Chronic pain

Chronic pain

Chronic or persistent pain is pain that lasts longer than 12 weeks, or beyond the natural healing time

What is chronic pain?

Chronic pain is a common condition affecting over one third of adults in the UK.

Chronic pain is pain that continues for longer than 3 months, either as part of another health condition, or despite investigations and treatment.

Phone your GP if:

• you experience pain for longer than 12 weeks
• you think you might have chronic pain
• you’re concerned about worsening pain
• you already have chronic pain and you’ve developed new symptoms

How does your body feel pain?

The brain and the nerves inside the spine (the spinal nerves) make up the central nervous system.

Nerves carry messages back and forth between our body and our brain all the time.

The brain acts like a control centre. It works out from these messages if it needs to do anything. It’s the brain’s interpretation of these messages that results in the feeling of pain.

Sometimes the brain’s interpretation of these signals isn’t accurate. You might feel pain even when there’s no damage or harm to your body.

Chronic pain can cause changes in your brain and nervous system. These changes can cause the brain to continue to send out pain signals even when there is no harm or damage. The signal pathway to the brain can become over sensitive meaning the signals are amplified.

We usually expect acute pain (for example following an injury) to reduce with the healing process. But sometimes the brain and body continue to send out pain signals long after your body has healed. These signals can be hard to stop, are often intense and at times seem to come for no obvious reason.

Fibromyalgia and complex regional pain syndrome are types of chronic pain conditions.

Watch this video to learn more about chronic pain.

What causes chronic pain?

There isn’t always an obvious cause for chronic pain.

Most people get back to normal after experiencing pain following an injury or operation. But sometimes the pain carries on for longer. Sometimes there’s no identifiable cause for chronic pain.

If you’ve had an injury and pain continues after the expected healing time, this might be chronic pain.

Visit Flippin Pain to understand more about pain.

What is the difference between living with acute pain and chronic pain?

Chronic pain is very different from acute pain.

Acute pain:

• can usually be easily explained – for example following an injury or illness
• can usually be reduced by medication
• causes a short term disruption to your usual routine and activities
• may cause short term frustration and stress
• reduces with the healing process – you can expect to return to normal in weeks or months
• family and friends often provide care and support

Chronic pain:

• cannot always be explained
• is not always helped by medicine
• can cause lasting changes to activities, routines and roles
• might mean you feel low, exhausted or overwhelmed
• might cause you to feel hopeless or uncertain about the future
• is often understood by family and friends who can provide care and support

Managing chronic pain

Chronic pain is a long term (chronic) condition that may not be cured or fixed. For some people the pain may reduce over time. For others, there are changes you can make that can help you live well with chronic pain.

Traditional treatments like pain medication only have a limited benefit for some people with chronic pain.

You might have already found this if you’ve tried different medications and treatments with little benefit.

Talking to a healthcare professional to find the right strategies and techniques for you is the best way to self manage your pain.

Getting the right support can help you to make changes to improve your quality of life.

Living with chronic pain

Chronic pain is different from acute pain. There’s no simple treatment for chronic pain. Finding the right pain management strategies can help you live better with your pain and hope for some recovery.

Traditional medical treatments, like pain medications, have limited benefit for chronic pain.

Finding the best strategies and techniques for you is the best way to manage your chronic pain. Learning to self manage can take time and might involve learning some new skills.

Managing your activities

Pain might impact your ability to carry out your normal daily activities.

Many people with chronic pain avoid being active because they’re worried it will make their pain worse. This is understandable. Being less active can make your pain worse. It might feel like it’s helping in the short term. But in the longer term, being underactive can make your pain worse.

Sometimes, being overactive and doing too much might cause flare ups of chronic pain.

It’s important to find a way to remain active in a way that’s safe for you. Being active is good for you and can help improve your quality of life.

Pacing

Pacing can gradually help you manage your daily activities in a way that’s right for your body and your condition, while reducing the risk of flare ups.

