Chronic Pain FAQs

Is all pain the same?

Think of the worst pain you can remember — a scratched cornea, a kidney stone, childbirth. Mercifully, relief finally came: the eye healed, the stone passed, the baby was born. That is acute pain — a normal alarm triggered by injury, designed to make you protect yourself, that fades as the body heals.

Chronic pain is different. Chronic pain persists — the signals keep firing for months or years, long after any injury has healed, and sometimes without any injury at all. It stops being a useful alarm and becomes a disease in its own right. The poet Emily Dickinson captured it: "Pain — has an Element of Blank — / It cannot recollect / When it begun — or if there were / A time when it was not."

What's actually different in the nervous system?

In many chronic pain conditions, the nervous system itself has changed. Nerves damaged by disease or injury (neuropathic pain — from shingles, diabetes, surgery, or amputation) can fire pain signals on their own, like a gate stuck open. And with long-standing pain of any kind, the spinal cord and brain can become sensitized — the volume knob gets turned up, so signals that shouldn't hurt begin to. This is why chronic pain is real, physical, and measurable even when scans look normal — and why treatments aimed only at the original injury site often fail.

What happens to a person with chronic pain?

Pain of this magnitude becomes the problem itself. It disrupts work, appetite, and activity, and it feeds what pain specialists call the "terrible triad": suffering, sleeplessness, and sadness. Poor sleep worsens next-day pain, which worsens mood, which worsens sleep — a spiral that is as hard on families as it is on patients. Desperation drives some people toward escalating medications, repeated surgeries, or practitioners promising quick "cures." Breaking that spiral is precisely what a pain specialist is for.

Why do I hurt more when I'm stressed?

Because pain is not just a signal traveling up the spinal cord — every pain message passes through the filter of your brain, where your stress level, emotions, past experiences, sleep, and even upbringing shape how much it hurts. This is not "in your head" in the dismissive sense; it's neurology. Famously, badly wounded soldiers have required less pain medicine than civilians with identical injuries — context changes pain. The practical lesson: treating stress, sleep, and mood isn't a substitute for treating your pain. It IS treating your pain.

How do doctors evaluate chronic pain?

Pain is subjective, but it can be measured — rating scales, questionnaires, and careful examination — and its causes can be found with a thorough history, physical exam, and imaging such as X-ray, CT, or MRI when indicated. When pain has resisted diagnosis and treatment, a team approach works best: pain medicine, physical therapy, and psychological support treating all facets of the problem at once. That multimodal approach has been the foundation of our practice since 1996.

Why would my doctor give me an antidepressant or a seizure medicine for pain?

Because both work on the pain system directly. Certain antidepressants (like duloxetine and the older tricyclics) strengthen the nervous system's own pain-inhibiting pathways — patients typically feel pain relief before, and independent of, any mood effect. Anticonvulsant-class medications (gabapentin and pregabalin) quiet the abnormal electrical firing of damaged nerves — the same property that calms seizures calms screaming nerves. These are first-line treatments for nerve pain such as diabetic neuropathy, shingles pain, and trigeminal neuralgia. Taking them does not mean you are depressed or epileptic.

What about opioids?

Opioids have a place — in acute pain, after surgery, and in cancer pain. But for most chronic non-cancer pain, decades of evidence show long-term opioids deliver diminishing relief with growing risk, and can even amplify pain sensitivity over time. Our practice has been a national leader in non-opioid strategies and in helping patients safely transition off regimens that no longer serve them. If that's your situation: we will not judge you, and we will not abandon you.

Is it better to tough out pain after surgery and take less medicine?

No — this is one of the most important questions here. Inadequately treated acute pain doesn't build character; it delays walking, slows recovery, raises the risk of complications like pneumonia and blood clots, and — critically — makes chronic pain more likely. Persistent pain signals sensitize the nervous system, and established pain is harder to suppress than prevented pain. Treat acute pain early and adequately, then taper off as healing proceeds.

Should I rest my back when it hurts?

Another answer that has reversed completely: no. Prolonged bed rest weakens the muscles that support your spine and is now known to slow recovery from back pain. Stay as active as you reasonably can, start gentle stretching and strengthening early, and build gradually. Exercise, done progressively, is one of the most powerful treatments for chronic pain — and one of the few that's free.

What treatments actually work?

No single treatment cures chronic pain; combinations manage it. The modern toolbox includes: targeted interventional procedures (epidural steroid injections, nerve blocks, facet and SI joint injections); non-opioid medications matched to the pain type; TENS and spinal cord stimulation for selected nerve pain; ketamine infusion therapy for certain treatment-resistant conditions; physical and occupational therapy; and psychological tools — cognitive behavioral therapy, relaxation training, biofeedback, and pain rehabilitation programs — that retrain the nervous system's response to pain. Surgery has its place for specific structural problems, but it is a last resort, not a starting point.

What can I do to help my doctor help me?

Tell us everything: which pain medicines you've tried and how they worked, everything you take now (including supplements and "non-medical" treatments — interactions matter), your allergies, your fears about treatment, and your other health conditions. Bring records and imaging from previous doctors. And keep telling us how treatments are working — your feedback is the steering wheel of your pain plan.

The bottom line

Pain may be universal, but it does not have to control your life. The keys are early treatment, an accurate diagnosis, a combined approach, and honest communication between you and your doctor. We've been helping Orange County patients do exactly that since 1996. Call Newport Pain Management at (949) 759-8400.

Adapted and updated from patient education material originally based in part on "Chronic Pain: Hope Through Research" (National Institute of Neurological Disorders and Stroke). This page is for general education and is not a substitute for individual medical advice.