Chronic pain

Also called Persistent pain, Chronic primary pain

Pain lasting beyond three months, often with no ongoing damage to find. Real, measurable, and badly served.

What it is

Being told there is nothing wrong is the sentence people with chronic pain remember for years. It is meant as reassurance. It lands as an accusation.

Acute pain is an alarm about tissue damage. Chronic pain is an alarm system that has become oversensitive and stayed switched on after the damage healed, or without any damage in the first place. The pain is entirely real: brain imaging shows it. What it is not is a reliable report about the state of the tissue.

Between a third and half of UK adults report chronic pain of some kind. It is the commonest reason people stop working before they intended to.

Signs you might notice

Pain persisting beyond three months, often spreading beyond where it began.

Sleep wrecked, which lowers the pain threshold, which wrecks sleep further.

Movement avoided, so muscles weaken, so movement hurts more.

Mood dropping, and then being offered as the explanation for the pain rather than a consequence of it.

Brain fog and poor concentration, sometimes called fibro fog when it accompanies fibromyalgia.

How it can affect day-to-day life

The medical journey does its own damage. Repeated tests that find nothing, referrals that go nowhere, and the slow suspicion that nobody believes you.

The boom and bust pattern is close to universal. A good day gets used to catch up on everything, which causes three bad ones, which makes the next good day feel even more precious. Around and around.

NICE guideline NG193 made a finding in 2021 that surprised a lot of people: for chronic primary pain, the evidence does not support starting opioids, paracetamol or anti-inflammatories, because long-term harm outweighs benefit. Exercise, therapy and antidepressants have better evidence than painkillers do.

Supporting someone well

Believe the person. This is not a soft opening, it is the intervention with the largest effect on outcome.

Pace by the clock, not by how it feels. Fixed activity, fixed rest, on good days as well as bad. Pacing breaks the boom and bust cycle and nothing else does.

Keep moving within limits. Rest is right for acute injury and wrong for persistent pain.

Treat sleep as a target in its own right.

Aim at function rather than at a pain score. "I got to my grandson's assembly" is a better goal than "the pain went from 7 to 5", and it is far more achievable.

Fiducia Life tracks how days actually went, which is what makes pacing possible: the pattern is invisible from inside it and obvious over a fortnight of records.

Where to get help

Ask a GP for referral to a pain management programme. These are group programmes built on the NG193 evidence, and they help more than most people expect.

Arthritis UK and Pain Concern both run helplines.

If pain changes character suddenly, or comes with weakness, numbness in the saddle area or loss of bladder control, that is urgent. Go to A and E.