Chronic pain can cause changes in your brain and nervous system. These changes can cause the brain to continue to send out pain signals, even when there’s no harm or damage. The signal pathway to the brain can become over sensitive meaning the signals are amplified.

Pacing can help because it allows you to do things within your limits. This can help re-train the nervous system settle and be less protective.

You can practice pacing activities to prevent overactivity or underactivity. This means deciding how much you’re going to do and not pushing beyond your limit. You should practice pacing regularly to allow your body to adapt. You can add on small amounts as you feel able to.

Pacing encourages you to choose when to take a break from an activity before pain, tiredness or other symptoms become too much.

If you don’t pace yourself, it could slow down your progress in the long term. Regular, paced activity can help build your fitness over time.

Activity and exercise

Finding activities and exercises that are suited to your condition can help you manage your symptoms. It can also improve your overall health.

Knowing where to start can be daunting for some people with chronic pain. Any type of movement can be exercise.

To begin with your muscles might hurt so it’s important that you choose a level of exercise that suits you. Learning how to pace your activity and exercise can help. Most of all it should be enjoyable.

You might want to try:

• walking – start off with a short walk and if you feel able, continue to increase the length of your walk each day or week
• dancing or moving to music – this can be done either standing or sitting (or a mixture of both)
• exercising in the pool – water makes us feel lighter and can make movement and exercise easier than on dry land
• exercise classes – if you’d prefer to exercise with others, you can find out about classes from your local sports centre

Watch and follow this mindful movement video for some guided exercise

Set yourself goals

You may find you’ve had to give up going places or doing things that you used to enjoy because you’re afraid your pain will get worse.

Goal setting’s a bit like pacing. You can use it to find the right activity level for yourself.

Here are some tips to help with goal setting:

• make the goal something that matters to you
• make it specific and measurable; instead of saying, “I want to go out more,” you could say, “I’m going to meet a friend for coffee every week”
• choose something realistic and achievable
• make it time bound, like “I want to walk one mile every Thursday for the next month or “I want to walk for 10 minutes three times a week”
• choose something that benefits you and makes you feel good about yourself

Once you’ve decided on your goal, create an action plan to record how you’ll achieve your goals.

Relaxation

It’s important to regularly take time to relax or practice relaxation techniques to help reduce stress. Stress can make your symptoms worse or cause them to flare up more often.

Relaxation is a skill you can learn. It happens when you guide your mind to unwind the tension and tightness within your body.

Try to find time each day to do something that relaxes you. Taking time to relax before bed may also help you sleep better.

Find out more about relaxation techniques you can try

Mindfulness

Mindfulness involves paying attention to what is going on inside and outside ourselves in the moment. It helps you become more aware of the natural and automatic reactions to pain like difficult thoughts, emotions and worries.

An important part of mindfulness is reconnecting with your body and the sensations you experience. A simple way to practise mindfulness is to pay attention to the sounds, smells, sights and tastes of the present moment.

Another part of mindfulness is paying attention to your thoughts and feelings without getting caught up in them.

Mindfulness can help you enjoy the world around you more and understand yourself better.

Read mindfulness tips and exercises on Mind

Find out more about relaxation and mindfulness

Managing your sleep

Chronic pain can cause a lot of problems with sleep. You might find it hard to get to sleep, or wake up during the night because of pain.

Lack of sleep and struggling to sleep can also increase your stress levels, making it more difficult to cope with your pain.

Try our self-help guide for sleep problems and insomnia to help you sleep better.

Sleepio provides a 6 week digital sleep improvement program based on CBT (cognitive behavioural therapy).

Getting a good night’s sleep – Pain Concern

Medication

Medication can be part of a pain management plan alongside other strategies like education, activity management and taking care of your mental wellbeing.

As chronic pain affects the nervous system it can affect your mental wellbeing. This makes it a difficult condition to accurately treat with medication.

