Living with Chronic Pain - How to Coexist with Pain That Won't Go Away

About a 3 min read.

What Is Chronic Pain?

The International Association for the Study of Pain (IASP) defines pain lasting more than 3 months as "chronic pain." In Japan, about 20% of adults (approximately 20 million people) suffer from chronic pain, with lower back pain, stiff shoulders, headaches, joint pain, and neuropathic pain being the most common.

Acute pain is a warning signal that "the body is damaged," but chronic pain is different. When pain persists after tissue damage has healed, it means the nervous system has shifted into a state of "continuously sending pain signals." The pain processing circuits in the brain and spinal cord become hypersensitive, and stimuli that should not be painful are perceived as pain - a phenomenon called "central sensitization."

How Chronic Pain Affects Mental Health

Comorbidity with Depression

About 30-50% of chronic pain patients also develop depression. Pain causes depression, and depression heightens pain sensitivity, forming a bidirectional vicious cycle. Serotonin and norepinephrine are involved in both mood regulation and pain suppression, so reduced function of these neurotransmitters worsens both depression and pain.

Social Isolation

"I can't go out because of the pain." "I keep canceling plans." "Nobody understands my pain." Chronic pain restricts social activities and deepens isolation. The lack of understanding from others - "but you look fine" - further intensifies the sense of isolation. (Books on chronic pain can deepen your understanding)

Four Approaches to Living with Chronic Pain

1. Pain Education (Pain Neuroscience Education)

Research has shown that understanding the mechanisms of chronic pain itself contributes to pain reduction. Shifting from "pain = tissue damage" to "pain = nervous system hypersensitivity" reduces fear of pain and decreases avoidance behavior.

2. Gradual Resumption of Activity

With chronic pain, people tend to avoid activity out of fear of pain (fear-avoidance behavior). However, reduced activity leads to decreased muscle strength, decreased flexibility, and worsened mood, which further worsens pain. Under the guidance of a physical therapist, gradually increasing activity within a tolerable pain range leads to long-term improvement.

3. Psychological Approaches

Cognitive behavioral therapy (CBT) for chronic pain aims not to eliminate pain itself but to change how you relate to pain. Shifting from "I can't do anything because of pain" to "there are things I can do even with pain" - this cognitive shift significantly improves quality of life. Acceptance and Commitment Therapy (ACT) has also been reported to be highly effective for chronic pain.

4. Multidisciplinary Approach

Treating chronic pain has limitations with any single method. Pharmacotherapy (analgesics, antidepressants, anticonvulsants), physical therapy, psychotherapy, exercise therapy, acupuncture, mindfulness. Combining these in "multidisciplinary pain management" is considered the most effective approach. Pain clinics (specialized pain outpatient departments) offer this multidisciplinary approach. (Books on pain management are also a good reference)

Summary

Chronic pain is something to "manage" rather than "cure." Understand the mechanisms of pain, gradually resume activity, incorporate psychological approaches, and combine multiple treatments. Even if pain doesn't reach zero, it is possible to reclaim your quality of life.