Managing persistent pain

(Persistent pain - also known as Chronic Pain)

What is pain?

Pain is our body's response to a perceived threat. It is a protective mechanism to help protect the body and optimise healing.

For example, if you were to roll your ankle and sprain a ligament, your brain would receive the sensory information that there is damage to the ligament and a protective mechanism is required to prevent further injury and optimise healing. That protective mechanism is to give you pain.

What is the difference between acute and chronic pain?

Acute pain comes on suddenly and is caused by something specific.  Acute pain usually doesn't last longer than 6 months.  It goes away when there is no longer an underlying cause for the pain, for example, when the ligament has healed.

Persistent pain is ongoing and usually lasts longer than 3-6 months.  This type of pain can continue despite the underlying cause having healed or gone away.  Persistent pain may be a symptom or consequence of a long-term condition such as Fibromyalgia or Rheumatoid Arthritis. Or it may develop following an injury or after an operation.  Some people experience chronic pain when there is no past injury or body damage. Therefore, pain does not always equal damage.

Living with persistent pain is associated with other symptoms, which can also include:

• Feeling very tired or wiped out
• Not feeling hungry
• Trouble sleeping
• Mood changes
• Weakness
• A lack of energy.

These symptoms can affect your life in more ways than just dealing with pain. It can affect your work, relationships, finances, mental health and social wellbeing. It is difficult to know whether these symptoms are due to the pain, but they are also known to make pain worse. Addressing the other impacts on your life can often help with pain. See section: 'Strategies to help persistent pain'.

Why do we get persistent pain?

Changes to the nervous system

There is evidence which shows that people living with persistent pain will have changes to their nervous system. This is because after prolonged periods of pain, the nervous system becomes more sensitive, and the brain sends pain signals without there being any physical damage. The signals are sent as a response to things which should not be painful, such as movement and pressure. 

Memory

Our own memories can influence pain.  Our brain remembers pain and can cause us to feel pain when we reproduce a previously painful movement based on stored memory of past pain.

Someone who strained their back muscles whilst lifting something may experience that pain when lifting again, a few months later. The muscles are healed from the initial injury, but their brain will want to protect them from another injury and will use the pain as a warning signal.

Increased attention

The brain decides what you will experience in response to information from the nervous system, the more attention certain information is given, the louder it is heard.

If you think about a ticking clock in room, when you busy and are not thinking about the clock you do not notice the ticking. However, if your attention is drawn to the clock for some reason such as, waiting for an important appointment, you will be more aware of the ticking noise.

So, are we saying the noise of the clock is louder? No, the sounds travelling from the ear to the brain is the same, but the brain decides how loud you hear it. This is very much like pain and how much we can experience it.

Mood and emotional state

A person's beliefs and attitude towards their pain can also contribute to persistent pain. Someone with negative thoughts, beliefs and attitudes towards their pain is more likely to have poorer outcomes compared to someone who is well informed and has a positive attitude.

It is widely accepted that mood and emotional state can affect pre-existing pain. Emotional distress can make pain seem worse. For instance, it is not uncommon for someone's pain levels to increase when they are going through a stressful time such as, experiencing a bereavement, going through a divorce, financial difficulties etc.

Deconditioning

People who are in pain tend to avoid movement, this can lead to muscle weakness and joint stiffness (deconditioning). These effects can contribute to our pain experience. Deconditioning can be effectively improved with physiotherapy.

Injury / condition

After an injury the scar tissue can have more sensory receptors, so it can feel more sensitive to movement and touch.

If you have a long-term condition, such as Rheumatoid arthritis, this pathology itself can contribute to ongoing symptoms.

Strategies to help persistent pain

Even though research suggests that persistent pain may never go away completely, there are several strategies and treatment options which have been proven to help make persistent pain less impactful on your life. These strategies need to be seen as a long-term management option, as they will not provide a quick fix for the pain.

Education: It is vital that you inform yourself about your condition so you are able to make the right lifestyle choices which may improve your symptoms over time. You may find that there are dedicated services and charities which are able to provide more specialist support. 

Pacing: If done properly, pacing can reduce the number of flare-ups you experience, and will enable you to become more active in the long term, as you will not need to spend so much time resting and recovering from a flare-up.

Pain medication: This could be over the counter medication or prescribed medication. Some people are reluctant to take medication for various reasons; nevertheless, pain medication may be necessary at times to ensure day to day tasks are able to be completed and you are able to stay active.

Pain relief: There are several options, other than medication, which can be used such as TENS, Acupuncture, cold treatment and heat treatment. Find what works best for you.

Regular exercise: This will prevent deconditioning of our muscles, joints and cardiovascular system and in turn reduce pain that was due to muscles being tight and weak. Regular exercise will also help to improve our fitness levels and reduce fatigue. 

Cognitive behavioural therapies: This can be useful to help challenge negative thoughts and beliefs about your pain, which may be leading to anxiety and stress.

Relaxation: This is another way to help manage emotional stress and can be done as little or as often as needed. There are several forms of relaxation which have some evidence to support their use in persistent pain: for example meditation and progressive muscle relaxation. Find a form of relaxation that suits your lifestyle.

To conclude

Pain is multifactorial and not always associated with tissue damage. When pain persists, it may be worthwhile thinking of strategies to keep active and minimise the impact of your pain on other aspects of your life using some of the strategies discussed.

Useful resources

• Turning down the volume on pain booklet. Body logic
• Headspace app: Meditation and sleep made simple. 
• Managing pain at home.    CSP guidance
• 12 tools to help with self-management. Pain Toolkit 
• Understanding Pain in less than 5 minutes, and what to do about it video by Live Active Chiropractic (Live Active Clinic) 
• Making decisions to help you live well with chronic primary pain - NHS

 

If you would like this information in another format, for example large print or easy read, or if you need help communicating with us please contact:

First Community (Head Office)

Call: 01737 775450 Email:    fchc.enquiries@nhs.net    Text: 07814 639034

Address: First Community Health and Care, Caterham Dene Hospital, Church Road, Caterham, Surrey, CR3 5RA.

For office use only: Version 1 PFD_TS091(2)  Publication date: April 2025