Chronic pain is pain that exists for three months and more, although some authorities define it as being six months and more. Perhaps I have a low threshold of pain; as above, I went to see a doctor after just two weeks of back pain.  I would advise anybody to see a doctor or specialist as soon as it interferes with your daily life.

Regardless of when it is diagnosed, it is a great burden for everyone. In the United States, it is estimated that 30.7% of people suffer from chronic pain, which is comparable to that throughout the world. As there are almost 320 million people in the U.S., there are about 98 million people with chronic pain. If they made up their own country then they would be the 13th-largest country in the world (just slightly behind the Philippines). People who suffer from chronic pain continue to suffer from it.

A survey done by the American Academy of Pain Medicine reported that even with a comprehensive treatment including prescription drugs, only slightly more than half (58%) of sufferers were helped. The British Pain Society reported that more than five million people develop chronic pain each year.

As the U.K. has about 65 million people, this would represent only about 8% of the population. Perhaps they did not take into consideration people who were already suffering from chronic pain, and perhaps there are millions and millions who have not found respite.

A thoroughly researched and analyzed study in 2012 by the American Pain Society estimated that the total cost of chronic pain in the United States is $560 to $635 billion dollars each year, with $299 to $334 billion of that being the value of lost productivity. It is actually a very conservative estimate as it did not take into consideration non-civilians (e.g., those in Afghanistan, Iraq and other places) and those who are institutionalized.

Again, perhaps the worst part of it (from my personal limited experience and knowledge of pain) is not knowing the cause. Perhaps even worse is that there sometimes is no observable cause. Chronic back pain is sometimes caused by accidents or other trauma, but sometimes it just appears; one day you may not have back pain but the next day you do. I have held a theory (or perhaps it is just a hypothesis) that proper diet and exercise (and now therapy) can prevent or ameliorate most illnesses and diseases.

I now believe that a lack of proper diet, exercise and therapy can cause most illnesses and diseases, including chronic pain. The following things have been shown to be possible causes of chronic pain, and which I have arranged in the following categories.

Here, I ought to not that there are other things–such as accidents, injuries and life (as in developing osteoporosis)–that are also known to cause

Obesity

Moderation in things is something that people find out as the get older. Obesity is certainly not a moderation of diet and exercise (although there can be genetic factors which contribute to its result) and is something that obese people soon find out (even when they are young) as it often leads to chronic pain, often in back pain or fibromyalgia.

The relationship between obesity and chronic pain was studied as far back as 1958 in the United Kingdom, but was also studied more recently (between 2008 and 2010) through a telephone survey, which provided frightening results. It revealed that people with a BMI (body mass index) of between 25 and 29 had 20% more pain than those in the normal BMI range of 18.5 to 25; a BMI of between 30 and 34 led to 68% more pain; 35-39 led to 136% more pain; and BMIs of 40 and over led to 254% more pain.

Pain medications

The very thing that is often prescribe to treat pain can result in more pain. This is analogous to antibiotics. It has been shown that infections, bacteria and other things require the treatment of antibiotics which often allows some bacteria to survive and become stronger, requiring the treatment of stronger antibiotics which can lead to even stronger bacteria which require the treatment of even stronger antibiotics.

In addition to pain medications (also known as opioids), prescription drugs for chemotherapy and for lowering cholesterol can also result in chronic pain.

Vitamins and minerals

A lack of Vitamin D (received in sunlight and fortified milk) and magnesium (found in leafy green vegetables, fruits, raw nuts and soybeans) often results in chronic pain (the latter often found in joint pain). The diagnosis of chronic pain often overlooks these possibilities. Ask your doctor to be tested for such a deficiency, or simply ensure that you get enough of these, either through those items or in the form of supplements.

Lack of rest/sleep

There are at least a couple of reports that indicate that poor-quality sleep contributes to chronic pain (especially back pain, when sleeping on an inadequate mattress). 8 hours of sleep per night has always been the recommended amount, but now the average amount of sleep is 6.5 hours per night. Although sleeping pills may (or may not) increase the quantity of sleep, it does not increase the quality of the sleep that is needed.

