Pain UK FAQs

The IASP (International Association for the Study of Pain) definition states “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.” 

The difference between short-term (acute) pain and long-term (chronic/persistent pain) is that long-term pain has lasted longer than the time it takes for the body to heal. It is therefore a medical condition in its own right. Clinicians define chronic pain as a persistent pain which lasts longer than 3 months, though this timing can be arbitrary in the individual patient. 

Treatments for long-term/ chronic pain aim to reduce the impact that pain has on a person’s life. They include medicines (“painkillers”) such as paracetamol, codeine and morphine. Importantly, though, most treatments are non-medical, and include physiotherapy, physical activity psychological approaches, such as Cognitive Behavioural Therapy (CBT), and self-management (including lifestyle adaptations, pacing). Rarely, specialist treatments such as injections might help. 

It is important to highlight that these treatments do not tend to provide a complete resolution of the pain and often the benefits are not sustained for long periods of time. They should all be used as part of a long-term management plan established between the person experiencing the pain and the team of healthcare professionals, which includes non-medical treatments.

Medication is rarely, if ever, the only solution to long-term pain.  Sometimes medication causes more harm in the long-term than good.  If taken as part of an overall management plan, including non-medical approaches, and with support from your healthcare professional team, they can help to minimise reduce the overall negative impact that pain has on your life. As with any type of medication, it needs to be taken in balance with everything else, it should hopefully not affect one’s functional ability especially if taken long term.

Although there are some causes of long-term pain that can be diagnosed (e.g. endometriosis, diabetic neuropathy, arthritis) very often no definite cause can be found. This does not mean that the pain is not real there, it just means that it is not showing up on scans, X-rays, blood tests etc. This can be called “primary pain” and is a diagnosis in its own right. There are clear treatments and management strategies that will help you manage this type of pain the best way possible.

We recognise that when medical tests do not show anything specific this can be very upsetting, frustrating and some describe feeling like a fraud, or not believed. It is important for everyone to recognise that the pain you are experiencing is indeed real.

There are traditionally two main types of pain.  Neuropathic pain is caused by diseased or damaged nerves, and is evident in sciatica, shingles and diabetes, among many other diseases or conditions.  Nociceptive pain is caused by actual or threatened damage to anything other than nerves, and is more common.  One important difference is that medicines that help neuropathic pain do not generally help nociceptive pain, and vice versa.  More recently, a third type of pain is becoming recognised, related to pain hypersensitivity (where the pain system is overactive, even when there is no apparent damage).  This is known as Nociplastic pain and is the subject of current research.

You should always visit your doctor (or other healthcare professional) if you are worried about your pain.  Doctors and other healthcare professionals can help with looking for a cause of pain, rule out any serious cause, and then support its management.  It is important to find a cause if one is there to be found, so you should visit your doctor if you have developed unexplained long-term pain.  They will assess your pain and the impact it is having, and support you in developing a management plan.  If they recommend a pain medicine, they will also keep an eye on your prescriptions and any unwanted or potentially harmful side effects.  If your long-term pain is established and stable, you may not need to visit your doctor, other than for medication reviews.  However, you may be best to visit your doctor if your pain becomes suddenly worse (a flare-up), (there is any change) or if you have questions about other types of treatment.

Long-term pain is often stable, which means that it doesn’t change much from day to day.  This means that you can learn how best to manage it, in partnership with your healthcare team. However, it is also common that your pain can become suddenly worse, and this can be alarming.  This is a flare-up. Flare-ups are common among those living with long-term/chronic pain. They can sometimes happen when other things are going on. For example, they can happen at times of stress, or when you have another illness or injury.  Sometimes they happen for no apparent reason, and this can be alarming.  If you are worried about a flare-up you should visit your doctor.  However, it is also important to understand that flare-ups do happen, and to have a plan in place for managing them.

