Many of the most common chronic pain conditions are well known, but others have gone unrecognized and underdiagnosed for decades—leaving untold numbers of people without proper treatment.
The most common chronic pain conditions in the U.S. are:
MigraineIrritable bowel syndrome (IBS)Osteoarthritis (OA)VulvodyniaTemporomandibular joint disorder (TMJ)Fibromyalgia
Together, those six conditions affect more than 150 million Americans.
Defining Chronic Pain Conditions
Chronic pain is defined as pain lasting for three months or longer, causing either significant emotional distress or functional disability, that is not explained by another chronic condition.
Migraine, IBS, vulvodynia, and fibromyalgia are defined as chronic primary pain conditions, meaning they involve pain not due to other conditions.
OA and TMJ are considered chronic secondary musculoskeletal pain, which means pain from a musculoskeletal problem (inflammation, joint damage) is a problem in its own right. They are included in this list due to their huge impact, because their major symptom is pain, and because primary treatments are aimed at relieving pain.
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Worldwide, migraine is the third most prevalent illness. It’s a neurological condition that causes intense headaches and sometimes a symptom called a migraine “aura.” More than 15 migraine attacks a month is considered chronic migraine.
Symptoms
Migraines often come in four phases, each of which has its own set of symptoms.
Prodrome: Food cravings, constipation or diarrhea, mood changes, stiff muscles, fatigue, nauseaAura: Visual phenomena like flashing lights, seeing spots, or partial vision loss; vertigo, confusion, tingling or numbness; smelling odors that aren’t there; hearing things that aren’t there; partial paralysisHeadache: Throbbing, pulsating, or pounding pain, usually on one side of the head; sensitivity to light and sound; nausea and vomiting; hot and cold spells; dizziness, sadness, or anxietyPostdrome: Fatigue, mood changes, muscle aches, dizziness, difficulty concentrating
Causes and Triggers
Migraines are believed to be caused by genetic factors and several types of dysfunction in the brain, including pain pathways and neurotransmitters (chemical messengers).
Several exacerbating factors are believed to trigger the migraines themselves, such as:
Stress Hormonal changes in women Not eating Weather changes Sleep schedule irregularities Fragrance sensitivity Caffeine, alcohol, chocolate, and other foods Dehydration Bright or flickering light
Diagnosis
No test can conclusively diagnose migraines, so your healthcare provider will consider your symptoms and family history, as well as conduct tests to rule out other possible causes of symptoms.
You may be given several blood and imaging tests to check for stroke, multiple sclerosis, seizures, thyroid disease, swelling of the optic nerve, and a host of other conditions.
Treatment
Treatment for migraines may include:
Prescription or over-the-counter medications Injections of anesthetics, muscle relaxants, or steroids Intravenous infusions of anesthetics Transcranial magnetic stimulation Ginger supplements Aromatherapy with lavender oil
You may also be able to learn how to prevent your migraines.
Irritable bowel syndrome (IBS) is classified as a functional gastrointestinal disorder. Abdominal pain is a major symptom, with severity ranging from annoying to debilitating.
Symptoms
The predominant symptoms of IBS include:
Abdominal pain Acid reflux Bloating Decreased appetite Diarrhea and/or constipation Excessive belching Gassiness/flatulence Heartburn Indigestion Lump in the throat (globus) Nausea
Different types of IBS include diarrhea-predominant (IBS-D), constipation-predominant (IBS-C), or alternating-type (IBS-A), which is characterized by alternating episodes of diarrhea and constipation.
Causes
The causes of IBS aren’t clear, but it’s believed to be a combination of:
Genetics Gut motility problems Pain sensitivity Disordered communication between the brain and gut Stress or trauma early in life Depression or anxiety Digestive tract infections Bacterial overgrowth in the small intestine Food intolerances or sensitivities
Diagnosis
No test can diagnose IBS, so healthcare providers run blood tests, check for blood in the stool, and sometimes use imaging tests like colonoscopy to rule out other possible causes of symptoms. Diagnostic criteria include:
Symptoms present at least one day a week for the prior three monthsRecurrent abdominal pain or discomfort
In addition, you must have at least two of the following:
Pain relieved by bowel movementOnset of pain is related to a change in frequency of bowel movementsOnset of pain is related to a change in the appearance of stool
Treatment
IBS treatment plans should be tailored to your specific symptoms and triggers. A typical plan includes:
Dietary changes, such as the low-FODMAP diet Over-the-counter laxatives or anti-diarrheal medications Probiotic supplements Prescription IBS drugs Prescription antispasmodics, antibiotics, or antidepressants Cognitive behavioral therapy Enteric-coated peppermint oil supplements
The most common form of arthritis, osteoarthritis (OA) involves the breakdown of cartilage, which is a flexible tissue inside joints that enables your bones to glide over each other.