Posture

Sit up straight! You ought to listen to people who say that. Poor posture often leads to chronic pain, often in the back or in the legs. Similarly, lifting improperly (using the back, rather than the legs, as support) can lead to chronic pain. In women, the wearing of high heels often leads to chronic pain to not only the foot, toes, heel or ankle but also the back and shins. Anything higher than a 2” (5cm) heel is too high.

Smartphones

When desktops and laptops were introduced into the workplace, many people developed carpal tunnel syndrome as a result. This was rectified or minimized by the introduction of ergonomic keyboards and an awareness of typing in a way to avoid CTS. Joint pain has been re-introduced as a result of smartphones which increase pressure even in the individual fingers. To avoid this, try using a stylus of voice activated apps.

Fear

“The only thing we have to fear is fear itself”. As a young child, I came to that conclusion after which my parents said that FDR said that several decades before. Regardless, a report of many studies which appeared in the May 2014 edition of The Spine Journal showed that fear is a self-perpetuating cause of lower back pain. People who fear the pain or soreness of exercise do not engage in those activities even though they can ameliorate or remove the back pain.

Medical diseases and ailments

Most of these are of pain itself, but which are made worse in that there is little or no cure for them, and which results in chronic pain. Some of these pains may result in further deterioration and which may result in other types of chronic pain. And with cancer, there should be more of a concern for the cancer itself than for the concomitant pain. Such medical diseases and ailments are fibromyalgia, headaches, spinal or back injury, arthritis, nerve inflammation or damage, and cancer.

Stress

Researchers have recently found that 70% of 13 to 18-year olds suffering from ADHD, depression, anxiety and other maladies also suffered from chronic pain. The conclusion seemed to be that neither the stress caused the chronic pain nor that the chronic pain caused the stress but that there was a very high correlation between the two.

In addition to stress and fear, any emotional trauma or upset such as anxiety, depression, being bullied and others can cause chronic pain. But what is chronic pain? It may be patronizing or over-simplistic to say that it is all in your mind, but it often is. If you put your hand on a hot stove, the nerves in your hand send a message to the receptors in your brain that it is hot and that there is a corresponding amount of pain associated with that.

However, if these receptors are turned off, then you never get that message and you do not experience pain. That is why opioids work so well, although they can also be unproductive or counter-productive (see “Pain medications” above) and they can be highly addictive.

Chronic pain is either nociceptive or neuropathic.

Nociceptive pain is either

1)    superficial, which begins from the nociceptors in the skin and other superficial tissues and examples of which are minor cuts or wounds or first-degree burns

2)    deep, which is either a) deep somatic and begins in the ligaments, tendons, bones, muscles, blood vessels and fibrous tissues (called the fasciae) and is characterized by a dull, aching and poorly-localized pain; examples of this are sprains and broken bones or b) visceral begins in the organs (also called the viscera) and can be well-localized but, at the same time, can be very difficult to locate.

The pain can be different from the actual site of the injury, illness or disease, and may be accompanied by nausea and vomiting. This type of pain is also described in terms of being thermal (i.e., hot or cold), mechanical (i.e., crushing, tearing, shearing, or others) and chemical (such as iodine in a cut or chili powder in the eyes).

3) peripheral, which begins in the peripheral nervous system which consists of the nerves and ganglia outside of the brain and spinal cord, and is characterized as being burning, tingling, pins and needles, stabbing or electrical–hitting the ulnar nerve (the “funny bone”) is an example of this

4) central, which does begin in the central nervous system (the brain and spinal cord) Regardless of the personal and social costs associated with chronic pain, regardless of the type of pain (acute or chronic), regardless of the cause of the pain (diet, exercise or therapy), and regardless of where and how it originates and how it is characterized, do see a doctor when you have pain.

Pain is the body’s warning system and can indicate the presence of more severe things (such as cancer). The sooner that it can be described and diagnosed by a doctor the sooner you can get treatment to minimize or eliminate it. With luck, knowledge and proper treatment, you may be as lucky as I have been in encountering pain.