Understanding and managing chronic pain

From left: Kemly Philip, MD, PhD, assistant professor and interventional pain specialist with UTHealth Houston and Jennifer Kawi, PhD, MSN, professor at Cizik School of Nursing at UTHealth Houston (Photo by UTHealth Houston)

Welcome to “Ask the Expert,” a UTHealth Houston news series in which leading experts examine pressing health challenges. In this edition, we address chronic pain. 

Imagine deciding not to take your morning walk because your knees hurt too much, skipping an afternoon of gardening because your back pain flares, or turning down time with your grandchildren because simple movements have become painful. These may seem like small decisions, but for millions of Americans living with chronic pain, these become part of their everyday life.  

Chronic pain affects more than one in five U.S. adults. The good news is that many people can successfully manage chronic pain. 

What is chronic pain? 

Chronic pain is pain that lasts longer than three months, typically exceeding the expected healing time after a tissue injury. Lower back pain alone is the single leading cause of disability worldwide. Other common sources include joint arthritis, spine or cancer pain, rheumatologic disorders, and headaches or migraines. 

How does chronic pain occur? 

Chronic pain is complex, but it typically develops when the body’s natural response to acute pain goes awry. Several factors influence this, including the degree of the initial injury. For example, damage to neural tissue or cancer affecting an organ system tends to take longer to resolve than a muscle strain. The nervous system itself can become sensitized, lowering the threshold needed to trigger a pain response, thereby amplifying more stimuli or signals than normal. Inflammation also plays a role—whether driven by the underlying disease process or the body’s response to infection, inflammation in the acute phase can drive and modulate these same changes in the nervous system, as well.

When should you seek medical care for chronic pain? 

If pain lasts more than a few weeks and is not improving, or if it is associated with any neurologic weakness, numbness, swelling, or balance and coordination deficits, seek evaluation as soon as possible. If pain severity is increasing and interfering with sleep, daily life, or activities you enjoy, it’s best to seek evaluation before chronic pain affects your mood and long-term mental health. You do not need to wait until the three-month mark. 

How is chronic pain treated?

Most evidence for treatment of chronic pain supports a combination of tools over any one “fix.” 

If you are experiencing chronic pain, reach out to a physical medicine and rehabilitation specialist in your area to perform a thorough, clinical, and neuromuscular evaluation to first identify the cause. The physical exam alone can often clue us in to different sources of pain from the spine, disc, hip, or myofascial tissues. Diagnostic imaging or laboratory testing may be ordered based on this evaluation, although it’s not always necessary. 

A physiatrist-led approach often incorporates therapy services, medications, image-guided injections, and other modalities, including thermal, massage, acupuncture, or Tai Chi (e.g., for low back pain). Other physicians or surgeons may be consulted when appropriate. Exercise and physical activity should be paired with attention to sleep, stress, and mental health, as chronic pain affects the whole nervous system, not just the injured body area. 

Treatment is not linear and requires ongoing titration between modalities, frequent reassessment of patient response, and close communication with the entire treatment team. My overall goal in caring for a patient with chronic pain is to identify the underlying cause, restore function and mobility, and manage pain through an adaptive, coordinated, multidisciplinary framework. 

-By Kemly Philip, MD, PhD assistant professor and interventional pain specialist with UTHealth Houston

How can research help us better understand chronic pain?

Chronic pain research is necessary because it affects millions of individuals, interfering with not only their overall health but also their quality of life and work productivity. Chronic pain has become a public health burden with extensive healthcare costs. Rigorous studies can help us understand chronic pain better, identify safe and effective pain management modalities, and minimize the current opioid crisis in the United States that has proliferated largely due to chronic pain. Research can also open the door to developing personalized approaches to pain management. 

How is UTHealth Houston helping those with chronic pain? 

One promising new treatment approach is auricular point acupressure, a needle-free intervention based on stimulating specific points on the ear. Since it is low-cost, portable, and can be self-administered at home, auricular point acupressure may be especially valuable for people who have difficulty accessing specialty pain care.  

During treatment, small adhesive seeds are placed on carefully selected ear points corresponding to the area of pain on the body. Patients gently press the seeds several times a day as part of their normal routine. Stimulating the ear points like this has been shown to help activate the body’s natural pain-regulating mechanisms.

With support from the National Institutes of Health through the Helping to End Addiction Long-term® Initiative, our team at UTHealth Houston is evaluating auricular point acupressure for adults living with chronic musculoskeletal pain in rural communities across Texas and South Carolina. Participants are assigned to either a self-administered or in-person auricular point acupressure group or to a pain education group, with both groups receiving resources to manage their pain at no cost. Pain education has also been shown to affect pain relief in some individuals, so our team intends to compare these two pain management approaches. 

People living in rural areas often face unique barriers to pain care, including long travel distances, fewer specialists, and limited access to non-drug treatment options. Since auricular point acupressure and pain education interventions can be taught outside of a clinical setting and continued independently at home, these approaches have the potential to make chronic pain care more accessible.  

Throughout the study, participants also complete brief smartphone check-ins about their pain, symptoms, and daily experiences. This real-time information helps us better understand how the intervention may fit into everyday pain management.  

Learn more about the study at https://go.uth.edu/pain

-By Jennifer Kawi, PhD, MSN, professor and Maria C. and Christopher J. Pappas Family Distinguished Chair in Nursing at Cizik School of Nursing at UTHealth Houston