America has a pain problem. A National Institutes of Health study revealed that ­Americans are more likely to develop chronic pain than they are to develop diabetes, high blood pressure or depression.

This is no shock to pain experts like Tara-lin Hollins, MD, from Cleveland Clinic South Pointe Hospital. She routinely sees patients battling pain described as unrelenting aching, stabbing, burning and more. In fact, one in five Americans live with chronic pain, defined as pain experienced on most or all days for three months…and nearly one in 10 have high-impact chronic pain that has lasted three months and is severe enough to limit at least one work or day-to-day activity. Bottom Line Personal asked Dr. Hollins why we have chronic pain and what we can do about it…

When The Pain Alarm Is Stuck

Pain is the body’s warning that whatever you’re doing will likely cause injury. When you unwittingly grab the handle on a hot pan, nerve cells in your hand detect the heat and release neurotransmitters that shoot a pain signal up the spinal cord to the brain screaming, Danger! This will burn you! When your brain hears this message, it makes you feel pain in your hand and prompts you to yank your hand away from the handle. Whether you’re left with a bit of lingering redness and sensitivity or an angry blister, the pain has accomplished its goal—to get you out of an unsafe situation. Other examples of acute pain—temporary pain that starts suddenly for a logical reason and stops once the injury has healed—include a stubbed toe, broken bone, herniated disk or even surgical pain.

The problem occurs when the pain-signaling neurotransmitters continue to fire back and forth for months even after the injury has healed, revving the brain in a way that perpetuates the pain. Your wound, broken bone or surgical site may be healed, but you still feel pain there. That pain actually is being created and sustained by the brain.

Chronic pain isn’t always due to injury—it is a symptom of many conditions, including osteoarthritis, back pain, fibromyalgia, migraine and irritable bowel syndrome. And there even are times when the pain lacks a clear cause.

Who’s at risk? Women, Native Americans and people of multi-racial ethnicity are at greater risk for acute pain that morphs into chronic pain. Also at greater risk are people who have experienced emotional trauma in the past, live with depression and anxiety, and/or whose pain started in a traumatic way.

When does pain become chronic pain? Chronic pain physically and chemically changes the nervous system, heightening a person’s sensitivity to pain. With the brain’s pain alarm stuck in the “on” position, the individual becomes hyper-
vigilant to pain in other areas of his/her body (a migraine patient may report higher-than-usual pain after knee surgery, for instance) or may start perceiving things that would otherwise not cause discomfort, such as a hug, as painful stimuli.

About 25% of people with chronic pain develop chronic pain syndrome, when recurrent pain creeps into other areas of life in the form of depression, anxiety, insomnia, alcohol or drug use, and other stress-related symptoms.

Breaking the Cycle

Chronic pain is notoriously difficult to treat. For decades, doctors tried to dull chronic pain with powerful opioid medications, including oxycodone (OxyContin), hydrocodone (Vicodin), codeine and morphine. But these drugs are designed for only short-term use to ease acute pain, such as post-operative pain. They usually don’t help chronic pain. In fact, long-term opioid use can worsen chronic pain—by making the opioid receptor sensitive, ­opioids cause a paradoxical response. (Opioids also have side effects and are highly addictive.)

Some smarter treatment options for chronic pain…

Diclofenac gel (Voltaren), a topical nonsteroidal anti-inflammatory gel, relieves pain where you apply it. Even though chronic pain originates in the brain, there can be local inflammation and muscle irritation that respond to topical products. Unlike oral nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen, diclofenac is well-tolerated by people with poor kidney function. Applying it topically also prevents the side effects of long-term NSAID use, such as peptic ulcer and gastrointestinal bleeding. Diclofenac also is available in a prescription-only patch called a Flector patch. The gel can be applied up to four times a day…the patch is changed daily. Both can be used for several months, with less needed over time.

Antidepressants and anti-seizure medications. Many chronic pain sufferers find relief with drugs that act on the brain or spinal cord—not by blocking the pain but by calming neurotransmitter activity to ease pain. Certain antidepressants treat pain by ramping up production of serotonin and other pain-relieving neurotransmitters. These drugs work double duty for patients with depression and anxiety, both of which fuel the chronic pain cycle. Examples of pain-relieving antidepressants and anti-seizure medications (these drugs all take several weeks to deliver relief)…

Venlafaxine (Effexor) This antidepressant, a serotonin and norepinephrine reuptake inhibitor (SNRI), is used to treat pain associated with osteoarthritis, rheumatoid arthritis and lower back pain.

Duloxetine (Cymbalta), another SNRI, can help with fibromyalgia, diabetic peripheral neuropathic pain, chronic back pain and arthritis.

Pregabalin (Lyrica), an anti-seizure medication, is a synthetic form of gamma-aminobutyric acid, an anti-inflammatory neurotransmitter that dampens nerve pain, including pain that occurs after shingles (postherpetic neuralgia).

Gabapentin (Neurontin) is an anti-seizure drug used to treat nerve pain.

Powerful pairing: Sometimes an antidepressant and an anti-seizure medication are needed. Example: A combination of pregabalin and duloxetine can ease chemotherapy-induced pain experienced by breast cancer patients.

Acupuncture. According to this traditional Chinese medical practice, inserting needles into points throughout the body unblocks energy, called Qi (pronounced “chee”), helping to resolve pain and other chronic conditions. Stimulating the acupoints triggers production of pain-relieving endogenous opioids—the body’s version of prescription opioids—which can offer a reprieve from discomfort while reducing the need for pain medication. Western medicine is catching onto acupuncture’s power to alleviate chronic neck, back and shoulder pain, osteoarthritis knee pain, chronic headache and more. Fascinating: Acupuncture lowers circulating levels of the inflammatory, pain-inciting enzyme cyclooxygenase-2 (COX-2). Oral NSAIDs such as ibuprofen (Advil) and naproxen (Aleve) work, at least in part, by inhibiting COX-2.

Pain Reprocessing Therapy (PRT). With this mind–body approach, patients work with a pain-management therapist to change how they think about their chronic pain. PRT teaches patients to view long-term pain as a real yet harmless sensation created by the brain, not as a sign of a physical abnormality. They learn how the pain–fear cycle intensifies pain and work with the therapist to gather evidence that shows the pain is not due to a physical problem. Example: A back pain patient may see on an MRI that she has no bulging disks, or the therapist may point out that her pain began during a very stressful time in her life. Reframing thoughts, beliefs and fears about pain often leads to a reduction in that pain.

PRT is most effective with pain that has no obvious physical cause (in other words, it is not related to a prior injury). You can find a pain psychologist at the website of the American Association of Pain Psychology (

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