Persistent Pain

About Persistent Pain

Persistent Pain (commonly referred to as chronic pain) is a complex, multisystem health condition defined as pain that persists or recurs for longer than three months, extending beyond the normal tissue healing time and lingering past its original biological purpose.

Rather than functioning merely as a passive symptom or warning signal of ongoing structural damage, persistent pain reflects an altered nervous system state that disrupts functioning across four core domains:

Sensory & Nociceptive Disturbances: Ongoing, widespread, or localized pain sensations (burning, aching, throbbing, or shooting) accompanied by hyperalgesia (heightened sensitivity to painful stimuli) or allodynia (pain caused by non-painful touch or movement).

Autonomic & Physical Impairments: Muscle guarding, joint stiffness, chronic fatigue, profound sleep architecture disruption, altered movement patterns, and reduced physical endurance.

Cognitive & Executive Shifts: Lags in processing speed, reduced working memory, difficulty maintaining attention ("brain fog"), and persistent hypervigilance centered around pain sensations or potential triggers.

Affective & Behavioral Impact: Chronic emotional distress, elevated anxiety, depression, loss of motivation, fear-avoidance behaviors (avoiding movement out of fear of reinjury), and progressive social isolation.

Frequency: An estimated 24.3% of U.S. adults—approximately 60 million people—live with chronic pain. According to the definitive CDC National Health Interview Survey (NHIS), chronic pain has risen significantly from earlier baselines, making it more prevalent than diabetes, depression, or high blood pressure across the country.

Age Differences: Advanced age is the clearest indicator of frequency. Chronic pain affects 36% of adults aged 65 and older, compared to 29% of those aged 45 to 64, and just 12% of younger adults aged 18 to 29.

Gender Differences: Women report a higher frequency of chronic pain than men across the board. National data shows 25% of women manage the condition compared to 23% of men. This gap widens for debilitating high-impact pain, which affects 10% of women versus 7% of men.\

Racial and Ethnic Variations: The recorded frequency shows a nearly threefold spread among different racial groups. American Indian and Alaska Native adults report the highest rate at 30.7%, followed by White (28.0%), Black (21.7%), Hispanic (17.1%), and Asian Americans (11.8%).

Types and classifications

• Traditional healthcare categorizes persistent pain that lasts longer than three months into two areas.
• Chronic Primary Pain: Pain in one or more anatomical regions that is characterized by significant emotional distress or functional disability, but cannot be better explained by another chronic condition (e.g., fibromyalgia or nonspecific chronic low back pain).
• Chronic Secondary / Neuropathic Pain: Pain caused directly by a structural injury, which is split into six distinct subtypes:
• Chronic cancer-related pain: Caused directly by a tumor or by cancer treatments like chemotherapy and radiation.
• Chronic postsurgical or posttraumatic pain: Persists past the normal tissue healing time (at least 3 months) following surgery or an injury.
• Chronic secondary musculoskeletal pain: Stems from ongoing persistent inflammation or structural changes in bones, joints, muscles, or tendons (such as severe osteoarthritis).
• Chronic secondary visceral pain: Originates from internal chest, abdominal, or pelvic organs due to persistent inflammation, obstruction, or vascular mechanisms.
• Chronic neuropathic pain: Caused by a direct lesion or disease affecting the somatosensory nervous system itself (such as diabetic neuropathy or post-herpetic neuralgia).
• Chronic secondary headache or orofacial pain: Recurring head, face, or jaw pain occurring on at least half of the days for a minimum of three months due to an underlying disorder.
• Functional medicine and functional neurologists define these types based on how the brain and nervous system process and filter sensory data. They look at pain as an "amplifier problem" in the central nervous system:
• Nociplastic (Functional/Primary) Pain: Pain persisting without clear tissue destruction or nerve injury, characterized by systemic amplification where the body remains stuck in a physiological stress response. Includes conditions like fibromyalgia or chronic migraines where the brain's cortex, brainstem, or thalamus misinterprets normal non-painful touch or movement as intense pain (allodynia and hyperalgesia).
• Central Neuropathic Pain: Miscommunication or dysregulation within the central nervous system processing pathways, even when peripheral nerves are structurally intact
• Movement and Output Dysfunction: Functional pairing of persistent pain with motor or autonomic imbalances, seen in conditions like Complex Regional Pain Syndrome (CRPS), where the brain poorly coordinates posture, blood flow, and sensory feedback.
• Inflammatory/Somatic Pain: Driven by chronic immune activation, gut dysbiosis, or food sensitivities that release systemic inflammatory cytokines, lowering pain thresholds in local tissues.
• Neuropathic Pain: Defined as structural or metabolic damage to peripheral nerves (such as from heavy metal toxicity or blood sugar imbalances) sending continuous false signals.

