pain they feel. After learning about your pain history and other medical concerns, your healthcare provider may conduct physical exams, clinical assessments, and order diagnostic tests and imaging to assess pain intensity and diagnose or rule out any conditions.¹

Healthcare providers have many approaches and technologies to help identify the cause of pain, including:

• A musculoskeletal and neurological examination in which the physician tests movement, reflexes, sensation, balance, and coordination.
• Laboratory tests (e.g., blood, urine, and cerebrospinal fluid) can help the physician diagnose infection, cancer, nutritional problems, endocrine abnormalities, and other conditions that may cause pain.
• Electrodiagnostic procedures including electromyography (EMG), nerve conduction studies, evoked potential (EP) studies, and quantitative sensory testing measure the electrical activity of muscles and nerves. They help physicians evaluate muscle symptoms that may result from a disease or an injury to the body’s nerves or muscles. EMG tests muscle activity and identifies which muscles or nerves are affected by weakness or pain. Nerve conduction studies (usually performed along with an EMG) record how nerves are functioning. EP studies measure electrical activity in the brain in response to sight, sound, or touch stimulation. Quantitative sensory testing can establish thresholds for sensory perception which can then be compared to normal values. These tests are used to detect abnormalities in sensory function and nerve disorders.
• Imaging, especially magnetic resonance imaging (MRI), provides a look inside the body’s structures and tissues, such as the brain and spinal cord. MRI uses magnetic fields and radio waves to differentiate between healthy and diseased tissue. Ultrasound imaging uses high-frequency sound waves to obtain images inside the body.
• Nerve blocks not only treat but can also help to diagnose the cause of pain. A person’s response to a nerve block may the help provider to determine what is causing the pain or where it is coming from, since pain signals can spread throughout the body.
• Psychological assessments often are performed when assessing chronic pain. There is a high prevalence of depression, anxiety, and emotional distress associated with chronic pain (and vice versa), and often the diagnoses can be hard to separate. A provider may ask a patient to complete psychological questionnaires or ask how the person is feeling emotionally.
• X-rays produce pictures of the body’s structures, such as bones and joints. Bone scans can help diagnose and track infection, fractures, or other bone disorders.¹

Treatment

General Tips

According to the NIH, the goal of pain management is to improve function.¹ Treatment of pain also includes treatment of the condition or disease causing it. Below are some general tips when it comes to pain:

• Avoid using alcohol as pain relief.
• Read the manufacturer inserts of any pain medication/treatment recommended by your healthcare provider. Some medical products used to treat pain have known adverse reactions that can cause more pain.
• Research your options. Pain is different for different people even with the same diagnosis. What helps one person may hurt another (or not work). Find all your options when it comes to treating your pain.
• Manage expectations. As stated earlier, your nervous system may have been rewired to handle the initial cause of your pain. It might take time and effort to treat chronic pain.
• Stay positive. According to the NIH, placebos have no direct effect on the underlying causes of pain, however the placebo effect is the degree to which people expect treatment to work. “Placebos work in part by stimulating the brain’s own analgesics.”
• For sprains and strains, follow Rest, Ice, Compression, and Elevation (R.I.C.E.)¹

Looking for a specific pain condition? Here is a directory to research.

Prescription Medicines

Opioids are a class of drugs that include the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription, such as oxycodone (OxyContin^®, Percocet^®), hydrocodone (NORCO®), codeine, morphine (Kadian^®, Avinza^®), and oxymorphone (Opana^®). Per the CDC:

Opioids are a class of drugs naturally found in the opium poppy plant. Some prescription opioids are made from the plant directly, and others are made by scientists in labs using the same chemical structure. Opioids are often used as medicines because they contain chemicals that relax the body and can relieve pain. Prescription opioids are used mostly to treat moderate to severe pain, though some opioids can be used to treat coughing and diarrhea. Opioids can also make people feel very relaxed and “high” – which is why they are sometimes used for non-medical reasons. This can be dangerous because opioids can be highly addictive, and overdoses and death are common. Heroin is one of the world’s most dangerous opioids, and is never used as a medicine in the United States.

