Chronic pain affects billions of people. It’s time for a revolution.

“In the beginning, everyone thought they were going to find this breakthrough painkiller that would replace opioids,” Gereau said. Increasingly, however, it appears that chronic pain such as cancer may have a number of genetic and cellular factors that vary depending on both the condition and the specific nature of the person experiencing it. “We learn that pain is not just one thing,” Gereau added. “It’s a thousand different things, all called pain.”

For patients too The landscape of chronic pain is incredibly diverse. Some people endure a miserable year of low back pain, but it disappears for no apparent reason. Others are not so lucky. A friend of a friend suffered extreme pain in his arm and face for five years after brutalizing his son. He had to stop working, couldn’t drive, couldn’t even drive without a neck brace. Doctors prescribed him endless medications: the maximum dose of gabapentin, as well as duloxetine and others. At one point he checked himself into a psychiatric ward because the pain was so severe that he had suicidal thoughts. There he met other people who, after years of everyday life in terrible pain, also fell into suicidal thoughts.

What makes chronic pain so terrible is that it is chronic: crushing suffering that never ends. For people in extreme pain, this is effortless to understand. But even less sedate cases can be miserable. A pain rating of 3 or 4 out of 10 seems gentle, but feeling it almost all the time is exhausting and limiting. Unlike a broken arm, which gets better, or tendonitis, which hurts mainly from overuse, chronic pain causes your entire world to shrink. It’s harder to work, exercise, and even do many of the smaller things that make life fulfilling and opulent.

It’s also lonely. When my hands first went crazy, I could barely function. But even after the worst was over, I rarely saw my friends; I still couldn’t drive for more than a few minutes or sit comfortably in a chair, and I felt guilty inviting people over when there was nothing to do. As Christin Veasley, director and co-founder of the Chronic Pain Research Alliance, put it: “For acute pain, medications, if you take them, get over the hump and you can move on. People don’t realize that when you have chronic pain, even if you also take medications, you rarely feel the same as before. At best, they can reduce pain, but usually do not eliminate it.

The cruel catch-22 of chronic pain is that it often leads to anxiety and depression, both of which can make the pain worse. This is partly because focusing on something can make it stronger, but also because emotional states have physical effects. Both anxiety and depression are known to enhance inflammation, which can also worsen pain. As a result, pain treatment often involves cognitive behavioral therapy, meditation practice, or other coping skills. While these tools are vital, reprogramming our responses is extremely complex. Our minds and bodies have evolved to anticipate and remember pain, making it harder to feel NO worry. And because chronic pain is so uncomfortable and isolating, it is also depressing.