Though chronic pain is often hidden from the USA's front pages and TV screens, it is actually Americans' biggest health problem. Chronic pain — typically defined as pain lasting more than three to six months — affects 100 million adult Americans, according to a 2011 report from the Institute of Medicine, part of the National Academy of Sciences. In 2010, that was more than 40% of the adult population. It is the leading reason people go to doctors and it costs the nation upwards of $635 billion a year — more than cancer, heart disease and diabetes combined.
Despite the prevalence of chronic pain, many people, including many physicians, are unaware of the growing number of non-narcotic treatments, backed up by considerable research.
Chief among these is exercise. To be sure, many people with chronic pain are terrified that if they move, they will damage themselves further, a problem technically called kinesiophobia — fear of movement. But nothing could be further from the truth.
"To date, there is no scientific evidence that activity and exercises are harmful, or that pain-inducing activity must be avoided," says James Rainville, a spine and rehabilitation specialist at New England Baptist Hospital in Boston.
Exercise is as close as there is to a magic bullet for pain. Even "aggressive" exercise, says Rainville, often does not raise the risk of more back problems in people with chronic low back pain, studies have shown.
In fact, he says, people with low back pain should get out and "exercise, run, ski and play sports as they desire."
When people in pain get up the courage to exercise, they are often pleasantly surprised: In a 2008 survey of more than 14,000 subscribers to Consumer Reports, the top-rated measure to help relieve back pain was exercise.
Exercise is also a powerful way to prevent chronic pain. Among young and middle-aged people, the prevalence of chronic pain was 10% to 12% lower for exercisers, a 2011 Norwegian study of 46,533 adults found. The advantage becomes even more striking for older people. For women aged 65 and over, the prevalence of chronic pain was 21% to 38% lower among exercisers; for men, exercisers had a significant, though slightly smaller, advantage.
Other non-drug treatments are also gaining the endorsement of mainstream medicine.
Acupuncture was once dismissed as little more than a placebo, a belief that was buttressed by some studies showing that "sham" (fake) acupuncture was almost as good for pain relief as real acupuncture (insertion of real needles into known acupuncture points).
But more recent studies suggest otherwise. A 2010 study in mice (which, presumably, are not subject to the placebo effect), showed that acupuncture stimulates adenosine, a powerful pain reliever made naturally in the body. A 2009 study that used brain scans showed that people getting real, but not sham, acupuncture had changes in nerve pathways running downward from the brain to the rest of the body, an important way in which the nervous system can control pain. And a 2012 study from Memorial Sloan-Kettering Cancer Institute in New York on nearly 18,000 patients found that for many types of chronic pain, real acupuncture was better than both sham or no acupuncture.
Acupuncture "is effective for the treatment of chronic pain and is therefore a reasonable referral option," concluded the researchers. It is, they said, "more than a placebo."
Other approaches, including massage, cognitive-behavior therapy, meditation, biofeedback and, in some studies, chiropractic manipulation, all can be helpful in relieving chronic pain. At the same time, some approaches have not been supported by research, including studies on magnet therapy.
The take-home message is not to give up: Don't be afraid to try opioid drugs if you and your physician think you need them and can take them responsibly. But whether you do or not, pursue the non-drug treatments as well. A multipronged approach is by far the most likely to yield the benefits you want.
(Judy Foreman is the author of the new book, "A Nation In Pain – Healing Our Biggest Health Problem," out this week from Oxford University Press.)
What is chronic pain?
Chronic pain is not just acute pain that doesn't go away.
It can literally shrink the brain, reducing the volume of gray matter as much as 20 years of aging, as researchers from Northwestern University have shown. Chronic pain can become not just a symptom of something else, but a transformation of a normal nervous system into a runaway, self-propelled freight train, in which the body no longer needs an injury to trigger pain -- revved-up nerves do it all by themselves.
In a sense, chronic pain is not all that different from learning to play the piano or speak French. The more the body "practices" processing pain, the better it gets at it and the stronger the connections between pain nerves become. Eventually, even the slightest touch, like a feather on the skin, comes to feel like the scalding burn of a blowtorch, a condition called allodynia. Pain can become so unrelenting that, for some people, suicide seems the only way out; indeed, the risk of suicide for people with chronic pain is twice that of other people.