The Centers for Disease Control and Prevention

Opioids bind to and activate opioid receptors on cells located in many areas of the brain, spinal cord, and other organs in the body, especially those involved in feelings of pain and pleasure. When opioids attach to these receptors, they block pain signals sent from the brain to the body and release large amounts of dopamine throughout the body. This release can strongly reinforce the act of taking the drug, making the user want to repeat the experience. Opioid misuse can cause slowed breathing, which can cause hypoxia, a condition that results when too little oxygen reaches the brain. Hypoxia can have short- and long-term psychological and neurological effects, including coma, permanent brain damage, or death. Researchers are also investigating the long-term effects of opioid addiction on the brain, including whether damage can be reversed.⁶

Injections are sometimes used to deliver pain relief medication locally, including: facet injections, steroid injections, sacroiliac joint injection, and trigger point injections.

Beta-blockers are medications which inhibit one arm of the sympathetic nervous system and adrenal “fight or flight” hormones. For example, propranolol is prescribed to prevent migraine headaches.¹

Botox (botulinum toxin) is prescribed for chronic migraines—those that last for or occur for 15 or more days a month. Botox is injected around pain fibers that are involved in headaches. Botox enters the nerve endings and blocks the release of chemicals involved in pain transmission.¹

Calcitonin gene-related peptide (CGRP) monoclonal antibodies are prescribed to help prevent frequent migraines. Some of the new medications include Aimovig, Ajovy, and Emgality.¹

Muscle relaxants are prescribed to relax and reduce tension in the muscles. They act as a central nervous system depressant and have sedative properties for musculoskeletal pain.¹

Anxiolytics, such as benzodiazepines, are used to decrease central nervous system activity. These drugs can act as muscle relaxants and are sometimes used to manage anxiety.¹

Nerve blocks use drugs, chemical agents, or surgical techniques to interrupt the relay of pain messages between specific areas of the body and the brain. Nerve blocks may involve local anesthesia, regional anesthesia or analgesia, or surgery, and are routinely used for traditional dental procedures. Some examples of nerve blocks include:

• Neurolytic blocks employ injection of chemical agents such as alcohol, phenol, or glycerol, or the use of radiofrequency energy, to kill nerves responsible for transmitting nociceptive signals. Neurolytic blocks are most often used to treat cancer pain or pain in the cranial nerves.
• Sympathectomy, also known as sympathetic blockade, typically involves injecting local anesthetic next to the sympathetic nervous system (involved with regulating heart rate, breathing, blood pressure, and response to stressful or dangerous situations). The procedure is often performed to treat neuropathic pain of a limb (e.g., complex regional pain syndrome) as well as vascular disease pain and other conditions.
• Surgical blocks are performed on cranial, peripheral, or sympathetic nerves. They are most often used to relieve cancer pain and extreme facial pain, such as that experienced with trigeminal neuralgia. There are several types of surgical nerve blocks and they are not without problems and complications. Nerve blocks can cause muscle paralysis and, in many cases, result in partial numbness. For that reason, the procedure should be reserved for a select group of individuals and should only be performed by skilled surgeons. Types of surgical nerve blocks include:
  • Spinal dorsal rhizotomy, in which the surgeon cuts the root or rootlets of one or more of the nerves radiating from the spinal cord.
  • Cranial rhizotomy and trigeminal rhizotomy, performed as a treatment for extreme facial or cancer pain.¹

Serotonergic agonists—triptans like sumatriptan, naratriptan, and zolmitriptan—are prescribed for acute migraine headaches because they block pain pathways in the brain. Taken as pills, shots, or nasal sprays, they may relieve symptoms of migraine.

Off-Label Medications

Per the CDC, medications for depression and seizures are prescribed off-label to relieve chronic pain. Anticonvulsants are used to treat seizure disorders because they dampen abnormally fast electrical impulses. They also are prescribed by physicians to treat various pain conditions, particularly neuropathic pain. Antidepressants are often used to treat chronic pain and are particularly used to help manage musculoskeletal pain, neuropathic pain, and headache-related pain.¹ Be sure to read all manufacturer inserts prior to accepting a medical product, especially if it being prescribed off-label.

