There are many excellent reviews and websites on chronic pain. I will list these below. As a physician I routinely read articles from peer reviewed medical journals and attend large medical meetings.

Over the last several years there is overwhelming evidence that chronic pain of all types is the result of abnormal pain processing in the brain. There is equally strong evidence that chronic pain is not the result of autoimmune activity, viruses, or vitamin deficiencies. It is quite easy for a physician to find excellent reviews in well respected journals such as the New England Journal of Medicine, Annals of Internal Medicine and Mayo Clinic Proceedings.  It is unfortunate that many medical providers have not recognized this important shift in medical philosophy. They continue to subject their patients to multiple tests, scans, and consults, which will all be negative, and they fail to prescribe appropriate measures for chronic pain.

Please go to  Click on the top center, “From the Experts.” This will take you to an excellent review by Dr. Roland Staud. He is a chronic pain expert. He is a professor at University of Florida. Dr. Staud and I were fellows at the NYU School of Medicine division of rheumatology in the late 80’s.
Other websites are

WebMD, Johns Hopkins Arthritis Center, and have good reviews on chronic pain and fibromyalgia.

Important points to remember:

  • Blood tests and x-rays will be normal or almost normal. Mild abnormalities such as a positive ANA or mild degenerative changes on imaging studies have very little impact on long term pain.
  • Chronic pain is controlled by chemicals or nerve connections in the brain, which cannot be detected by currently available scans but are noted on research center studies.
  • Almost all chronic pain patients have multiple areas of pain (back, neck, head, “all over,” stomach, TMJ ).
  • Most patients have more than one pain syndrome. These include fibromyalgia, irritable bowel syndrome, low back pain, chronic headaches.
  • Most patients have chronic fatigue and difficulty sleeping.
  • Many have odd sensations of burning and tingling in their extremities.
  • Many have a history of depression or anxiety.


Conditions that make chronic pain worse or less responsive to treatment include:

  • Long duration of pain (more than 2 years).
  • Tobacco use
  • Untreated depression or anxiety
  • Past history of addiction to alcohol or drugs
  • Stress – financial or social
  • Long term narcotic or opiate use
  • Lack of access to low impact exercise and/or sedentary life style
  • Lack of support from primary care provider and/or family
  • Strong belief that there is a quick cure or fix such as surgery or vitamin
  • Strong belief that there is a “real disease “despite many normal tests.
  • Strong belief that chronic pain is “not a real diagnosis.”



  • Low impact exercise (pilates, tai chi, swimming, circuit training).
  • Exercise must be planned and structured for the purpose of improving health and fitness. Daily or almost daily routines are necessary.
  • Unstructured or random activities such as gardening may be fun but are not helpful for improving fitness.
  • Exercise must be continued even if it temporarily increases pain or fatigue.
  • Excuses like “I have no time” or “I’m too busy” or “I can’t afford it” or “I don’t like exercise” will not help you get better.
  • Expect to feel a little worse before you get better.
  • Make adequate time for sleep, typically 8 hours.
  • Read articles on how to deal with stress. Avoid feeling stressed or “too busy.”
  • Treat your providers (doctors, nurses, therapists, trainers) with respect. They are your coaches.

Medications are discussed in detail in reviews on fibromyalgia. In brief antidepressants (SSRI or SNRI types) or anticonvulsants work to reduce pain by changing chemicals in the brain. Theses medicines have been proven in clinical trials. Serious adverse effects are rare. Mild side effects such as nausea are usually mild and temporary. They may take several weeks to work. They need to be taken daily.

The role of opiate analgesics has been reviewed recently. Most studies indicate that the potential for side effects and long term dependence outweigh their temporary pain relieving benefits. If one is already using Vicodin or other narcotic routinely, consider a gradual taper.

In summary I hope the review above provides some useful insights to chronic pain, its causes, and recommended treatments.