There are different types of pain medicines for different types of pain and you may be prescribed a combination. Your pain can also change over time so it’s important to get your pain medicines reviewed at least once per year to see if they’re still effective and safe for you. Medication is not effective for everyone with chronic pain.

Opioids

Opioids are medicines that produce a morphine like effect. They can be useful for a short time, for example, after an injury or surgery. But longer term they aren’t effective. They typically reduce pain for about 10 percent of people in the long term. If you’re taking opioids, the chances are you’ll be experiencing at least some side effects.

Anti-depressants

You might be trying to manage chronic pain and low mood. Some antidepressants can be useful for pain whether there’s low mood or not.

You might be trying to manage chronic pain and low mood. Some antidepressants can be useful for pain whether there’s low mood or not.

All medications can have side effects. Sometimes this can cause more problems than the condition itself, including making your pain worse or creating a physical dependency. With chronic pain it’s good to consider whether you think you’re getting more benefit from your medicines than side effects. You can speak to your GP, a Pharmacist or Pain Specialist for a review of your medications.

Pain and work

Being in work is good for your physical and mental health. Living with chronic pain can impact your ability to find work, stay in work, and return to work.

There are different ways you can spend your time. This could include paid employment, self-employment, volunteering and education. You do not have to be 100% healthy to work.

If you’re struggling to remain in work, you could:

• discuss with your employer what you’re finding difficult about work
• think about what reasonable workplace adjustments like variations in job pattern or hours could help keep you in work
• speak to Citizens Advice Scotland about your rights to request flexible working changes
• get support through Access to Work

If you’re on sick leave and want to work towards going back to work, you can:

• start ‘stay in contact’ conversations with your employer
• start to explore a return-to-work plan with your employer even if the date might some time in the future
• consider ways for going back to work in a gradual way
• explore what current options exist for return to work
• find out what benefits you’re entitled to through Citizens Advice Scotland

Chronic pain and your mental health

Pain doesn’t just affect our bodies. It can also affect your mental health.

The close links between the emotion and pain centres in our brains make it almost impossible to have pain without difficult emotions as well.

Chronic pain can have a huge impact on all aspects of life, which can cause emotional strain on top of the pain.

Talking therapies, like counselling, can also be helpful in managing the impact of pain on your mental health. Speak to your GP to discuss your options.

You can also get help from the following services:

• Breathing Space
• Mental health services at NHS 24
• SAMH
• Samaritans

Coping with a flare up of chronic pain

A flare up of chronic pain is a period of time where the pain increases and can become more difficult to cope with.

Many people feel able to cope with their day to day activities if the pain stays the same. During a flare up it might feel like the pain is overwhelming. People often say they feel a sense of helplessness.

Flare ups are a normal part of chronic pain. They’re not necessarily a sign that things are getting worse.

What causes a flare up of chronic pain?

Sometimes a flare up of chronic pain might be caused by:

• overactivity or underactivity
• stress or worry
• low mood and depression

Sometimes there isn’t an obvious cause for a flare up of chronic pain

Watch this video to hear more about chronic pain flare ups.

How to manage a flare-up of chronic pain

There are some things you can do to help manage a flare up of chronic pain.

You need to be kind to yourself during a flare-up – you didn’t choose this. Caring for yourself and slowing down a little will help you get past the flare-up quicker.

Be prepared for a flare up of chronic pain

By having an action plan for when your chronic pain flares up, you can feel more prepared and ready to cope.

There are some things you can consider as part of your action plan:

• increase relaxation and mindfulness activities
• prioritise your tasks
• cut back on physical activities but do not stop altogether – some activity is better than no activity
• acknowledge that although you may feel bad just now, the pain will pass
• do what you can to soothe the pain like taking a warm bath or using a heat pad

You might be able to adjust your medication during a flare up. Discuss this with your doctor or healthcare professional in advance so you’re prepared.

