Persistent pain (sometimes called chronic or long-term) is described as ‘pain that continues for three months or more and may not respond to standard medical treatment’. It is quite common, affecting around one in seven of us, and can be caused by a longstanding condition, like arthritis, or as a result of a specific problem. Persistent pain can also develop gradually, sometimes for no obvious reason, and may even come on some time after an activity or injury.
Persistent pain can be felt in a specific part of the body such as back, shoulder or leg(s), or throughout the body. The pain may be continuous or vary in its level – sometimes flaring up or getting worse very quickly while at other times being easier to manage.
At the moment we don’t have a cure for persistent pain, and some patients may have to accept that this is a condition they have to live with long-term. The good news is you can learn skills that can help you to better manage your condition.
Some become so good at managing their pain that it fades completely into the background for much of the time. Everyone is different so the right plan will vary from person to person.
Self-managing persistent pain can involve learning how to do things differently and the right treatments and medicines, as well as learning to think and react differently to the pain, and life events in general.
Yes, because pain can disrupt sleep patterns by making it difficult to fall – and stay – asleep. Coping with pain can also be tiring in itself, while a lack of rest could lead to increased pain.
Some sufferers find relaxation techniques help, as well as avoiding daytime naps and stimulants like tea and coffee in the evening.
Keeping active, stretching and regular exercise is important. Many people who feared it found exercise actually reduced their pain.
Watch a cat or dog when it gets up – they stretch their legs and bodies so they are prepared to move around. We can take a massive tip from them, by doing the same.
Tense muscles tend to feel more painful, so it’s important to learn relaxation skills. Some people do this by listening to music or reading. Prayer also works for some.
Learning distraction techniques can also help. This could be a hobby such as gardening or DIY. Don’t forget to pace yourself – sometimes we can lose ourselves in the activity and forget about time, so set an alarm to remind you to take a break.
This is always a tricky one for those who work and have pain. As always, it’s best to be honest with your boss about the difficulties you have and work out an action plan. This may mean altering your duties or how you carry them out. You may need to take regular breaks or work different hours.
If you are unable to work out a flexible approach that accommodates your needs, consider other roles you could do with your skills and which could better suit your lifestyle and condition. Working is good for us – it helps us interact with others, while being alone and unoccupied can make us feel isolated and out of touch.
Pain can affect your confidence when it comes to participating in special events, like holidays and birthdays. We need to keep socialising so we don’t retreat into ourselves – which could lead to depression – so keep in touch with family, friends and colleagues.
Try to avoid talking about your pain too much, as you will just reminding yourself of your condition, instead of focusing on more enjoyable distractions.
Sex is an important part of most relationships and it’s natural for us to want to carry on wanting to be intimate. Talk to your partner about any problems you have or are worried about so you can work out alternatives and avoid increasing your pain.
Sadly, medications can’t cure persistent pain. They can only lessen it by 40%, at best, and often by less. Watch the video on this page about pain and pain systems to understand more about why this is. If drugs don’t provide the relief you expected, it can lead to frustration and worry. This, in turn, adds to the stress of pain and a vicious cycle sets in.
To get the best out of the medication your GP has prescribed it’s important you:
Eating well, losing weight and generally improving your overall health will help you cope better with your persistent pain. Foods like pasta, fish, lentils, chicken, vegetables and fruits can help joints, muscles and nerves work better. Using olive oil as your main cooking oil is very healthy. These types of foods are known as the Mediterranean diet.
Healthy eating can not only help you lose weight but reduces your risk of heart disease, stroke, dementia, cancer, constipation as well as depression and anxiety.
Eating small meals regularly through the day, rather than skipping breakfast, helps the body become less stressed, tired – and painful! Try porridge or fruit. Start with easy, small portions like two or three tablespoons of cereal or half a banana. Many people with pain who rarely have breakfast find eating very small portions can be a good start to living better with pain.
Reducing caffeine drinks like tea, coffee and cola-type products can help reduce tension, sleep problems and anxiety symptoms. Cut back gradually over days and use more decaffeinated choices, pure fruit drinks or water instead.
