Chronic Pain As a Disease: Why Does It Still Hurt?

People with severe, chronic back pain know how it can utterly disrupt and damage one’s life. Chronic back pain can be cruel—making it hard to enjoy even the simplest daily activities or carry out an exercise routine.

Despite the toll chronic pain takes—surveys estimate that 11 to 40 percent of Americans are dealing with chronic pain —chronic pain has not always been well understood. The medical profession used to believe that pain was always a manifestation of an underlying injury or disease. Doctors focused on treating the cause of the pain, with the belief that the chronic pain would disappear once the injury or disease was cured.

If no underlying cause could be found, the patient was told that very few treatments are available, or worse—that “the pain must be in your head.” Some doctors still practice in this manner, having no appreciation for the unique problem of chronic pain, newer theories about chronic pain, and the many factors that influence a chronic pain problem. Fortunately, efforts to focus public attention on the problem of chronic pain care have been encouraging in recent years. A National Pain Strategy, drawing on the efforts of patient advocates, scientists, and governmental experts, was released in 2016 by the Department of Health and Human Services. The strategy proposed improved access to quality care and better tracking to determine which therapies are most effective.

Pain may not be recognized at times clearly,  like a broken leg can be confirmed by an X-ray, or an infection can be confirmed by a blood test to measure white blood cell count. There is no medical test to measure chronic pain levels. Thus, many people with chronic pain go from one doctor to the next searching for explanations. This process can lead to unnecessary evaluations and treatments.

A further complication in getting care is that everyone experiences and expresses pain differently. Two people with the same injury will feel and show their pain in unique ways depending on a number of factors such as:

  • The circumstances in which the pain occurs
  • Thoughts about the chronic pain, such as “this is nothing serious” versus “this pain could kill me”
  • Emotions associated with the chronic pain, such as depression and anxiety versus hopefulness and optimism
  • Cultural influences leading a person to be more stoic or more dramatic in showing pain to others Contrary to what some people believe, all pain is real. This may seem obvious, but people with chronic pain are sometimes treated as if their chronic pain is either imaginary or exaggerated. In some cases, they feel they have to prove their chronic pain to their friends, family, and doctors.

Some patients are told by their doctor that there is no reason for the chronic pain and therefore face dismissive attitudes exemplified by statements such as , “it cannot be that bad.”  It is imperative to seek the evaluation and care of a fellowship trained physician in the specialty of pain to ensure you are getting the most up to date and comprehensive attention/treatment for your pain condition.