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Understanding Chronic Pain

Long-lasting pain can affect all aspects of your life – but relief is possible.

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Chronic pain – a common problem for people with arthritis and other rheumatic conditions like fibromyalgia – doesn’t just hurt. It can drain your ability to work, enjoy life and be active. Often, it leads to ongoing problems with sleep, fatigue, depression and anxiety. These factors interconnect, such that difficulties with any of them make the others worse.

People with arthritis can have both acute and chronic pain. Acute pain happens when you have an active injury; it lasts for days or weeks until the injury is healed. Chronic pain persists for three months or longer. A flaring knee joint, for example, can cause acute pain, but the same person may have issues with pain, fatigue and low function for months or years after that joint quiets down.

Ongoing disease can cause ongoing pain. “If inflammation in the joints continues and is not controlled, individuals can continue to experience pain, from the inflammation itself, the damage it’s causing or both,” explains Yvonne C. Lee, MD, assistant professor of medicine at Brigham and Women’s Hospital in Boston.

It’s also possible that, if disease is controlled but has left permanent joint damage, that damage may also contribute to chronic pain, though Lee notes scientists are still working to understand this aspect of chronic pain.

Other Ways Pain Becomes Chronic

Scientists think, in some people, acute pain sensitizes the central nervous system and leads to chronic pain.

“We still don’t fully understand how acute pain becomes chronic, but it’s thought that an untreated acute stimulus, such as pain, inflammation or both may lead to changes in the way the brain and spinal cord regulate pain,” explains Lee. “These changes may cause individuals to feel pain even in the absence of an obvious reason, such as tissue damage.”

Many factors besides inflammation and joint damage go into the development of chronic pain in arthritis. People’s emotions and psychology, for example, can also contribute.

Depression and anxiety can amp up physical sensations, worsening pain and its effects on function. If you have issues with anxiety or a tendency to focus on the worst case scenario (psychologists call this catastrophizing), you’re more likely to develop chronic pain, more intense pain and have a harder time coping with it. 

There are likely many other contributing factors, says Anne-Marie Malfait, MD, PhD, professor of medicine and biochemistry at Rush University Medical Center in Chicago.

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