Chronic pain is different from the pain after a new injury for many reasons. Inflammation is no longer the predominant cause of the discomfort. Treatment with opioid pain medications is also less effective because it fails to treat the other contributing factors. Additionally, opioid pain medications carry addiction risks. Their prescribed use contributed to an epidemic of opioid addiction.

A bit of background on the history of opioid use in medical practice. “Pain is the 5th vital sign.” That was the lesson during my medical training. Another lesson I can distinctly remember “Addiction from opioids is rare.” Previously, an article published in the 1980 New England Journal of Medicine, perhaps the most trusted journal in medicine, concluded addiction to pain medication is rare in those without a history of addiction. This conclusion was based on 6 sentence article. It reported that of the 11,000 patients hospitalized and given pain medications, only 4 developed addiction. The 6 sentence article goes on to be cited in numerous publications over the years. Undoubtedly, a frightening example of the risks of low-quality research. It is misleading and often wrong. The risks of addiction with opioid pain medications are, indeed, much higher.

Cause of Chronic Pain

Persistent pain, or chronic pain, is very common and develops for multiple reasons. Back pain is one of the most common causes. First, the joint or nerve has some lasting damage. After a large injury, healing may not be 100 percent. The second, and less well understood, is nerve sensitization. The body develops increased sensitivity to pain in some people. When this occurs, nerves send pain signals at lower levels of pain. For example, a person may feel a “2 out of 10” pain as an “8 out of 10” pain. Nerve sensitization is treated differently than pain from other causes. For more information on sensitization see


Persistent pain is treated differently than pain from a new injury. With a new injury, diagnostic tests and procedures may be indicated. Treatment targets the injury and the inflammation. With chronic pain, the main reason for pain is no longer inflammation. A process called nerve sensitization may develop and the part of the brain that processes emotions mixes with the part that processes pain. All of these factors make treating chronic pain more complex.

As pain becomes chronic, treatment shifts from diagnostic tests and procedures to the new factors discussed above. The approach to chronic low back pain is an example. The focus is on good care of the body and the mind. To care for the body, in this case, the back, an exercise program for core strength and flexibility is important. Fortunately, there are many self-guided programs available. Alternatively, physical therapy can help develop a program. Other options for support treating back pain include chiropractic care and massage. Chiropractic care can help restore healthy motion, while massage may alleviate muscle spasms.

In addition, treat nerve pain sensitization. Sensitization means pain is felt at a lower level than usual. There are non-opioid medications that reduce nerve sensitivity. Gabapentin is a common example. Addressing mental health issues, such as depression and post-traumatic stress disorder, cannot be overstated. The pain and emotional paths affect one another. Lastly, understanding the mind-body connection is a key. The practice of mindfulness and yoga are two ways to work on the mind-body connection.


In summary, chronic pain has a different treatment approach than a new injury. The treatment shifts from diagnostic tests and procedures to new factors. The new factors include evaluating for nerve sensitization, optimizing mental health, and understanding the mind-body connection.