When Pain Becomes Chronic: 7 Powerful Steps Toward Hope
By Dr. Shiroko Sokitch, MD | Heart to Heart Medical Center
When pain becomes chronic, you may start asking: Why am I still hurting? The injury happened months ago. You followed instructions, tried treatments, and waited for the improvement you expected. Yet sleep, movement, and everyday activities still feel difficult.
I want you to know that your pain deserves attention. You do not need to minimize it because someone else recovered more quickly, or because an earlier treatment did not give you the relief you hoped for. Your experience is worth understanding in its own right.
In my recent live conversation, I discussed what can happen when pain continues, the whole-person questions I consider in my practice, and how acupuncture may fit into an individualized plan. Here, I am expanding that conversation into practical steps you can bring to your next appointment.
The National Institute of Neurological Disorders and Stroke describes chronic pain as pain lasting longer than three months or beyond the expected healing period. It may persist after the initial problem resolves, and sometimes there is no clearly identified starting cause. [1]
For context, a CDC report using 2023 U.S. survey data found that 24.3% of adults experienced chronic pain; an addition 8.5% experienced pain that frequently limited life or work activities.
Your own story tells us what it means in your life. Perhaps you cannot stand long enough to prepare dinner. Perhaps an evening with friends becomes difficult because sitting hurts.
The seven steps below are ways to organize that conversation, clarify your goals, and consider options with a qualified practitioner. You do not have to complete them perfectly before seeking support. Start with the information you have and the question that matters most today.
Table of contents
1. Start with a fresh assessment
2. Prepare your symptom and treatment history
3. Look at the whole person, many factors play a role in chronic pain
4. Coordinate medication and movement decisions
5. Ask where acupuncture may fit
6. Set meaningful goals and review progress
7. Know when to seek emergency care
Frequently asked questions
Your next conversation
References
1. When pain becomes chronic, start with a fresh assessment
A useful starting question is: What do we understand about this pain now? The answer may have changed since the first injury or the first appointment. Bring that possibility into the room without assuming your earlier care was wrong or that you need every investigation repeated.
Ask your practitioner to explain the working diagnosis in ordinary language. What findings support it? What remains uncertain? What would make the team reconsider it? Understanding those distinctions can help you follow the plan and recognize why a particular next step has been recommended.
You might say, “My shoulder improved at first, but I still wake when I roll onto that side. What should we assess at this stage?” Many factors play a role in chronic pain, not being able to sleep due to pain, affects hormones, energy levels, and brain chemistry.
When pain becomes chronic, the next assessment should also consider what is happening in your whole body, not just the area that is painful. Discuss symptoms elsewhere, previous illnesses, relevant surgery, and treatments that changed the pattern.
It can help to ask who will coordinate your care. One primary person who supports your overall care can refer you to others who will help you. Knowing whom to contact with a new concern makes life easier for you.
Before you leave, try summarizing the plan in your own words: “We are checking this issue first, continuing these supports, and reviewing the result at my next visit.” If that summary feels unclear, ask for a written version you can refer to at home.
2. Prepare your symptom and treatment history
Describe your history since the pain began. A single page can give an appointment a clearer beginning. Write down approximately when symptoms started, whether there was an injury or illness, and what changed as the weeks or months passed.
Describe the sensation using words that feel accurate to you. Aching, burning, shooting, pressure, or tingling may describe different experiences. Include whether the pain stays in one area or travels. You are providing observations; the practitioner will interpret their significance with the examination.
When you have chronic pain, it is easy for separate appointments and treatment attempts to blur together. List what you have tried, approximately when you tried it, and what happened. Include physical therapy, procedures, acupuncture, medication, and changes you made at home.
Bring the names and doses of prescription medicines, over-the-counter products, and supplements. If you are unsure of a name, a photograph of the label may be easier than relying on memory. Note benefits and side effects separately so both receive attention during the review.
Add a few everyday observations: “Walking to the mailbox is manageable, but carrying groceries is difficult,” or “I fall asleep comfortably and wake after turning over.” Specific examples can communicate more than a number alone, especially when the number changes throughout the day.
