Chronic pain

Pain intensity is not a damage meter

Chronic pain may involve ongoing disease, nerve injury or changes in pain processing, and factors can coexist. A test that does not explain the pain does not make the experience imaginary. Equally, a new pattern should not automatically be attributed to an existing chronic problem.

Start with a meaningful activity goal

Record location, changes and effects alongside intensity. Walking distance, sleep and difficulties with work or household tasks give useful detail. Agreeing on achievable goals helps assess treatment value; function and quality of life may improve before pain disappears.

Choose care for the type of pain

Suitable activity and rehabilitation, psychological treatment and some medicines may contribute, but different pain conditions need different plans. Psychological treatment helps with pain and its effects; it does not mean the cause is purely psychological. Complementary approaches also need condition-specific evidence and a discussion of risks.

Review benefit, harms and changes

If a treatment causes sedation and less activity without meaningful benefit, discuss a review rather than judging it only by temporary pain relief. Medication changes need a safe plan, especially when withdrawal is possible. A substantial change in symptoms warrants renewed assessment of the cause.

Questions for your clinician

• Which mechanisms may explain my pain, and what remains uncertain?
• Which activity or sleep problem should we aim to improve first?
• When will benefit and adverse effects be reviewed, and what should trigger an earlier visit?

Explore the underlying science

• 29 · Anxiety: responses, persistent difficulties and help
• 50 · Sports injury, healing and return to activity
• 74 · Pain: bodily signals and nervous system processing
• 83 · Rehabilitation and long-term care

Sources

• NICE NG193: Chronic pain assessment and chronic primary pain management
• NCCIH: Chronic pain and complementary health approaches