Over-the-Counter Medicines

Analgesic or “painkillers” (click on trade names for inserts)

• Non-steroidal anti-inflammatory drugs (NSAIDs): aspirin, ibuprofen, and naproxen.
• Acetaminophen (Tylenol^®)
• Topical pain creams and gels are sprayed on or rubbed into the skin over painful muscles or joints. Although they are all designed to relieve pain, they have different ingredients. Topical pain creams and gels (e.g., compounded pain creams to treat specific pain) are sometimes prescribed by a physician, while others can be bought over the counter. Below are the most common ingredients in products available without a prescription.
  • Capsaicin (pronounced cap-SAY-sin) is a chemical found in chili peppers and is also a primary ingredient in prescription or over-the-counter pain-relieving creams as a treatment for several pain conditions, including shingles. This topical cream may be helpful for deep pain. It works by reducing the amount of substance P—a compound thought to be involved in the synaptic transmission of pain and other nerve impulses—that is found in nerve endings and interferes with the transmission of pain signals to the brain. Individuals can become desensitized to the compound, however, perhaps because of long-term capsaicin-induced damage to nerve tissue. Some people cannot tolerate the burning sensation they experience when using capsaicin cream.
  • Counterirritants include ingredients such as menthol, methylsalycylate (oil of evergreen), and camphor. They are called counterirritants because they create a burning or cooling sensation that distracts the person from the pain.
  • Salicylates are the same ingredients that give aspirin its pain-relieving quality and are found in some creams. When absorbed into the skin, they may help with pain, particularly in joints close to the skin, such as fingers, knees, and elbows.¹

Physical Therapy

Per the NIH, physical therapy uses techniques such as heat, cold, exercise, massage, and manipulation. It can help to control pain, as well as condition muscles and restore strength.

Physical therapy and rehabilitation may help to decrease pain and improve mobility by increasing function, controlling pain, and aiding recovery. Individuals may engage in a number of physical therapy treatments simultaneously. A few of the most common forms in addition to the above are:

• Traction to decrease pain and improve mobility in the spine.
• Joint mobilization, such as when a physical therapist passively moves the joints of the body in specific directions to help decrease pain and improve mobility.
• Heat to increase circulation to the injured tissues, relax the muscles, and provide pain relief. Ice to help decrease pain and control inflammation.
• Kinesiology taping uses a flexible tape to support body parts and muscles to reduce bruising/swelling and provide pain relief.¹

Chiropractic Care

Going to a chiropractor, according to the NIH, may ease back pain, neck pain, headaches, and musculoskeletal conditions. It involves “hands-on” therapy designed to adjust the relationship between the body’s structure (mainly the spine) and its functioning. Chiropractic spinal manipulation includes the adjustment and manipulation of the joints and adjacent tissues. Chiropractic care focuses “emphasizes the body’s ability to heal itself.”

Exercise and Weightloss

Participation in some form of exercise, physical activity, and stretching may help individuals with pain better manage their symptoms, handle daily activities, and maintain flexibility and muscle strength. Exercise, sleep, and relaxation can all help reduce stress, thereby helping to alleviate pain. Supervised exercise has been proven to help many people with low back pain.¹

Cognitive Behavior Therapy

Per the CDC, cognitive behavioral therapy utilizes a psychological, goal-directed approach in which patients learn how to alter physical, behavioral, and emotional responses to pain and stress.

Additionally, the NIH, states, “psychotherapy (talk therapy) uses methods such as discussion, listening, and counseling to treat mental and behavioral disorders. It can also help people who have pain, especially chronic pain, by teaching coping skills, addressing negative thoughts/emotions that can make pain worse, and providing support.”

Acupuncture

Acupuncture, per the NIH, involves stimulating acupuncture points. These are specific points on your body. There are different acupuncture methods. The most common one involves inserting thin needles through the skin. Others include using pressure, electrical stimulation, and heat. Acupuncture is based on the belief that qi (vital energy) flows through the body along paths, called meridians. Practitioners believe that stimulating the acupuncture points can rebalance the qi. Research suggests that acupuncture can help manage certain pain conditions.