You can also write down the questions you tend to forget once the appointment begins. Put the most important one first. If completing a diary feels exhausting, bring three recent examples instead. Useful information should support your care without becoming another task that overwhelms you.
3. When pain becomes chronic, look at the whole person
In my book, Healing When It Seems Impossible: Seven Keys to Defy the Odds, I describe the Triangle of Wellness: hormones, the nervous system, and the immune system. This is my framework for considering how different parts of a person’s health may relate to their experience.
In practice, that means I ask broader questions. What else changed around the time you became unwell? Have your sleep or energy patterns shifted? Are there relevant hormonal symptoms or an established inflammatory condition? Your answers help guide a clinical conversation rather than automatically pointing to one explanation.
When you’ve had persistent pain for a while, it affects your whole body. Your hormones, nervous system and immune system are stressed when your body is stressed and over time, that may cause certain changes. Especially if your pain has not gotten better with some basic standard interventions or has gone on for months, it will begin affecting other systems.
Chronic pain will affect the nervous-system and may contribute to the continuing experience of pain. This does not make the symptoms imaginary. NINDS explains that pain is a personal sensory and emotional experience and that persistent pain can affect many parts of daily life. [1]
Talking about emotional strain also deserves care. If you have experienced grief, trauma, or ongoing stress, you should mention it as well. It is part of your history, and you can decide how much you feel ready to share.
I also want to hear about relevant diagnoses and previous infections. An old infection does not, by itself, prove that an infection remains active or explains present symptoms.
4. Coordinate medication and movement decisions
In the livestream, I explained that I do not immediately remove medication when someone comes to me with ongoing pain. I first want to understand the person’s condition and the support they need. Any later changes belong within an individualized plan coordinated with the prescribing clinician.
When pain becomes chronic, medication reviews should include what each medicine helps you. Does it make sleep easier? Help you get through a workday? Cause effects that interfere with your life? Bring those observations to the prescriber so the discussion includes benefits as well as concerns.
For people taking opioids, CDC guidance emphasizes shared decisions and careful consideration of the risks and benefits of continuing or tapering treatment. Abrupt discontinuation is generally avoided unless there is a life-threatening issue requiring immediate action. Do not design a taper from a blog or social post. [4]
Movement also deserves a specific conversation. Ask which activities are appropriate for your diagnosis, what restrictions apply, and whether physical therapy would help you develop a plan. “Move more” can feel frustrating when nobody has explained what that means for your current limitations.
For example, ask, “What amount of this activity should I begin with, and what response means I should contact you?” This article cannot prescribe the same walking, stretching, or strengthening routine for everyone reading it.
The livestream also raised questions about icing and anti-inflammatory medicines. Their appropriate use depends on the injury, stage of recovery, and individual risks. When pain is chronic, icing is often not the recommended treatment. Heat may be more helpful. The same goes for some medications, they may be helpful in the short term but not so helpful when pain is chronic. Ask your treating clinician for guidance rather than assuming that all icing or all anti-inflammatory treatment is good for healing. Include products you use without a prescription in that discussion.
5. Ask where acupuncture may fit in your plan
Acupuncture is an important part of my practice. In the livestream, I described how I consider it within a whole-person approach, rather than focusing only on the location that hurts. Your history, goals, and response help shape how we discuss that option.
When pain becomes chronic, it is reasonable to ask about evidence-supported nondrug approaches alongside other care. NCCIH reports that acupuncture may help several pain conditions, including certain back, neck, and knee pain conditions.
In Chinese medicine, descriptions of organs and patterns have their own meaning. They are not interchangeable with a Western medical diagnosis of organ disease. If I use that language during your visit, you can ask me to explain what I mean and how it relates to your treatment plan.
Before starting, ask what improvement we will look for and when we will review the response. A useful conversation might include pain during a particular activity, comfort at night, and your ability to carry out a routine that matters to you. Agree on observations you can realistically make.
