Ask Our Experts

Understanding Chronic Pain: Modern Approaches to Long-Term Relief

Chronic pain is one of today’s common and complex health challenges, affecting roughly one in four adults in the United States each year and rising steadily since 1990.1,2 For many, it leads to prolonged disability and declines in overall health.3 Chronic pain can persist for months to years after an injury or illness, and often has no clear explanation on imaging or lab tests. Because it involves a mix of biological, psychological, and lifestyle factors that vary from person to person, chronic pain is often difficult to diagnose and manage.

At Private Health Management (PHM), our experts stay at the forefront of chronic pain research and treatment, where care must be personalized to achieve lasting relief. This article explores what chronic pain is, why it’s so complex, and how new insights are guiding more effective, whole-person care.

Defining Chronic Pain

The International Association for the Study of Pain defines pain as an unpleasant sensory and emotional experience associated with, or resembling actual tissue damage.4 This definition underscores pain’s evolutionary purpose—to alert the brain to potential harm. But sometimes, pain persists long after the typical recovery window of about three months, at which point it’s considered chronic pain.5

Chronic pain can manifest as:

  • A primary condition, where pain itself becomes the disease (as in fibromyalgia or chronic low back pain)
  • A secondary condition, where pain develops as a symptom of an underlying condition (such as cancer or nerve injury)

These distinctions help clinicians better understand, diagnose, and treat pain when no clear source can be identified.

Although certain risk factors, such as physical inactivity and age, have been identified,6 there are still no reliable biomarkers to definitively diagnose chronic pain or guide its treatment.7 This gap reflects the multifactorial nature of pain, now understood to be a biopsychosocial phenomenon shaped by the interaction of biological, psychological, and social factors. Because of this complexity, no single diagnostic test, such as neuroimaging, can pinpoint the source or capture the full essence of chronic pain. Understanding pain through this broader lens underscores why effective treatment must address the whole person, not just the site of discomfort.

Low Back Pain – A Window into Chronic Pain

The story of low back pain mirrors the broader challenges of chronic pain management. Despite decades of research, it remains one of the most poorly understood conditions and the leading contributor to years lived with disability worldwide, according to the most recent Global Burden of Disease study.8,9

For many years, treatment was guided by the belief that pain stemmed from structural degeneration in the spine (pathoanatomical view) that could be identified with imaging and corrected with surgery. This oversimplified model dominated medical thinking and led to dramatic increases in spinal surgery with disappointing outcomes.10 Many patients continued to experience pain, or even worsening symptoms after surgery (later termed failed back surgery syndrome or persistent spinal pain syndrome).11

These surprising outcomes prompted researchers to explore alternative explanations, yielding discoveries such as the identification of central nervous system sensitization — a process where an overactive nervous system amplifies pain signals, leading to pain perception even in the absence of tissue damage.12 Today, experts view low back pain through a holistic, biopsychosocial framework. This shift has transformed treatment, emphasizing multidisciplinary care that integrates physical rehabilitation, psychological support, lifestyle modification, and when appropriate, medical or surgical care.13

New Insights and Innovations in Chronic Pain Management

Since the opioid crisis, pharmaceutical innovation in chronic pain management has been modest, with one recent exception involving a new approach to postsurgical pain — Suzetrigine (Journavx™), the first non-opioid medication approved by the FDA for moderate to severe acute pain in more than two decades.14

Want to learn more? Read our full article: “First Non-Opioid Treatment Approved for Acute Pain in Two Decades”

With slow progress in therapeutic development, research has turned toward nonpharmaceutical strategies. Studies consistently show that multidisciplinary approaches, combining interventions like physical therapy, exercise, stress reduction, and cognitive behavioral therapy, consistently match or outperform conventional treatments such as medications and surgeries across many chronic pain conditions.15 Although more research is needed to fully understand how these treatments work,16,17 emerging evidence suggests these strategies may help the body deescalate pain signaling through natural biological pathways.

For instance, recent studies show that as aerobic exercise intensity increases, so does the body’s release of natural opioid chemicals, improving pain control in patients with chronic low back pain.18 The profound benefits of generalized aerobic exercise may be further enhanced by individualized rehabilitation programs, particularly when paired with psychological interventions19 and complementary or alternative medicine approaches such as acupuncture.20–22

For patients with treatment-resistant pain, more intensive options including non-invasive brain stimulation,23 spinal cord stimulation,24 and intrathecal medication pumps25 may also be considered. Together, these approaches underscore the breadth of evidence-based treatment options available to individuals living with chronic pain.

Finding the Path Forward

From the uncertainty of diagnosis to the wide range of treatment possibilities, managing chronic pain can feel overwhelming. PHM helps restore comfort, function, and quality of life for those living with chronic pain. As research advances, PHM continues to translate emerging discoveries into actionable care strategies. By integrating the latest medical advances with personalized, biopsychosocial interventions, PHM ensures that every individual receives comprehensive, multidisciplinary pain management designed to restore comfort, function, and quality of life.