Symptoms associated in the NPA database

The NPA Treatment Database groups the following symptom information with Persistent Pain. This list is educational and is not a diagnostic checklist.

Treatment information in the database

The NPA Treatment Database lists 37 treatment records in connection with Persistent Pain. A database relationship does not establish that a treatment is effective, safe, or appropriate for any individual.

• Acceptance and Commitment Therapy (ACT) for Chronic Pain
• Acupuncture
• Amygdala / Limbic Retraining
• ANS Rewire
• AppliedVR
• Biofeedback
• Breathwork
• Cognitive Behavioral Therapy (CBT)
• Curable
• Deep Brain Stimulation (DBS)
• Dynamic Neural Retraining System (DNRS)
• Feldenkrais Method®
• Focused Ultrasound (FUS) / MR-Guided Focused Ultrasound (MRgFUS)
• Graded Motor Imagery (GMI)
• Havening Therapy
• HeartMath
• HRV Biofeedback / HeartMath
• KAATSU / Blood Flow Restriction Training
• Ketamine / Ketamine-Assisted Therapy
• Lin Health
• LiveO2 (Adaptive Contrast Oxygen Training)
• Meditation / Mindfulness
• Mindset Reframing
• Mirror Box Therapy
• Pain Reprocessing Therapy (PRT)
• Photobiomodulation (PBM) / Professionally Delivered Red/Near-Infrared Light Therapy
• Primal Trust
• re-origin
• Saluda Medical Evoke System
• Specialized Neurorehabilitation Centers and Hospitals
• Transcranial Direct Current Stimulation (tDCS)
• Transcranial Magnetic Stimulation (TMS)
• Transcutaneous Auricular Vagus Nerve Stimulation (taVNS)
• Vagus Nerve Stimulation (VNS)
• Virtual Reality (VR) Therapy
• XRHealth
• Yoga

Related questions

These controlled question pages use the same stored condition and treatment relationships.

• What treatments are listed for Persistent Pain in the NPA database?

Recommended reading listed by NPA

These titles come from the current NPA condition record. Structured citation details are not yet available.

• The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma by Bessel van der Kolk, M.D. — Explains how trauma reshapes the brain and body and presents body-based and neuroplastic approaches to healing.
• The Brain That Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science by Norman Doidge — Landmark exploration of neuroplasticity featuring dramatic recoveries from stroke, brain injury, and other neurological challenges.
• The Brain's Way of Healing: Remarkable Discoveries and Recoveries from the Frontiers of Neuroplasticity by Norman Doidge — Shows how light, sound, vibration, and movement can awaken the brain's self-healing capacities after injury and illness.
• The Mind and the Brain: Neuroplasticity and the Power of Mental Force by Jeffrey M. Schwartz, MD & Sharon Begley — Demonstrates how focused attention and intentional mental effort can physically reshape the brain, with applications for recovery and habit change.
• Train Your Mind, Change Your Brain by Sharon Begley — Explores the science of neuroplasticity and shows how mental training and mindfulness can improve brain function, emotional regulation, and resilience.