Acupuncture should be delivered by an appropriately qualified practitioner using sterile, single-use needles. Tell the practitioner about medicines and health conditions that may affect treatment. You can learn more about my approach on the practice’s acupuncture page: https://hearttoheartmedicalcenter.com/services/acupuncture-in-santa-rosa-ca/ [3]
6. Set meaningful goals and review progress
What would you like to do more comfortably? This question can bring the plan back to your life. You might want to sit through a family meal, dress with less difficulty, or participate in a valued activity. Choose something specific enough that you can describe a change.
When pain becomes chronic, a pain score may be useful, but it does not capture everything you want from treatment. Bring observations about sleep, mobility, participation, and side effects. Your clinician can help decide which measures make sense and how to interpret them alongside the examination.
Try agreeing on one short-term goal and a review point. Ask what you should do if the plan is too difficult, if symptoms change, or if access and cost become obstacles. Practical barriers deserve discussion because a plan you cannot carry out needs adjustment.
Recovery timelines also need context. In the livestream, I described how initial improvement and longer-term tissue remodeling can occur on different schedules. Those examples illustrate why recovery may feel uneven; they should not be used to predict your exact course or justify delaying an assessment.
When pain becomes chronic, you may need to revisit both the explanation and the plan. If a treatment is not helping, say so. Ask what the team learned from the trial and what options remain. Honest review gives you a clearer next decision than continuing without a shared purpose.
Consider bringing a trusted person to an appointment if you would find that helpful. They can take notes, remind you of questions, or help you remember the plan afterward. Your preferences should stay central, including what information you want shared and how involved you want them to be.
7. Know when to seek prompt care
A longstanding pain condition does not explain every new symptom. In the livestream, I emphasized seeking urgent help for sudden changes, including weakness or numbness. New symptoms deserve attention even if you have lived with pain for years or have another appointment already scheduled.
When pain becomes chronic, keep emergency instructions separate from your routine treatment plan. Sudden weakness or numbness on one side, difficulty speaking, or other possible stroke symptoms warrant emergency help. Do not wait for a routine consultation or an answer to a social media message. [6]
With back pain, new loss of feeling around the groin, new bladder or bowel problems, or severe or worsening weakness in both legs needs emergency assessment. The NHS also advises urgent evaluation for back pain that becomes severe suddenly, worsens quickly, or occurs with feeling feverish or unwell. [5]
When pain becomes chronic, seeking help is a reasonable next step even when there is no emergency. If pain is disrupting daily life or the current plan is not working, arrange a review. You do not have to wait until you have a perfect symptom record.
For that review, bring your brief timeline, treatment list, and one meaningful goal. Those three pieces can start a focused conversation about what is understood, what still needs assessment, and which options fit you. Your experience deserves both compassion and a practical response.
Frequently asked questions
How do I know when pain becomes chronic?
Pain lasting more than three months or beyond the expected healing period is commonly described as chronic. That description does not identify its cause. If symptoms persist, worsen, or interfere with daily activities, arrange an assessment rather than using the calendar alone to decide when you deserve care. [1]
Can pain continue even after an injury has healed?
Yes. Pain may continue after the initial injury resolves, and in some cases no single cause is identified. That is a reason for an individualized assessment. It is not evidence that you are imagining the symptoms or that nothing can be done to support you. [1]
Will I need hormone testing?
That depends on the clinical question. In my framework, hormonal health is one area to consider alongside your other symptoms and history. Discuss any relevant changes with your practitioner. Testing should be selected because it may clarify your situation or change a care decision, rather than ordered automatically.
Does considering stress mean my pain is psychological?
Your physical symptoms deserve to be taken seriously. Discussing stress, grief, or coping can be part of a broader conversation without replacing a medical assessment. Tell your practitioner if you feel dismissed or misunderstood. You should understand why a question is being asked and how it relates to your care.
Can I try acupuncture while taking medication?
Often, acupuncture is considered alongside other treatments. Tell both practitioners what you are taking and ask them to coordinate any relevant decisions. In my practice, medication changes are considered individually with the prescriber. Starting acupuncture is not, by itself, a reason to stop a prescribed medicine.