References

  1. Zhu, M. et al. Global and regional trends and projections of chronic pain from 1990 to 2035: Analyses based on global burden of diseases study 2019. Br J Pain 20494637241310696 (2024) doi:10.1177/20494637241310697.
  2. Lucas, J. W. & Sohi, I. Chronic Pain and High-impact Chronic Pain in U.S. Adults, 2023. NCHS Data Brief CS355235 (2024) doi:10.15620/cdc/169630.
  3. Pitcher, M. H., Von Korff, M., Bushnell, M. C. & Porter, L. Prevalence and Profile of High-Impact Chronic Pain in the United States. J Pain 20, 146–160 (2019).
  4. Raja, S. N. et al. The Revised IASP definition of pain: concepts, challenges, and compromises. Pain 161, 1976–1982 (2020).
  5. Treede, R.-D. et al. Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11). Pain 160, 19–27 (2019).
  6. Mills, S. E. E., Nicolson, K. P. & Smith, B. H. Chronic pain: a review of its epidemiology and associated factors in population-based studies. Br J Anaesth 123, e273–e283 (2019).
  7. Mackey, S. et al. Innovations in acute and chronic pain biomarkers: enhancing diagnosis and personalized therapy. Reg Anesth Pain Med 50, 110–120 (2025).
  8. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 403, 2133–2161 (2024).
  9. GBD 2021 Low Back Pain Collaborators. Global, regional, and national burden of low back pain, 1990-2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol 5, e316–e329 (2023).
  10. Baber, Z. & Erdek, M. A. Failed back surgery syndrome: current perspectives. J Pain Res 9, 979–987 (2016).
  11. Christelis, N. et al. Persistent Spinal Pain Syndrome: A Proposal for Failed Back Surgery Syndrome and ICD-11. Pain Med 22, 807–818 (2021).
  12. Woolf, C. J. Central sensitization: implications for the diagnosis and treatment of pain. Pain 152, S2–S15 (2011).
  13. Kamper, S. J. et al. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis. BMJ 350, h444 (2015).
  14. Jones, J. et al. Selective Inhibition of NaV1.8 with VX-548 for Acute Pain. N Engl J Med 389, 393–405 (2023).
  15. Scascighini, L., Toma, V., Dober-Spielmann, S. & Sprott, H. Multidisciplinary treatment for chronic pain: a systematic review of interventions and outcomes. Rheumatology (Oxford) 47, 670–678 (2008).
  16. Williams, A. C. de C., Fisher, E., Hearn, L. & Eccleston, C. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev 8, CD007407 (2020).
  17. Geneen, L. J. et al. Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database Syst Rev 4, CD011279 (2017).
  18. Bruehl, S. et al. Are endogenous opioid mechanisms involved in the effects of aerobic exercise training on chronic low back pain? A randomized controlled trial. PAIN 161, 2887 (2020).
  19. Fleckenstein, J. et al. Individualized Exercise in Chronic Non-Specific Low Back Pain: A Systematic Review with Meta-Analysis on the Effects of Exercise Alone or in Combination with Psychological Interventions on Pain and Disability. J Pain 23, 1856–1873 (2022).
  20. Vickers, A. J. et al. Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis. J Pain 19, 455–474 (2018).
  21. Chou, R. et al. Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med 166, 493–505 (2017).
  22. Qaseem, A. et al. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med 166, 514–530 (2017).
  23. O’Connell, N. E., Marston, L., Spencer, S., DeSouza, L. H. & Wand, B. M. Non-invasive brain stimulation techniques for chronic pain. Cochrane Database Syst Rev 4, CD008208 (2018).
  24. Huygen, F. J. P. M., Soulanis, K., Rtveladze, K., Kamra, S. & Schlueter, M. Spinal Cord Stimulation vs Medical Management for Chronic Back and Leg Pain: A Systematic Review and Network Meta-Analysis. JAMA Netw Open 7, e2444608 (2024).
  25. Deer, T. R., Pope, J. E., Hanes, M. C. & McDowell, G. C. Intrathecal Therapy for Chronic Pain: A Review of Morphine and Ziconotide as Firstline Options. Pain Med 20, 784–798 (2019).
See More New Stories
Patrick Knox

Patrick Knox, DPT, PhD

Associate Research Director

Pat is an Associate Research Director at Private Health Management. He has nearly a decade of experience as a clinician-scientist focused on researching chronic pain mechanisms in aging populations. Pat’s postdoctoral research at Emory University explored the neurophysiology of altered pain perception, and his graduate work culminated in a dissertation on psychosocial and physiological factors that contribute to chronic low back pain in older adults. He earned his PhD in Biomechanics and Movement Science and Doctor of Physical Therapy degrees from the University of Delaware, and holds a Bachelor of Science in Exercise Science from the University of South Carolina.