Chronic pain: When no physical cause can be found

Chronic pain sometimes develops for no apparent reason — but the pain is very real. Consider possible causes and ways to reclaim your life.

Chronic pain may develop for no apparent reason. Despite thorough exams and tests, your doctor may be unable to find a specific physical cause. But this doesn't mean your pain isn't real.

What's going on?

Often, the cause of chronic pain isn't found. Years of research have failed to uncover the precise physical causes of many painful ailments, including fibromyalgia and irritable bowel syndrome.

Sometimes altered electrical and chemical nerve signals cause pain to persist long after an injury has healed. In other cases, a serious infection is followed by chronic pain.

A heightened sensitivity to pain also may be a factor. People with chronic pain often have lower than normal levels of painkilling endorphins. In other cases, pain signals from injured or diseased tissue amplify or distort pain messages by activating pain circuits in the peripheral nervous system, spinal cord and brain.

It's not your imagination

Without an identifiable physical cause for your chronic pain, you may worry that the pain is all in your head.

"In a sense, pain is always in our heads," says David Martin, M.D., an anesthesiologist who specializes in pain medicine at Mayo Clinic, Rochester, Minn. "By definition, pain is always a personal, subjective experience. Its existence cannot be proved. But what you feel is very real."

Help is available

Chronic pain is a challenge — but you don't need to face it alone. Work with your doctor to manage your pain. Treatment options may include:

Medication. Sometimes over-the-counter pain relievers or medicated creams or gels are effective. For more severe pain, your doctor may prescribe an opioid medication. Some people find relief with tricyclic antidepressants such as amitriptyline. Seizure drugs such as gabapentin (Neurontin) or carbamazepine (Tegretol) may relieve some types of chronic pain as well.
Injection therapy. Instead of prescribing pills to control chronic pain, your doctor might inject medication directly into the affected area. Such injections are usually a combination of a numbing agent (local anesthetic), which provides immediate relief, and a corticosteroid to reduce inflammation.
Nerve stimulation. Various devices use electric impulses to help block or mask pain. With transcutaneous electrical nerve stimulation (TENS), a portable, battery-powered unit delivers an electric impulse through electrodes placed over the affected area. Some spinal cord and peripheral nerve stimulators are implanted beneath the skin with electrodes placed near the spinal cord. A hand-held unit allows you to control the level of stimulation.
Medication pumps. An implantable medication pump supplies pain medication directly into the spinal fluid. To replenish the pump, drugs are injected through the skin into a small port at the center of the pump.
Physical and occupational therapy. Stretching and strengthening exercises can improve your strength and flexibility. Sometimes learning new ways to handle daily activities can minimize the pain.
Complementary therapies. Various complementary therapies may offer relief from chronic pain, including acupuncture, biofeedback, chiropractic care and hypnosis. Ask your doctor if such therapies may be helpful for you.
Counseling. A counselor can help you manage your emotional response to chronic pain, as well as identify patterns of thought or behavior that may aggravate your pain.

Your lifestyle matters, too. Reduce stress. Do something relaxing every day. With your doctor's OK, exercise regularly. Build a solid support system. Focus on the good things in your life. Chronic pain may be unavoidable, but it doesn't need to control your life. Take action today.