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Chronic Pain

The below information is purely for educational purposes and does not constitute medical advice. This content should not be used as a substitute for professional medical advice.

Chronic pain is a type of pain that lasts longer than three months and feels like it’s not getting any better. There are many conditions that can cause chronic pain, and sometimes the cause is unknown. The management of your chronic pain can depend on your specific condition and other needs.

In this guide we go through all of your options for managing chronic pain.

Chronic Pain Definition

Chronic pain is any pain the lasts longer than 3 months. Pain can be an unpleasant physical or emotional experience caused by actual or possible damage to our bodies.

An example of chronic pain is long-lasting knee pain. You might need to take medicines or practise daily exercises to manage the knee pain.

For some people there is an obvious ongoing cause of the pain. For others the cause of the pain has gone, or there was no obvious cause to start with. Every person’s pain is as unique as they are and should be managed individually.

What Causes Chronic Pain?

What are the common causes of chronic pain?

There are many common causes of chronic pain. These can include problems with the muscles, bones and joints, such as arthritis and back pain. Other causes include injury to nerves, cancer, or surgery.

Whether there is an underlying cause for your chronic pain or not, there are many options to improve what you can do and how you feel.

Chronic Pain Symptoms

What are the common symptoms of chronic pain?

Common symptoms of chronic pain include:

  • Dull throbbing in the area of pain
  • A sudden sharp pain once every so often
  • Tingling or numbness in the area
  • Finding it difficult to move around due to the pain
  • Feeling unable to sleep well because of the pain
  • The pain getting worse when you make certain movements
  • Lingering pain that you need medication for to carry on with your day

Your experience of chronic pain is unique to you. Pain can be constant, or it comes and goes. You might find there are specific triggers that can increase how much pain you feel. This sudden increase in pain is known as a flare-up.

Some people with chronic pain have what we call neuropathic symptoms. These are unusual feelings that may be due to nerve damage. They are often described as a burning, tingling or numb feeling in the area where they get pain.

How to cope with chronic pain​

Medications used for chronic pain

Medications that are used for chronic pain include those you can buy yourself without a prescription. These are called over the counter (OTC) medications which you get from a pharmacy, and include:

  • Paracetamol
  • Non-steroidal anti-inflammatory medicines (NSAIDs), such as aspirin, ibuprofen or naproxen
  • Co-codamol, which contains codeine and paracetamol
  • Codeine with ibuprofen

Some medications need to be prescribed by a doctor and include:

  • Different NSAIDs, such as diclofenac
  • Amitriptyline
  • Pregabalin
  • Gabapentin
  • Opioid medicines, such as codeine, dihydrocodeine, tramadol, morphine, buprenorphine, fentanyl or oxycodone
  • Lidocaine patches
  • Capsaicin
  • Medical cannabis, from a doctor that is a specialist prescriber

In pain clinics or hospitals, doctors might suggest an injection to areas that are causing chronic pain. These injections may contain corticosteroid medicines to reduce swelling and numb pain. They can relieve chronic pain for a long time. In some cases, pain can be relieved for a few months or years.

Chronic Pain Conditions

Common conditions that cause chronic pain

Your chronic pain might be from another source or have no obvious condition causing it.

It’s worth seeing a medical expert, such as a doctor that specialises in chronic pain, to understand your needs and help you manage your chronic pain. They can also try to determine what the cause of the chronic pain could be and offer effective ways to treat it.

Common conditions that cause chronic pain include bone, muscle and joint issues, such as:

Problems with the brain or nerves can cause chronic pain, including:

  • Headaches
  • Nerve damage

Pain from internal organs that can cause chronic pain include:

How is Chronic Pain Diagnosed?

Chronic pain is usually diagnosed by taking a thorough history and examination to identify the type of pain, severity, functional impact and context.

Patients with musculoskeletal pain may benefit from X-Rays of the affected joint(s).

In neuropathic pain, nerve conduction studies and electromyography are frequently used to identify which nerves are affected.

A clinician may make recommendations for other investigations depending on the underlying cause of the pain.