Keep an activity diary

You can use an activity diary to track what you’re doing for a few weeks. We often do more or less than we think. An activity diary can help to identify possible causes of a flare up of chronic pain. It can also help you to identify when you might be trying to do too much during a flare up.

Pace yourself during a flare up of chronic pain

Pacing encourages you to choose when to take a break from an activity before pain, tiredness or other symptoms become too much. Pacing your activities during a flare up helps prevent overactivity or underactivity.

Continuing to use your pacing strategies can help to prevent future flare ups.

Manage your stress

Stress can make pain worse, so it’s important to learn how to manage it. At the same time, pain itself can make you feel stressed and anxious, creating a vicious cycle.

Learning relaxation skills can help you to break this cycle, and manage both stress and pain in a way that works for you.

We have a number of breathing and relaxation exercises on NHS inform that can help with anxiety and stress.

Breathing and relaxation exercises for stress

Sleep

Chronic pain can cause a lot of problems with sleep. You might find it hard to get to sleep, or wake up during the night because of pain. Unfortunately, the more you try to force yourself to sleep the harder it can become.

Lack of sleep and struggling to sleep can also increase your stress levels, making the pain worse.

Use our self-help guide for sleep problems and insomnia to help you deal with these issues.

Sleep problems and insomnia self-help guide

Getting a good night’s sleep – Pain Concern

Communicate

Chronic pain can cause you to lose your confidence and make it hard for you to express your needs. If you can’t say what you need, you may find yourself dealing with more pain and discomfort. This can make you feel more tense, and tension can increase your pain.

Follow these tips to help you become more assertive and confident about communicating:

• say what you mean clearly and don’t be afraid to be firm
• try not to shout or raise your voice
• remember you don’t have to apologise for needing something
• make sure your message is clear – don’t expect people to guess what you mean or know what you’re thinking
• explain to people why you’re asking them to do something
• ask for help when you need it
• remember it’s okay to say no

Fibromyalgia

Fibromyalgia is a long-term condition that causes pain all over the body.

Symptoms of fibromyalgia

The main symptom of fibromyalgia is widespread pain that might feel like:

• an ache
• a burning sensation
• a sharp stabbing pain
• a mixture of these 3 feelings

The pain is likely to be continuous, but it might be better or more severe at different times.

As well as widespread pain, people with fibromyalgia might also have:

• increased sensitivity to sensations like touch, light, temperature, noise
• fatigue (extreme tiredness)
• muscle stiffness
• difficulty sleeping
• problems with mental processes (known as “fibro-fog”) – like problems with memory and concentration
• headaches
• irritable bowel syndrome (IBS) – a digestive condition that causes stomach pain and bloating
• dizziness and clumsiness
• feeling too hot or too cold
• restless legs syndrome
• tingling, numbness, prickling or burning sensations in your hands and feet (pins and needles, also known as paraesthesia)
• unusually painful periods (if you get periods)
• anxiety
• depression

Speak to your GP or healthcare professional if:

• you think you might have fibromyalgia

Causes of fibromyalgia

It’s not clear why some people develop fibromyalgia. The exact cause is unknown, but it’s likely that many factors are involved.

Altered pain messages

Your brain, nerves and spinal cord make up your central nervous system. Changes in the way your central nervous system sends and receives information to your body might cause fibromyalgia.

Fibromyalgia is a type of chronic pain.

Read more about chronic pain

Genetics

Some people are more likely than others to develop fibromyalgia because of the genes inherited (passed on) from their parents.

Triggers

Fibromyalgia is often triggered by a stressful event. This might be a physically stressful event or an emotionally (psychologically) stressful event.

Possible triggers of fibromyalgia might be:

• an injury
• a viral infection
• giving birth
• an operation
• the breakdown of a relationship
• being in an abusive relationship
• the death of a loved one

Sometimes there isn’t an obvious trigger.