How many acupuncture visits will I need?
There is no single schedule that fits every diagnosis or person. Ask about the proposed initial trial, its cost, the goals, and when the response will be reviewed. I often have my patients try 4 treatments at once a week to see how they respond to treatment. There should be some change within 4 treatments that will indicate if it could be helpful. Bring your own observations to that review so you can decide together whether to continue or adjust the approach.
What if previous treatment did not help?
Bring the details to your next appointment, including what was tried and how you responded. An unsuccessful trial still provides information. Ask whether the diagnosis needs another look, whether other supports are appropriate, and what a different option would aim to change in your everyday life.
Is Seasonal Reboot part of treatment for this pain?
In this article, the connection is broader wellness: making room to consider nourishment and daily routines while you discuss your health needs. Explore my Seasonal Reboot overview if that interests you, and ask whether the program suits your situation and medications. It is a separate wellness conversation from diagnosing or treating your pain.
How does the November webinar relate to this topic?
Persistent symptoms can make health planning feel difficult. My free November 25 webinar, “What Do You Want for Your Health in 2027?” offers time to reflect on priorities and consider a manageable beginning. It is a health-planning conversation, with live Q&A and a replay planned, rather than an individual pain assessment.
What should I bring to a first conversation?
Bring your main question, a brief symptom timeline, your medication list, and relevant reports you already have. Add one example of what you want to do more comfortably. If you are missing records, ask the practice what is needed rather than postponing contact until your paperwork feels complete.
Your next conversation
When pain becomes chronic, the next step can begin with being heard. At Heart to Heart Medical Center, I welcome a conversation about your history, your questions, and the goals that matter to you. Visit https://hearttoheartmedicalcenter.com/ and choose the free consultation option to explore working together.
If you would like to reflect on daily nourishment and wellness routines, read the Seasonal Reboot overview: https://hearttoheartmedicalcenter.com/seasonal-reboot/. For an overview of the care approaches available at the practice, visit https://hearttoheartmedicalcenter.com/services/. Choose the conversation that fits what you need now.
You can also save November 25 for my free online health-planning webinar. As you think ahead to 2027, ask yourself one question: What would I like more room for in my life? Bring that hope, along with your questions, into your next health conversation.
This article provides general education and reflects my clinical perspective. It does not establish a diagnosis or replace individual medical advice. Treatment choices, testing, and medication changes should be discussed with your healthcare professional.
References
[1] National Institute of Neurological Disorders and Stroke. Pain. Definition, persistence, and lived experience of pain. https://www.ninds.nih.gov/health-information/disorders/pain
[2] Lucas JW, Sohi I. Chronic Pain and High-impact Chronic Pain in U.S. Adults, 2023. NCHS Data Brief No. 518, November 2024. https://www.cdc.gov/nchs/products/databriefs/db518.htm
[3] National Center for Complementary and Integrative Health. Acupuncture: Effectiveness and Safety. Condition-specific evidence, mechanisms, and safe delivery. https://www.nccih.nih.gov/health/acupuncture-effectiveness-and-safety
[4] Centers for Disease Control and Prevention. Continuing Opioid Therapy. May 7, 2024. Shared decisions and avoiding abrupt discontinuation. https://www.cdc.gov/overdose-prevention/hcp/clinical-care/continuing-opioid-therapy.html
[5] NHS. Back pain. Reviewed March 5, 2026. Back-pain warning signs and escalation. https://www.nhs.uk/conditions/back-pain/
[6] Centers for Disease Control and Prevention. Signs and Symptoms of Stroke. https://www.cdc.gov/stroke/signs-symptoms/
Primary editorial source: Dr. Shiroko’s supplied livestream transcript, “When Pain Becomes Chronic,” approximately 00:03–16:12. Triangle of Wellness discussion approximately 02:20–05:51; medication and acupuncture approximately 06:23–10:15; preparation and urgent symptoms approximately 10:32–12:31; recovery, icing, and medicines approximately 12:31–15:42. The webinar title and November 25 date come from her reviewed webinar-copy document, not this livestream.
