Chronic pain is usually defined as pain that persists beyond the normal time that tissues take to heal following an injury. Most soft tissue injuries heal up within weeks, although some can take several months to completely heal. If a pain continues longer than 3-6 months, it is usually described by pain specialists as “chronic” pain. It is helpful to understand the differences between chronic, persistent pain and acute pain.
Acute, short-term pains act as an alarm, telling us that something is wrong. While most minor pains are easily treated and quickly forgotten, others are a sign of something more serious that we shouldn't ignore. For example, the pain of a broken leg is helpful because it makes us rest the leg until it heals.
Chronic, persistent pain though often serves no useful purpose. The pain messages linked to long-term conditions such as back pain or arthritis are not helpful, and can be annoying and sometimes devastating. Over time, the pain may affect how we function, including our ability to work and our sleep patterns. It can also have a negative effect on our family and friends.
The causes of chronic pain are not always clear but in some conditions the pain is thought to be due to the pain signals through the nerve fibres becoming confused. The brain is then unable to understand the signals properly. Chronic pain can affect any part of the body and people of any age, including children.
The nerve network associated with chronic pain is also linked to those parts of the brain concerned with emotions. So, pain can affect our emotions, and our emotions can affect our pain. If we are angry, depressed or anxious, for example, the pain often feels worse. If we are feeling positive and happy, we may experience less pain and will often be better able to cope. Pain then is never "just in the mind" or “just in the body”, but a complex mix affecting our whole being.
If your pain persists and becomes chronic then the emphasis might shift more to managing the condition and minimising its impact on your life, rather than necessarily finding a cure. Research shows that the causes of chronic pain are complicated and can be hard to resolve.
Some treatments are available which can reduce the pain intensity. For example, you might be prescribed medication, from simple pain-killers to more complex drugs. Other treatments to help reduce the pain include “hands on” treatments, massage and acupuncture, although the benefits of these treatments tend to wear off after each treatment session.
Another way of managing long-term pain is to find ways to reduce the impact of the pain on overall quality of life. This might include learning relaxation techniques, developing goal-setting skills, and learning ways of improving sleep quality. You could be referred to a specialist pain clinic or a specific pain management programme. Some pain clinics have teams of expert healthcare professionals including doctors, psychologists and physiotherapists. However, pain clinics are not available in every area.
A pain management programme is a specialist rehabilitation approach for groups of patients run by a healthcare team which includes a physiotherapist and a psychologist, and may include an occupational therapist and a nurse. People with chronic pain may find that it affects many areas of their lives, including how they think and feel. Pain management programmes teach people how best to cope with pain and how to live a more active life. Referral to a pain management programme is usually through your local pain clinic. Pain can have a direct effect on your mental well-being. The relationship between body and mind is complex, so it is important to seek help for any aspect of your condition that you might be struggling with, physical or mental.
Everyday activities such as walking, swimming, gardening and dancing have been shown to improve wellbeing for people with chronic pain. Exercise helps by increasing levels of chemicals known as endorphins which occur naturally in your body and act as pain killers. Exercise can also help relieve tension and stiffness in your muscles, ligaments and joints: all of this helps to keep the body more functional. If you increase your activity gradually you can help relieve problems such as stiff joints and weight gain, and reduce the risk of heart disease, osteoporosis, poor balance and falls.
Relaxation techniques can help to reduce persistent pain, can reduce muscle tension, and can help to improve broken sleep. There are many types, including breathing exercises and meditation. There may be local classes available, perhaps through your local pain clinic. Ask your physiotherapist, GP or other healthcare professional for advice.
Pain can send you into a downward spiral of fatigue, low mood and anxiety. Talk to someone who understands what you are going through. Several organisations have helplines staffed by people living with chronic pain and they can also put you in touch with local support groups (see below). It can help to see a counsellor or psychologist. Your GP can advise you about where you can find help.
Try distracting yourself from the pain with an activity that you enjoy. Many hobbies such as photography, sewing or knitting can be done even when your mobility is restricted.
Many people find the pain is worse in bed, but sleep deprivation can add to the problem. Give yourself the best chance of a good night's sleep by going to bed at the same time each evening, getting up at the same time each morning and avoiding taking naps during the day. If sleep problems persist, speak to your physiotherapist, GP or other healthcare professional.
Keeping in touch with friends and family is good for your health and well-being. If getting out and about is difficult, try shorter visits, perhaps more often. If you can’t get out, phone a friend, invite someone round for a coffee or have a chat with your neighbour. Aim to talk about anything other than your pain.
Chronic pain can affect many different areas of your life, including how you think and feel. It is vital to seek help with anything that you are struggling to cope with, whether physical or mental. If you, or someone you care for, is experiencing an impact on mood and feelings then talk it through with your GP, physiotherapist or other healthcare professional. They can help you or refer you to someone who can.
You might not be able to avoid pain completely but you can prevent it from taking control of your life. This might involve making some changes to your lifestyle, including the work you do and your leisure pursuits, but you can still enjoy life and find it worthwhile.
Physiotherapists often see patients with chronic pain on an individual basis. Your physiotherapist will assess you and work with you to agree a treatment plan. A specific manual treatment such as massage or soft tissue mobilisation may be appropriate, or perhaps acupuncture. However, treatment is more likely to include advice about movement, posture and finding ways of achieving your goals.
A physiotherapist can also identify practical ways to help, such as making sure you have the correct equipment or the right shoes. Physiotherapists also see patients at a pain management clinic, working as part a specialist team. This is more likely to be a group session.
It is important to have regular reviews with your physiotherapist and ask to see them if your condition changes.
Find a Physio
Your physiotherapist will assess your condition and difficulties, give you advice and perhaps offer you a physical treatment (see above). You might need to remove some clothes so that the physiotherapist can see your movement and muscle activity that may be contributing to your pain, so it's a good idea to dress comfortably and wear suitable underwear.
- British Pain Society
- NHS Choices
- Pain concern (helpline 0300 123 0789)
- Action on Pain (helpline 0845 6031593)
- Arthritis Care (free helpline 0808 800 4050)
- Backcare (helpline 0845 130 2704)
- Expert Patients (free NHS training programme for people with chronic conditions such as arthritis)
- Arthritis Research UK (high quality information for people with arthritis)
Produced in association with the Physiotherapy Pain Association.