Summary: Chronic pain is very different from acute (sudden, short-term) pain. So health experts say chronic pain needs a different treatment approach. With acute pain, doctors mainly look for physical changes in the body. Chronic pain, though, is made worse by mental and emotional factors. In many cases, doctors fail to relieve chronic pain because they focus too much on finding and fixing physical changes.
Millions of US adults live with chronic pain. Even with the best treatment, they keep suffering. Now some health experts say the reason is the wrong approach to treatment. New studies show it is time to rethink how doctors treat chronic pain. The main way to diagnose and treat chronic pain is to look for physical changes in the body. Then doctors prescribe drugs that change body chemistry, or even do surgery to fix physical problems.
But health experts say this approach often fails. In many cases, the cause of pain is not a clear, visible physical change. Often it has more to do with how the mind responds to pain and with certain brain changes. Take back pain. It is one of the most common kinds of chronic pain. Yet it is no secret that doctors often treat backache poorly. That is because they focus too much on changes in the spine and not enough on the mental side of pain.
As soon as someone sees a doctor for a backache, the doctor usually orders scans. This is not all wrong. But experts warn it can often lead to the wrong conclusion, and so to the wrong treatment.
Why? How could scans go wrong? Studies show that physical problems in the spine do not always cause chronic pain. For example, a study of 3000 healthy young adults with no history of backache found that 37% had signs of disc wear. Another 30% had disc bulges.
So most healthy adults already have some visible changes in the spine, but those changes do not cause pain. No wonder doctors find disc changes in most people with backache. But the question is, do these disc changes have anything to do with backache? Probably not. They might play a part but may not be the main cause of chronic back pain.
Now studies confirm that the classic approach to chronic pain is failing. In many cases, it does more harm than good. After a spine MRI, doctors are quick to blame chronic back pain on disc problems. So spine surgery has become the most common surgery in the US. But a new study shows that only about 26% of people return to work after spine surgery, compared to 67% who did not have spine surgery. So if the pain is not from physical changes, what could cause it? Researchers suggest the cause of chronic pain is in the brain.
Take one of the largest studies of its kind. It found that anxiety and pain catastrophizing were clear predictors of chronic pain after surgery. So in most cases, pain becomes chronic not because of the injury but because of the mind’s response to it. Another study found that disc wear does raise low back pain risk, but mental distress was more closely tied to the pain. Many other studies suggest mental distress plays a big role in sudden pain turning into chronic pain.
These studies do not say physical changes have nothing to do with pain. But they show that whether sudden pain turns chronic depends mostly on a person’s mental state. In many cases, mental causes seem to matter more than physical changes.
This may explain why even a placebo works quite well for chronic pain. Treating mood disorders and improving sleep may also lower pain scores. So pain, especially chronic pain, has a lot to do with mental state. That is why a whole-person approach to chronic pain treatment and care matters.
Frequently asked questions
What is the difference between acute and chronic pain?
Acute pain usually tracks a visible change in the body, such as an injury. So doctors look for the damage and fix it. Chronic pain acts differently. It often has no clear, visible cause. And it is driven heavily by how the brain responds to pain, including anxiety and mental distress. Treating chronic pain as if it were just long-lasting acute pain is why so many people never get relief.
Does a bulging or degenerated disc on my MRI mean it is causing my back pain?
Not always. In a study of 3,000 healthy young adults with no history of back pain, 37% already showed disc wear. Another 30% had disc bulges. Most healthy adults have some visible changes in the spine that cause no pain at all. So when an MRI of someone with back pain shows a disc problem, that finding may play a part but may not be the main cause.
What makes acute pain turn into chronic pain?
Research points to a person’s mental state more than the injury itself. One of the largest studies of its kind found that anxiety and pain catastrophizing were clear predictors of chronic pain after surgery. Catastrophizing is the habit of expecting the worst. Another study found that mental distress was more closely tied to low back pain than disc wear was. Anatomy still matters, but it is often not the deciding factor.
How should chronic pain be treated?
With a whole-person approach, not a focus on anatomy alone. Chronic pain has so much to do with the brain and mental state. So treating mood disorders and improving sleep can lower pain scores. This also helps explain why even a placebo can work quite well for chronic pain. Scans and structural fixes still have a place, but they cannot be the whole plan.
Dr. Gurpreet Singh Padda, MD, MBA, MHP