Symptoms
The symptoms of OA are caused by the loss of cartilage in the joints and degeneration of the joints themselves. Primary OA symptoms include:
Joint pain and stiffnessLimited range of motionSwelling
The most common joints affected are the neck, low back, knees, hips, shoulders, or fingers.
Causes and Risk Factors
OA, often called “wear-and-tear” arthritis, used to be considered an inevitable part of aging. However, experts now know that a combination of many factors combine to cause degradation of the cartilage and joints.
While the exact causes of OA aren’t yet clear, experts have identified several risk factors.
Age: It’s more common over 40, and especially over 65. Sex: It’s more prevalent in men until age 45, after which it’s more prevalent in women. Injury: About 12% of all OA diagnoses are considered post-traumatic arthritis. Genetics: Having a parent or a sibling with OA means you’re more likely to get it. Lifestyle factors: Being overweight or having a job that puts extra stress on your joints increases the likelihood that you’ll develop OA.
Diagnosis
If you have symptoms that suggest OA, your healthcare provider will likely perform a physical exam, order blood tests for inflammatory markers and to rule out other causes, and possibly send you for imaging tests such as X-rays or magnetic resonance imaging.
The specific diagnostic criteria differ depending on which joint(s) you’re having trouble with.
Treatment
OA treatment may include:
Prescription and/or over-the-counter medications aimed at reducing pain and inflammation Supplements that improve joint health Topical pain relievers Joint injections Physical therapy Acupuncture Joint surgeries and other procedures
Vulvodynia is chronic pain in the vulva, which is the exterior portion of the female genitalia. It can impact the labia, clitoris, or the opening of the vagina, and makes sexual intercourse painful.
Symptoms
Symptoms vary, but the pain of vulvodynia can be constant or come and go. It’s often described as burning, stinging, itching, throbbing, or rawness. Most cases fall into one of two subgroups: generalized vulvodynia and localized vulvodynia. The localized form is more common.
Symptoms of generalized vulvodynia include:
Pain throughout the vulvar region, sometimes spreading to the perineum, mons pubis, or inner thigh Pain may or may not be triggered by pressure or touch While most cases don’t involve visible findings, the vulvar tissue appears inflamed in some people
Symptoms of localized vulvodynia include:
Pain only at one sitePain triggered by intercourse, gynecologic exam, tampon insertion, tight clothing, or riding a bicycle, motorcycle, or horseHigher likelihood of red, inflamed tissue
Causes
Researchers haven’t yet uncovered the cause of vulvodynia, but several possible causes have been proposed, including:
Allergic response to irritantsExcess oxalate crystals in the urineHypersensitivity to yeastIrritation of pelvic floor musclesNerve damage
Vulvodynia is especially common in people with fibromyalgia, suggesting a possible common underlying mechanism.
Vulvodynia is not believed to be related to any kind of infection, including sexually transmitted infections.
Diagnosis
Vulvodynia is diagnosed based on symptoms and ruling out other conditions with similar symptoms, including skin disorders and sexually transmitted infections.
Your healthcare provider may use a cotton swab to apply pressure to multiple areas of your vulva to see where and how much it hurts. Depending on the appearance of the skin, they may perform a biopsy. A colposcopy, which uses a specialized instrument to examine the vulva, may also be ordered.
Treatment
Treatments for vulvodynia are aimed at alleviating symptoms and may include:
Avoiding irritants Pain medications Topic pain relievers (hormone cream, topical anesthetics) Muscle therapy for the pelvic floor Neurostimulation Biofeedback Nerve-block injections Surgery
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Temporomandibular joint disorder (TMJ) is chronic jaw pain from the temporomandibular joint or surrounding muscles. The temporomandibular joint connects your lower jaw to your skull.
TMJ is the name of the joint, but it is also often used as the name of the condition, which is alternatively called TMD, for temporomandibular disorder.