Pain can affect how you manage the range of activities in your day. We can tend to use pain as a guide: “Oh, my pain has increased…I’d better stop or rest.” Or: “I must get this done before the pain increases again.” Sound familiar? It’s very common to fall into an unhelpful trap of over-doing or ‘trying to keep up’ patterns, where on days with less pain you find yourself doing catch-up jobs, extra work and spending more time to complete the task or activity.
Sometimes only pain or tiredness stops you. Then you find you have severe pain flare-ups, are exhausted and have to rest for hours or days until pain levels lessen. This pattern is called the ‘Boom and Bust cycle’.
It leads to being stuck in the vicious cycle of pain. It is miserable and your confidence drops. Taking action early to plan in a more balanced approach means less severe pain flare-ups which impact on your health and life.
Learning to find your personal balance of activity and relaxation – such as changing or doing activities in different postures and places – can lead to a better life. Building confidence like this means you can do more of the things you want.
Smoking is linked to persistent pain. Research shows people with pain who smoke have more pain symptoms which tend to last longer. There are lots of ways you can reduce and stop smoking when you are ready to make this change.
Most people with pain find they are able to stop smoking usually within 12 months of starting to live better with pain.
There is help from your pharmacist, GP, practice nurse and local stop smoking services.
It is very common for living with persistent pain to get you down. You may feel depressed, angry, frustrated and stressed. Although these emotions are understandable, they actually make pain signals in the body worse.
Many people with pain have found coping better with moods can lead to less pain which improves their quality of life.
Making mood changes is not easy and often takes practice – but, importantly, it usually works.
Sleep is one of the most common problems for those with persistent pain, affecting 1 in 3 people. With chronic tiredness you can get irritable, while worrying about not sleeping just adds to the stresses of living with pain.
It is possible to get into better sleep patterns through a mix of balancing daily activities, relaxation techniques and learning to deal with negative thoughts.
Relaxation and gentle stretching before you go to bed can help improve the quantity and quality of sleep. Turning off the mobile phone to prevent calls and texts interrupting your rest, and generally avoiding too much screen time is also a useful tip.
Pain can affect how you do everyday activities. It’s very common to fall into an unhelpful trap of ‘boom and bust’ patterns, where on days with less pain you find yourself saying: “I must get this, that and even this done before pain increases again.”
You can push yourself into doing more work, more stretching and increasing the time to complete a task or activity. Sometimes only pain or tiredness stops you. Then you find you have severe pain flare-ups, feel exhausted and have to rest for hours or days until pain levels lessen.
This pattern of activity leads to you being stuck in the vicious cycle of pain and is demoralising. Learning to find your personal balance of activity, breaks, relaxation, change or activities in different postures and places can boost your confidence as you can do more of the things in life you want.
Setbacks sometimes also called pain flare-ups happen and are part of living with pain. Flare-up plans and taking action early mean fewer setbacks and ensure flare-ups become much shorter and less painful.
Over pacing, having another illness or flu-like infections or going through upsetting or stressful life issues are typical triggers for flare ups. Spotting these triggers and making a note of what caused the setback, and also what you did to help you get over it, are really useful.
Problems in life can increase stress. Sometimes you can feel overwhelmed when faced with issues like family illness, money worries, work and relationship issues. This can affect your confidence to cope with persistent pain, as well as juggle other troubling issues.
Many people who learn to self-manage find they cope much better and can live life to the full.
Stress, worry and anxiety can all lead to even more pain. Pain itself is really stressful on the mind and body. It can make tense muscle and joints feel stiff and tight, cause neck and headaches, poor sleep and changes in appetite. The stress of pain can affect your thinking with unhelpful or ‘catastrophic’ thoughts or repeated worries such as “what if this happens…”
This can make you feel very anxious and on edge, and it can then be tricky to focus on making the small, helpful changes needed to lessen stress and pain. There are many ways to reduce anxious feelings and pain-related stress. Relaxation can be a very useful coping tool.
Sometimes it helps to have some good coping thoughts when you are anxious or stressed.
It can help to write your own coping thoughts on a card or save them on a mobile phone to remind and reassure you when anxious feelings start to bother you.
Frustration, fear, anger and irritability are all very common if you are in pain. There can be many reasons for feeling this way. Work out your anger triggers and think about the issues. Ask yourself: Is it worth it? More information on dealing with anger is available by visiting NHS Moodzone.