Diagnosing fibromyalgia

Diagnosing fibromyalgia can be difficult. There’s no specific test to diagnose the condition.

The symptoms of fibromyalgia can vary. The symptoms can be similar to those of several other conditions. Your GP will have to rule out other conditions with similar symptoms.

You’ll be asked about how your symptoms are affecting your daily life. You’ll be examined to check for signs of other conditions. They’ll check for swollen joints which might suggest arthritis, rather than fibromyalgia.

Tests to check for some of these conditions include urine and blood tests. You may also have X-rays and other scans. If you’re found to have another condition, you could still have fibromyalgia as well.

Criteria for diagnosing fibromyalgia

For fibromyalgia to be diagnosed, certain criteria usually have to be met. The most widely used criteria for diagnosis are:

• you have pain in multiple areas of your body
• your symptoms have stayed at a similar level for at least 3months
• your symptoms can’t be explained by any other reason
• you feel unrefreshed after sleep
• you have problems thinking or remembering (cognitive difficulties)
• you experience fatigue

Diagnosing other conditions

It’s also possible to have other conditions alongside fibromyalgia, like:

• depression
• anxiety
• irritable bowel syndrome (IBS)
• osteoarthritis
• hypermobility spectrum disorder

Identifying all possible conditions will help to guide your treatment.

Treating fibromyalgia

Fibromyalgia is a long term (chronic) condition.

There’s no cure for fibromyalgia. But there are treatments to help relieve some of the symptoms. This can make the condition easier to live with.

Traditional treatments like pain medication aren’t always helpful for people with fibromyalgia. Learning about your condition and finding the best self management approaches for you is the best way to manage it.

A healthcare professional can help you explore your options.

Exercise, movement and activity

Exercise, movement and activity can be helpful way to manage pain.

A physiotherapist can help you to develop self-management skills to reduce the impact of pain on your life. They might help you create a tailored exercise programme suited to your needs, abilities and goals.

Physiotherapy can also help prevent further loss of strength and increase your fitness.

Pain management movement videos

Visit the living with chronic pain page for more information about exercise and relaxation techniques.

Occupational therapy can help you manage your everyday activities around fibromyalgia. The aim is to do this without increasing your pain or overwhelming yourself.

Your occupational therapist may suggest new ways to do things. They may be able to support you to continue to work, if you want to.

Access to Work has information on how to get or stay in work if you have a health condition or disability.

Group support

Some pain clinics offer pain management programmes run by a team of specialists. These specialists can include physiotherapists and psychologists. They can provide support to develop coping skills and manage your activity levels.

Speak to your GP if you think you’d benefit from a pain management programme.

Talking therapies

Talking therapies can help you manage the stress of living with fibromyalgia.

Examples of talking therapies are:

• cognitive behavioural therapy (CBT) – a treatment approach to help you understand the link between how we think and what we do
• acceptance and commitment therapy (ACT) – often used for pain management

Medication

Medication can’t treat fibromyalgia but it can help reduce some symptoms. Speak to your GP or pain specialist to find out the potential benefits and risks.

Your GP will likely suggest you try exercise, CBT and physiotherapy first. This is because these treatments are more likely to help.

Antidepressants can help some people with fibromyalgia. They help:

• relieve pain
• treat sleep problems

This can be useful even if you haven’t been diagnosed with depression.

Other medications can be used for the treatment of fibromyalgia symptoms, but they’re likely to be less effective.

Speak to your GP, pharmacist or healthcare professional if you’re taking medication and you don’t feel its helping.

Alternative therapies

Some people with fibromyalgia try complementary or alternative treatments, like acupuncture or massage.

There’s little scientific evidence that these treatments help in the long term. Some people find that certain treatments help them to relax and feel less stressed. This allows them to cope with their condition better.

If you decide to use complementary or herbal remedies, check with your GP or healthcare professional first. Some remedies can react unpredictably with other medication, or make it less effective.