Symptoms
Symptoms of TMJ include:
Radiating pain in the jaw, face, or neck Jaw stiffness Impaired range of motion in the jaw Painful popping or clicking with jaw movement Change in bite alignment
Causes
TMJ is believed to be caused, in some cases, by trauma to the jaw. However, the cause of most cases is never known. The condition is more common in women, so researchers are investigating a possible connection with female hormones.
TMJ may also be linked to:
Teeth grinding (bruxism) Anxiety, stress, or depression Structural abnormalities in the jaw
Diagnosis
TMJ is diagnosed based on symptoms, including severity, location, and quality of the pain. Your healthcare provider may ask questions or order tests to rule out other possible causes of your symptoms, including dental problems, migraine, and trigeminal neuralgia.
Your practitioner may also assess the range of motion in your jaw and check surrounding muscles for tenderness. In some cases, he or she may order imaging tests.
Treatment
TMJ treatment usually starts conservatively and progresses if symptoms aren’t alleviated. The first step is self-care, including:
Resting your jaw Eating soft foods Applying heat to the jaw Stretching exercises Relaxation techniques Avoiding triggering behaviors, such as jaw clenching or chewing gum
Your healthcare provider may recommend massage therapy, physical therapy, or a dental device to help you stop clenching or grinding, especially while you sleep.
The next step is medication, which ranges from over-the-counter anti-inflammatory drugs (ibuprofen, naproxen) to prescription muscle relaxants and tricyclic antidepressants, which are commonly prescribed for several pain conditions.
Severe TMJ that doesn’t respond well to these treatments may require surgery, but this is rare and controversial.
Fibromyalgia is a condition of “central sensitization,” meaning the pain originates from a central nervous system that’s become hypersensitive to pain signals.
Symptoms
Fibromyalgia can involve more than 60 symptoms, with each person experiencing a unique mix. Primary symptoms include:
Widespread pain that may be aching, stabbing, burning, or shooting Pain from stimuli that shouldn’t cause pain (temperature, pressure) Abnormal nerve sensations such as itching, tingling, or “zings” (paresthesias) Pain that moves around the body Cognitive dysfunction (“fibro fog”) Unrefreshing sleep Fatigue Sensitivity to light, noise, or fragrances Dizziness and fainting
Symptoms may be constant, or they may have remissions (when symptoms are light or absent) and flares (when symptoms are more severe).
Causes
The causes of fibromyalgia aren’t yet understood. Possible causes include a combination of the following factors.
Genetic predisposition: The condition clusters in families. Sex hormones: Women appear to be more susceptible, especially during times of hormonal fluctuations such as pregnancy or menopause. Age: While anyone can develop fibromyalgia, it’s most often diagnosed during the childbearing years. Stress levels: The onset of some cases occurs during or after periods of heightened stress.
Diagnosis
No blood or imaging test can diagnose fibromyalgia. Healthcare providers diagnose it in one of two ways.
Tender-point exam: Pressure is placed on 18 points around the body to gauge widespread pain and heightened pain response. Widespread pain index and symptom severity scale: Two questionnaires assess the level and nature of pain and other symptoms. (This is the newer and preferred method. )
Your healthcare provider will also likely order blood tests and possibly imaging tests to rule out other conditions.
Treatment
Fibromyalgia treatment should be tailored to your specific symptoms and their severity as well as known symptom triggers. A typical treatment regimen involves:
Prescription medications (antidepressants, anticonvulsants, painkillers) Topical pain relievers Cognitive behavioral therapy Moderate, gradually increased exercise Complementary treatments (acupuncture, cupping, myofascial release) Mindfulness meditation Supplements (omega-3s, vitamin D, SAM-e, 5-HTP) Medical marijuana and cannabidiol, known as CBD Physical and occupational therapy Lifestyle changes (diet, weight loss, not smoking )
Some of these major chronic pain conditions include the following.
Myofascial pain syndrome: A connective tissue disease often confused with fibromyalgia Gout: An intensely painful type of arthritis Endometriosis: Tissues from the uterus grow in other places Interstitial cystitis: Also called painful bladder syndrome Central pain syndrome: Results from nervous-system damage, such as a stroke Degenerative disc disease: Involves the discs between vertebrae in your spine Lupus: An autoimmune disease that comes in many forms Psoriatic arthritis: A type of arthritis that affects the skin Rheumatoid arthritis: A form of arthritis characterized by persistent inflammation Multiple sclerosis: Involves damage to the nerves
Those conditions, combined, impact an estimated 40 million or more people.