Pain Clinics are available in most secondary care (hospital) services.  They are run by healthcare professionals who are highly trained in supporting pain management.  These include doctors, nurses, physiotherapists, occupational therapists, pharmacists and psychologists, among other professionals.  You may be referred to a Pain Clinic if your doctor or other local healthcare professional wants to have your pain further assessed, or if they think that further treatment might be helpful in a specialist setting.  Importantly, Pain Clinics do not specialise in finding a cause for your pain, but aim to support you in managing it and help you improve your quality of life.

A Pain Management Course/Programme (PMP) is provided to help people live with their pain most effectively. You are usually referred to a PMP by a Pain Clinic.  PMPs usually run over several weeks, in a group setting.  They look at how pain happens, how it affects the different aspects of your life, and how you can manage your life in a positive way despite the pain.  There is input from a range of healthcare professionals, including physiotherapists, pharmacists, nurses and psychologists.  They offer the opportunity to learn from these experts and from other people living with pain. It is a journey of management that may not suit everyone, but research shows that for those that are keen to explore this approach it presents various benefits, such as improving quality of life.

Pain can be extremely difficult to live with, and many people experiencing long-term pain report that it stops them living the life they want to live. For some people, there is also a huge sense of loss, as they feel that they are not the same person that they were before. This naturally leads to a number of different feelings and emotions, such as feeling low and depressed, stressed, angry, frustrated, anxious etc. If this is the case, it is important to speak to your doctor as there is help available.

Having help for your mental health needs may aid in the overall journey of improving life and general wellbeing. 

“Disability” is quite a subjective term.  If your pain is substantially limiting your ability to do things, then you can be considered disabled.  Many people are able to live and work, despite having long-term pain, and do not want to consider themselves disabled.  If you do consider yourself disabled, you may be eligible for benefits such as PIP (Personal Independence Payment, and you might want to explore this further: https://www.gov.uk/pip

One issue is that pain is usually a private experience.  Unless you have an outward sign such as a walking stick or a wheelchair, people might not realise that you have pain, and may be disabled.  This can be frustrating, especially if people expect you to be able to do everything that they can, or that you used to.

The Equality Act 2010 sets out when someone is likely to have a disability and thus needs to be protected from discrimination. According to the Act a disability is present when both of these apply: 1. a ‘physical or mental impairment’; and 2. the impairment ‘has a substantial and long-term adverse effect on their ability to carry out normal day-to-day activities’. Here long-term means either continuously or on and off, lasting at least 12 months or for the rest of their life.

Pain is biological, psychological and social. This means that it affects our body, our mind, and our relationships with others. We can’t separate the mind from the body. Pain is a private experience that only you feel, but pain is normally expressed in our ‘pain behaviour’. The privacy of pain can make it hard for others to know that you are feeling pain. But, everyone needs to acknowledge that even if pain is not visible in behaviour or on MRI scans, it is real. Pain must be acknowledged. We also say pain is subjective i.e. it is the perception of the person who experiences it that matters.

Pain can affect various areas of one’s life including relationships. If you feel that your relationships may be affected by long-term pain it may be worth reaching out to the GP so that further help can be provided. There are services such as Primary Care Mental Health services who offer ‘Long-term Conditions’ support, or your GP may also consider a referral to Pain Management Services. If long-term pain is affecting your relationships, it is also likely that it may be affecting other areas of your life and therefore a multidisciplinary approach may be helpful.

Most important is to recognise the effect your pain is having on your work, and also the effect your work is having on your pain.  You should speak with your colleagues, boss and employer to explain the situation.  There are often things that can be done to help.  These might include a change in duties, or the way in which duties are done (for example more sitting).  You might ask for support such as being allowed to take more breaks, without reducing your overall workload.  If your work has an Occupational Health Department, or equivalent, they may be able to suggest workplace adaptations to allow you to keep working.  Sometimes, you may need to think about reducing your working hours so that you can keep working.  In extreme circumstances, a change of job, or stopping work altogether may be needed for your overall health.  However, being able to work is also important for overall health and wellbeing (not just because of the money).  It is much better to get support in adapting your job/workplace than to give up altogether.