Acupressure

Similar to acupuncture, without the needles. Acupressure used finger and hand pressure to release neurotransmitters which help inhibit the reception and transmission of pain.⁸

Meditation

According to the NIH, meditation is a mind-body practice in which you focus your attention on something, such as an object, word, phrase, or breathing. This helps you to minimize distracting or stressful thoughts or feelings. An individual’s automatic reactions to pain, often unconsciously, can amplify the pain-generating activity of the nervous system.

Relaxation strategies (e.g., imagery, progressive muscle relaxation, autogenic relaxation) and mindfulness techniques (exercises that help the individual observe physical, cognitive, and emotional reactions and make skillful choices to relieve pain) are evidence-based practices that help shift the nervous system back toward a non-pain state.¹

In addition to meditation, the NIH recommends relaxation therapy which can help reduce muscle tension and stress, lower blood pressure, and control pain. It may involve tensing and relaxing muscles throughout the body. It may be used with guided imagery (focusing the mind on positive images) and meditation.

Hypnosis

According to the NIH, hypnosis is generally used to control physical function or response—that is, the amount of pain an individual can withstand. Some believe that hypnosis enables individuals to improve their ability to concentrate and/or relax.

Massage Therapy

Per the NIH, massage therapy is a treatment in which the soft tissues of the body are kneaded, rubbed, tapped, and stroked. Among other benefits, it may help people relax as well as relieve stress and pain.

Electrical Stimulation

According to the NIH, electrical stimulation involves using a device to send a gentle electric current to your nerves or muscles. This can help treat pain by interrupting or blocking the pain signals. Types include: transcutaneous electrical stimulation (TENS), implanted electric nerve stimulation, and deep brain or spinal cord stimulation.

TENS (transcutaneous electrical stimulation) uses tiny electrical pulses, delivered through the skin to nerve fibers, to cause changes in muscles, such as numbness or contractions. This in turn produces temporary pain relief. TENS can activate subsets of peripheral nerve fibers that can block pain transmission at the spinal cord level.¹

Biofeedback

Mostly used for headache and back pain, biofeedback techniques, per the NIH, use electronic devices to measure body functions such as breathing and heart rate. This teaches you to be more aware of your body functions so you can learn to control them. For example, a biofeedback device may show you measurements of your muscle tension. By watching how these measurements change, you can become more aware of when your muscles are tense and learn to relax them. Biofeedback may help to control pain, including chronic headaches and back pain.

Herbal Medicine

According to the NIH, “natural substances from plants and animals have been used for thousands of years for pain relief and are the sources of many well-known drugs.” Natural products used in complementary health include herbs (also known as botanicals), vitamins, minerals, probiotics, and other substances such as glucosamine and fish oil. Many of these products are sold as dietary supplements or as products for topical use, which you put on your skin. For example, here are some herbal medicines discussed by the NIH:

• Low-Back Pain: cayenne (capsicum) cream/plasters, brazilian arnica, and comfrey root extract used topically. Devil’s claw and white willow bark, taken orally (by mouth), may also be helpful.
• Rheumatoid Arthritis: omega-3 fatty acids of the types found in fish oil and gamma-linolenic acid (contained in evening primrose oil, borage seed oil, and black current seed oil.)
• Migraine: coenzyme Q10, feverfew, magnesium, and the B vitamin riboflavin might be helpful for reducing the frequency of migraines. Also diets high in omega-3 fatty acids may be helpful for migraines.
• Irritable Bowel Syndrome (IBS): probiotics (different strains of probiotics may have different effects) and peppermint oil for overall symptoms and abdominal pain.

