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WHEN pain lasts for three months or longer, it is classified as chronic, a condition that affects .

Chronic pain was long believed to be a stubborn version of acute pain 鈥� which passes in less than three months once the damage is healed 鈥� and it was treated in much the same way. Yet an increasing body of research has led doctors to believe that chronic pain should be treated as a disease in its own right, rather than an enduring symptom of tissue damage or physical trauma. This could have major implications for the treatment of lasting pain, together with the way we prescribe addictive opioids.

Recent research has revealed that in some people, chronic pain is a problem with the brain. An injury can lead to pain that persists after the tissue has recovered because the brain has rewired itself and learned to send pain signals, despite there no longer being a reason. Known as central sensitisation, it is as if the volume has been turned up on pain.

One way this seems to occur is when the brain experiences pain without relief for an extended period. 鈥淭he brain interprets tissue damage and misfired pain signals exactly the same way,鈥� says , director of the Pain Psychology Center in California. 鈥淸The pain is] all equally real and equally valid.鈥�

To help deal with the issue, Gordon has developed a talk therapy called , which involves shifting people鈥檚 beliefs about the causes and threat of pain (see The new pain treatments that may finally stem the need for opioids).

There are other explanations for chronic pain. In his book The Song of Our Scars, at Brigham and Women鈥檚 Hospital in Massachusetts, argues that chronic pain isn鈥檛 always linked to physical sensations, but rather to a combination of physical sensation, emotional trauma and memory.

This fits with the fact that chronic pain can happen without any physical injury at all. Gordon describes people who come to him with chronic pain complaints without being able to identify any initial injury.

He believes chronic pain can occur when people experience psychological stressors as well as physical ones, which may be the result of an overactive fear response. 鈥淪omewhere along the way, their relationship with danger or fear has become oversensitive,鈥� says Gordon. This idea is supported by multiple studies showing .

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This oversensitisation of pain pathways is now implicated in many conditions, such as fibromyalgia, in which people experience widespread pain, often without a clear physiological cause 鈥� as well as chronic fatigue syndrome, irritable bowel syndrome and chronic daily headache.

The different mechanisms behind acute and chronic pain that research is beginning to reveal mean that for decades, people with chronic pain have been dismissed or wrongly treated by a medical profession that continues to prescribe therapies that work for acute pain, but, it transpires, simply don鈥檛 work for persistent pain. Improved understanding of the distinctions now offer a more hopeful future with treatments that are non-addictive and work to target the real cause of the pain.