Chronic pain

What is Chronic pain?

Pain that persists beyond the normal tissue healing period (typically 3 months) is classified as chronic pain. It is distinct from acute pain, which serves an important protective function signalling tissue damage. In chronic pain, the pain system itself becomes sensitised — continuing to generate pain signals in the absence of ongoing tissue damage, or generating pain disproportionate to any underlying injury.

This neurological understanding of chronic pain — pain as a product of a sensitised central nervous system rather than purely a tissue problem — has transformed how it is treated. Approaches that address the psychological, emotional and behavioural dimensions of pain are now recognised as central to effective management, not as an alternative to "real" treatment.

Chronic pain is extremely common: around 43% of UK adults live with it. It includes conditions such as fibromyalgia, chronic back pain, neuropathic pain, complex regional pain syndrome (CRPS), and pain without a clearly identified structural cause.

Signs and symptoms

By definition, chronic pain is pain that has been present for more than three months. Beyond this, presentations vary enormously. Chronic pain frequently involves:

• Persistent pain that may be constant or fluctuating, dull or sharp, localised or widespread
• Pain that is disproportionate to or independent of any identifiable structural cause
• Sleep disturbance due to pain
• Fatigue — both from the pain itself and from the physiological cost of living with it
• Low mood, depression or anxiety — both as consequences of chronic pain and as factors that amplify pain experience
• Reduced activity and physical deconditioning through avoidance of movement
• Social withdrawal and impact on relationships, work and quality of life

How therapy can help

Effective chronic pain management typically requires a multidisciplinary approach that addresses both the physical and psychological dimensions. Psychological therapies for chronic pain are not suggesting "the pain is in your head" — they are addressing the real neurological processes by which thoughts, emotions and behaviours influence pain experience.

• Pain-focused CBT — addresses unhelpful pain-related thoughts (catastrophising, fear-avoidance) and behavioural patterns (boom-bust cycles, avoidance) that amplify and perpetuate pain
• Acceptance and commitment therapy (ACT) — one of the best-evidenced psychological approaches for chronic pain, building psychological flexibility and valued living despite pain
• Mindfulness-based approaches — reducing the emotional amplification of pain through present-moment awareness
• Physiotherapy and movement therapies — graded activity and exercise, which have strong evidence for reducing chronic pain through central sensitisation mechanisms
• Acupuncture — NICE recommends acupuncture for chronic primary pain and chronic tension-type headaches
• Osteopathy and massage — address the musculoskeletal and soft tissue components of chronic pain

Seeking help

If pain has been present for more than three months and is affecting your quality of life, it is worth seeking a comprehensive assessment. Pain management programmes — available through the NHS — offer multidisciplinary input combining medical, psychological and physiotherapy perspectives and produce significantly better outcomes than single-discipline approaches.

Ask your GP about referral to a pain clinic or pain management programme. Psychological therapies for pain can also be accessed through IAPT or privately. When looking for a therapist, look specifically for experience with chronic pain or medically unexplained symptoms.

Therapies that may help with Chronic pain