It is common to feel down about the way pain affects you and your life. Share your concerns around your mood difficulties or feeling low about your pain with your GP or other healthcare professional. This can change for the better. There are different options available including self-management skills, anti-depressant medication to talking therapies.
Remember that old saying ‘a problem shared is a problem halved’. Well, it really does help to talk – share your feelings of loss, sadness and anger and explore real, hopeful possibilities for the future. This will help you to find a different and more positive way to live better with pain. Anti-depressants can help improve low moods, motivation, sleep and can reduce negative thinking patterns.
They are not addictive and do not cause dependence. The medication can take four to eight weeks to start to work and needs to be taken as a six to 12 month course. This is to make sure the mood benefits for depression and anxiety last. Taking these medications for shorter times can mean more relapses.
While treatments can be an important part of the whole care package, it is important to remember that they will never completely cure your pain.
Treatments can help you to manage your pain better, be more active and healthy and can be delivered in different settings – in hospital pain clinics, community-based clinics or sometimes through your GP.
There are very rarely any side effects. However, the benefits often don’t last very long – typically between a couple of days to a few weeks. This can lead to regular repeat treatments, or having to tolerate wide variations in pain from week to week.
Painkillers are one of the options for helping with pain. They can be useful in helping to reduce pain, but they are not usually the complete answer for longstanding problems.
Most people are familiar with taking painkillers for short term pain like a headache or after an injury or operation. As you will learn on this site, persistent pain is different and just relying on painkillers does not work. Some people find the benefits of painkillers are outweighed by the side effects in the longer term
At times, a pain specialist may recommend an injection treatment to help with persistent pain. However, these are not common, as they often don’t last for long and there are risks – although rare – of nerve damage, dangerous bleeding or infection.
Although a small number of people will benefit from injections, for most persistent pain, injections are unlikely to be a long-term solution.
For some patients, injections can be effective in reducing pain for a period of time allowing the mind and body to ‘recover’ to a degree, which will enable other treatments to work better. A good example of this is where the injection reduces pain for long enough for a physiotherapist to treat the affected part of their body.
Injections can be used to help people through a particularly bad flare-up of pain and help them get back to a point where they are able to take control of their own pain management again.
Your pain specialist will discuss with you whether an injection is likely to help in reducing pain and improving function and the associated risks. Your GP will advise you on whether you need to see a pain specialist.
A physiotherapist has specialist knowledge about the way the body works. They have an understanding and experience of how the nerves, bones, muscles, tendons, joints and ligaments work together.
Often people living with persistent pain move in awkward ways to try to protect their body, but this can make pain worse in the long run. As they understand the way the body works, physiotherapists can identify problems in the way someone moves.
The physiotherapist will coach and guide you through a range of activities or exercise skills in order to gradually increase your stamina, strength and flexibility.
A physiotherapist will often not actually touch you, but focus more on helping you to gain confidence in your own mobility. They may at times use manipulation, massage or acupuncture to help you regain normal movement. However, you must remember at the end of the day it is your body and muscles that need to do the work.
Physiotherapists who work with people in persistent pain will often also focus on the same core skills for managing persistent pain that other health practitioners will teach such as pacing, problem solving and managing set-backs.
Your GP will advise you on whether you need to see physiotherapist.
Persistent pain can have a significant impact on your moods and your life at home or work. It can be a miserable experience which leaves you feeling alone and low – so it can be helpful to talk about it.
Talking therapies involve discussing your issues with a psychologist or psychiatrist. These professionals are skilled at helping you understand the ways thoughts and mood affect pain.
They can help you learn strategies and skills to improve their quality of life and ability to deal with pain. Talking therapies allow you to share the ways pain has changed you as a person, your moods and thought patterns. It can help to talk through your losses and experiences and allow you to self-manage your pain by starting to think more positively and proactively.
Talking therapies can be helpful with persistent pain or other long-term illnesses because health problems can affect the person, their moods and their life in so many difficult and distressing ways. It helps to learn a range of skills to recognise how the way you think can cause unhelpful moods, for example becoming very angry. The therapy helps the person learn how to make changes to unhelpful thoughts or behaviours.
This means becoming less affected by unhelpful moods and having better, more pleasurable times, despite the pain.
Your area IAPT service helps individuals cope better with long-term pain.