Summary: Studies show that doctors often fail people with chronic pain because those people live with several chronic illnesses at once. These chronic overlapping pain conditions (COPCs) are harder to manage than pain from a single cause. A patient may have IBS, arthritis, fibromyalgia, depression, and more, all at the same time. But with too few pain specialists, one doctor treats one disease and another doctor treats the next. The result is poor pain relief. Doctors also miss other COPC symptoms, like mood problems and sleep disorders.
Chronic pain is a big problem and is hard to manage. Many people take painkillers for years and still do not get enough relief. And in many cases, doctors cannot cure the condition. There are many reasons chronic pain is so hard to manage and cure. One overlooked reason is having several illnesses at once. Doctors tend to treat the most common cause of pain. But they may miss smaller causes that sit alongside it. This is called chronic overlapping pain conditions (COPCs).
COPCs are more common in women. So women are more likely to have pain that is hard to diagnose and treat. In women, chronic pain also often comes with mood swings, fatigue, sleep problems, and trouble thinking. When several conditions exist together, they feed each other and make the pain worse. They also amplify each other’s effects. That means more widespread and local pain, and treatments that work less well. It also means worse physical and mental health, more disability, and a much lower quality of life.
The trend is even more worrying. COPCs are common even in young Americans. But the number rises to 75% in people older than 65. It seems most people live with several chronic, painful conditions. Doctors say that to manage chronic pain well, we need to understand COPCs better. We need to stop looking at single pain causes and instead see COPCs as one complex illness that spans many body systems.
COPCs cause two kinds of problems. The first is body-wide sensory sensitivity, which makes pain and internal symptoms feel stronger. The second is hyperalgesia (too much pain from a small trigger) in many body areas. The person also suffers from SPACE (sleep disturbances, pain that is widespread, affect is negative, cognitive dysfunction, and energy depletion). One reason COPCs are so poorly spotted and treated is the shortage of pain specialists in the US. So people with several conditions get treated by different specialists. For example, one doctor may treat irritable bowel syndrome (IBS), another bladder and genital problems, and yet another jaw pain.
Another challenge is that each patient needs a personal treatment plan. Everyone lives with a different mix of painful conditions. One person may have diabetes, low back pain, and cystitis (bladder pain). Another may have IBS, depression, and sleep disorders. Researchers say these patients need doctors with different skills. Doctors must take a detailed history. They should not focus only on the pain. They must also ask about sleep, mood, thinking, and fatigue. They may also ask about sexual problems, quality of life, and more.
Treatment must start with US FDA-approved drugs for ten major COPCs (chronic low back pain, migraine, fibromyalgia, endometriosis, cystitis, IBS, and so on). Doctors need to pick treatments that act on the brain and spinal cord. These include drugs like anticonvulsants, antidepressants, muscle relaxants, and others.
Doctors also need to consider drug-free options like physical and occupational therapy to help patients function better. Counseling is another piece. People with COPCs often live with mood disorders and unhelpful thinking patterns.
Finally, doctors need to look at complementary care, including acupuncture, massage, yoga, and chiropractic care.
Frequently asked questions
What are chronic overlapping pain conditions?
Chronic overlapping pain conditions, or COPCs, are two or more painful conditions in the same person at the same time. Examples are IBS, arthritis, fibromyalgia and depression. The conditions feed and amplify each other. That worsens both widespread and local pain. It weakens treatment, raises disability and lowers quality of life. Researchers argue COPCs should be treated as one complex illness that spans many body systems, not a list of separate problems.
What conditions count as chronic overlapping pain conditions?
The ten major COPCs include chronic low back pain, migraine, fibromyalgia, endometriosis, cystitis and irritable bowel syndrome (IBS). Jaw pain and bladder and genital problems also show up in the mix. Every person carries a different mix. One may live with diabetes, low back pain and cystitis. Another lives with IBS, depression and sleep disorders.
Why is chronic overlapping pain so hard to treat?
The pain has more than one source, and the sources are often split between doctors. The US has too few pain specialists. So one doctor may treat IBS, another bladder and genital problems and a third jaw pain. No one looks at the whole picture. Doctors also tend to treat the most common cause and miss the others. So relief falls short, and poor sleep and low mood go untreated.
Who is most likely to have chronic overlapping pain conditions?
COPCs are more common in women. Women are also more likely to have pain that is hard to diagnose and treat. It often comes with mood swings, fatigue, sleep problems and trouble thinking clearly. COPCs are common even in young Americans. The share rises to 75% of people older than 65.
How are chronic overlapping pain conditions treated?
Treatment is built around each patient, since everyone has a different mix of conditions. It starts with a detailed history. That covers sleep, mood, thinking, fatigue and quality of life, not only pain. Doctors use FDA-approved drugs for the major COPCs and drugs that act on the brain and spinal cord. They add physical and occupational therapy and counseling. They may add acupuncture, massage, yoga or chiropractic care.
Dr. Gurpreet Singh Padda, MD, MBA, MHP