Additionally, research the following herbs for pain relief:

• Chamomile has an anti-inflammatory effect and may reduce inflammation caused by infections, wounds, and metabolic disorders. Can help relieve swelling and pain in teeth when applied to gums.⁷
• Burdock Root has been used as a blood purifier and pain killer especially for symptoms of arthritis and other inflammatory diseases.⁷
• Rosemary Leaf has been used to treat headaches and stomach pains due to its analgesic activity.⁷
• Blue Vervain contains verbenalin which has moderate parasympathetic properties (calming, restorative effect on the nervous system).⁷

Poultices may be recommended which are made from herbs into soft, paste-like substances and then spread on or between layers of cloth. The cloth is then placed on a body surface to help increase blood flow, relax tense muscles, sooth inflamed tissues, or draw toxins from an infected area⁸

As with pharmaceutical medicines, be sure to work with an experienced healthcare provider prior to starting any herbal treatment. To research any potential herb-drug interactions, be sure to read the insert of any drugs you are taking and search for the herb on the “Herb List” on the NIH website.

Cannabis (Marijuana)

According to the NIH, “products containing substances from cannabis (marijuana), which typically include both tetrahydrocannabinol (THC) and cannabidiol (CBD), have been tested for their effects on chronic pain in short-term studies. Oral products with high THC/CBD ratios and sublingual (under-the-tongue) products with roughly equal amounts of THC and CBD may reduce chronic pain in the short term but may also have adverse side effects including dizziness and sleepiness. Not much is known about other formulations or the effects of longterm use. Research funded by NCCIH is looking at the potential pain-relieving properties of substances from cannabis.”

Nutrition

Research suggests, according to the NIH, that some people with chronic pain can benefit from eating anti-inflammatory foods to help reduce their level of pain with limited negative side effects.¹ A low-inflammatory diet is rich in fruits, vegetables, nuts, and lean protein sources.⁴

Conversely, excess of acid-forming foods can precipitate painful episodes. Lack of essential nutrients that insure the health of the nerves and their insulating sheaths can lead to inflammation.⁷

Kelp, for example, can help increase iodine. Acting as a tranquilizer, kelp can interrupt the cylce of disease to pain to aggravation to more disease and more pain. Kelp also supplies essential vitamins and mineral salts that nourish nerves.⁷

Other potentially healing foods include potato peeling broth and barley water. Potato peels are high in potassium, however avoid potatoes with green tint. The chemical solanine gives the green tint and can interfere with nerve impulses.⁸

Homeopathic Remedies

Homeopathy for pain depends largely on the type of pain you’re experiencing. Explore your options here.

Music

According to NIH, increasing evidence suggests that listening to or making music affects the brain in ways that may help promote health and manage disease symptoms. Music-based interventions may involve listening to music, singing, playing instruments, moving to music, or other activities. Evidence suggests that music-based interventions may have beneficial effects on both pain intensity and emotional distress from pain and may lead to decreased use of pain-relieving medications.³

Performing or listening to music activates a variety of structures in the brain that are involved in thinking, sensation, movement, and emotion. These brain effects may have physical and psychological benefits. For example, music causes the release of brain chemicals (neurotransmitters and hormones) that can evoke emotional reactions, memories, and feelings and promote social bonds. Music can even affect the structure of the brain. Certain structures in the brain have been found to be larger in musicians than nonmusicians, with particularly noticeable changes in people who started their musical training at an early age.⁵

Balneotherapy

Per the NIH, the terms “balneotherapy” and “spa therapy” refer to bathing in mineral water for health purposes and related techniques such as mud packs. Balneotherapy may be helpful for some symptoms of fibromyalgia and for improving quality of life in people with rheumatoid arthritis.

¹ National Institutes of Health

² Centers for Disease Control and Prevention

3 NIH National Center for Complementary and Integrative Health

⁴ International Association for the Study of Pain

⁵ NIH on Music Therapy

⁶ CDC on Opioids

⁷ “The Scientific Validation of Herbal Medicine” by Daniel B. Mowrey, PhD

⁸ “Prescription for Nutritional Healing” by Phyllis A. Balch, CNC

Products to Research

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Good for: sore muscles, back pain, migraines/headaches, arthritis, joint pain, cramps, neck tension, congestion/coughs, bruises, scar prevention and treatment. Be sure to read how to use for each condition at the bottom of the linked webpage.

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