What is chronic pain?
In short Pain that persists or returns for more than 3 months. It may start after an injury or illness—or without a clear trigger—and can affect sleep, mood, mobility, and daily function.
Goal: improve function and quality of life using a multimodal plan (movement, skills, medicines when appropriate, and supports).
When to seek urgent help
- New weakness, numbness in both legs, loss of bladder/bowel control
- Severe, sudden back pain with fever, unexplained weight loss, or cancer history
- Chest pain, shortness of breath, jaw/arm pain, or fainting
- Severe abdominal pain, black/bloody stools, or vomiting blood (especially on NSAIDs)
These can indicate emergencies—seek care immediately.
Common pain conditions
- Low back pain (degenerative changes, facet pain, spinal stenosis)
- Osteoarthritis (knees, hips, hands)
- Neuropathic pain (diabetic neuropathy, post-herpetic neuralgia, radiculopathy)
- Fibromyalgia (widespread pain, sleep/mood issues)
- Chronic neck/shoulder pain, tendon problems, osteoporosis fractures (healed but painful)
Related topics
- Back Pain (Chronic)
- Osteoarthritis
- Diabetic Neuropathy
- Sleep & Routines
Evaluation
- History & exam: pain pattern, triggers, sleep, mood, daily function
- Screen for red flags and mood symptoms (anxiety/depression)
- Imaging only when indicated by red flags or persistent focal deficits
- Review medicines (interactions, side effects), alcohol, and supplements
- Consider contributing conditions (diabetes, kidney/heart disease, osteoporosis)
The plan is based on function goals, not imaging alone.
Non-drug care (core)
Movement & physical therapy
- Gentle aerobic activity most days (walking, cycling, water exercise)
- Targeted strength and flexibility (hips, core, back)
- Balance training to reduce falls
Skills & supports
- Pacing strategies to avoid “boom–bust” cycles
- Relaxation and breathing, mindfulness or CBT-based skills
- Heat/ice, massage, topical rubs, TENS if helpful
Sleep basics
- Regular schedule; wind-down routine; reduce late caffeine
- Comfortable mattress/pillow; positioning aids
Medicines (senior-safety notes)
| Option | Where it helps | Senior cautions |
|---|---|---|
| Acetaminophen | Osteoarthritis, general pain | Mind total daily dose from all products (liver safety) |
| Topical NSAIDs | OA knees/hands, local tendon pain | Lower systemic risk vs oral; avoid on broken skin |
| Oral NSAIDs | Inflammatory flares | Kidney/heart/stomach risks ↑; use shortest time at lowest dose if used |
| Duloxetine | OA knee/hip, neuropathic pain, chronic back pain | Monitor for nausea, sleep changes, BP; interactions review |
| Gabapentin/Pregabalin | Neuropathic pain | Drowsiness/dizziness/falls; adjust for kidney function; start low |
| Tramadol (selected cases) | Breakthrough pain when others inadequate | Confusion, constipation, falls; interactions; short courses only if used |
| Topical lidocaine/capsaicin | Localized or nerve pain | Skin tolerance; follow application limits |
Medicine plans are individualized to your health, other medicines, and goals. Avoid mixing sedating drugs without guidance.
Procedures & devices
Options (selected cases)
- Joint injections (e.g., knee OA), bursal injections
- Spine interventions (facet injections, epidurals) when appropriate
- TENS, bracing/assistive devices, canes or walkers for mobility
Pacing & flare plan
Daily pacing
- Break tasks into short blocks; alternate light and light-to-moderate activities
- Set timers; stop before a big spike, then rest briefly and resume
- Use “permission to pause” on higher-pain days
Flare strategy
- Heat/ice, gentle mobility, relaxation breathing
- Short-term medicine adjustments if part of your plan
- Call if new red flags or if not improving within a few days
Sleep & mood
Better nights
- Regular bedtime/wake time; wind-down routine; reduce screens late
- Positioning aids (pillows under knees/hips) to reduce strain
Mood tools
- Brief daily relaxation practice (5–10 minutes)
- CBT-based skills or group programs; treat anxiety/depression when present
- Connect with peers, family, or support groups
Weight, diet, and movement
Weight & joints
- Even small weight changes can reduce knee/hip load
- Focus on steady habits rather than strict diets
Food patterns
- Fiber-rich meals, adequate protein, healthy fats
- Limit excess alcohol; review supplements with your clinician
Questions for your clinician
- What is my most likely pain diagnosis (or mix), and what are realistic goals?
- Which exercises and pacing plan fit my condition today?
- Which medicines are safest for me, and what should I avoid?
- Could I benefit from physical therapy, CBT-based pain skills, or a group program?
- Are procedures appropriate for me, and what results should I expect?
- How do we adjust the plan during flares?
Quick answers
Is rest best for chronic pain?
Prolonged rest can worsen stiffness and de-conditioning. Gentle, paced activity usually helps long-term.
Do I need an MRI?
Only if red flags or persistent deficits suggest a specific problem. Imaging findings often don’t match pain levels.
Are opioids recommended?
They carry risks (falls, confusion, constipation) and are generally avoided or limited in older adults. Other options are preferred.
Can mood treatment reduce pain?
Yes—addressing sleep and mood can meaningfully lower pain intensity and improve function.
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