Chronic Pain Treatment

NICE chronic pain guidelines

NICE is the National Institute for Health Care and Excellence. The NICE chronic pain guidelines help doctors and other healthcare professionals in the UK decide how to treat chronic pain.

In the NICE chronic pain guidelines, they state that the team that treats you should:

  • Focus on treating you as a whole, rather than just your condition
  • Think about other possible causes of your pain
  • Ask how your pain affects you
  • Ask about activities that affect your pain
  • Provide you with advice and information
  • Develop a care and support plan, including how to manage flare-ups of pain

There are specific NICE chronic pain guidelines for conditions like:

For chronic primary pain, NICE recommends these chronic pain treatments:

  • Exercise and general daily physical activity
  • Psychological therapy, such as acceptance and commitment therapy (ACT), or cognitive behavioural therapy (CBT)
  • Acupuncture
  • Medication, starting with antidepressants

Ways to relieve chronic pain

Here are some helpful ways to relieve chronic pain without medication:

  • Staying active – find what you can manage to do each day, and work your way up to 30 minutes per day
  • Reducing stress – this can include mindfulness meditation, thinking of ways to relax or considering seeing a professional therapist
  • Social activities – these can include meeting with other people who can share how they manage their chronic pain
  • Seeing a physiotherapist if the chronic pain is due to bone, muscle or joint problems
  • Speaking to a doctor that specialises in chronic pain treatment

You may need to try more than one way to relieve chronic pain, and some ways will work better for you than othersWatch this documentary online to see how others deal with living with chronic pain.

Chronic Pain and Medicinal Cannabis

Research into the effect of medicinal cannabis on chronic pain is limited. However, following the legalisation of cannabis for medical purposes in 2018, there has been a rise in people looking towards medical cannabis. When first-line therapies have not proved effective at reducing symptoms, medical cannabis may be considered an option for chronic pain.

For further information and to find out more about medical cannabis, click here to discover more about our multi-award-winning Sapphire Access Scheme. Alternatively, complete an eligibility assessment now. Once complete, one of our clinicians will review your application and advise whether you are eligible for progression to an appointment.

 

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Frequently Asked Questions about Chronic Pain

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Physiotherapy can be an effective treatment of chronic pain. Officially, the NICE chronic pain guidelines recommend physiotherapy and physical activity as chronic pain treatments.

Many pain clinics have physiotherapists as team members. They can help you manage your chronic pain in several ways, such as:

  • Using a supervised exercise program, where they find exercises that allow you to remain active and relieve chronic pain
  • Manual therapy, where they move parts of your body where you feel pain to relieve it
  • Therapies like acupuncture, where very fine needles are placed in the skin to relax muscles and stimulate nerves to relive chronic pain

The NICE chronic pain guidelines advise that exercise programs and physical activity are a core part of managing chronic pain. Physiotherapists are experts in helping suggest which activities and exercises can help you with your specific chronic pain needs.

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Cognitive therapy is a type of cognitive behavioural therapy (CBT). It’s also known as psychotherapy or a talking therapy. The NICE chronic pain guidelines recommend both CBT, and acceptance and commitment therapy (ACT) as effective chronic pain treatments.

Pain clinics are likely to have a psychologist, therapist, or trained counsellor as part of their team to provide cognitive therapy for chronic pain.

With psychological therapies, you need to try them for a while to see if they’ll work for you. You might find some of the techniques you learn through ACT or CBT are helpful and an effective way to treat chronic pain long term.

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Acupuncture is a chronic pain treatment that is recommended in the NICE chronic pain guidelines. With acupuncture, very fine thin needles are placed in specific places in the skin to relax muscles and stimulate nerves to relieve chronic pain.

Acupuncture can give you short or long-term pain relief depending on the type of chronic pain you are treating. You may need to get acupuncture more than once for it to be an effective chronic pain treatment. Normally, you’ll have one or two sessions of acupuncture per week for a few months.

It’s important to make sure you get acupuncture treatment for chronic pain from a qualified healthcare professional, so we recommend that you get acupuncture at a pain clinic or with a certified physiotherapist.

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Some painkillers are available without a prescription, and these are called over the counter (OTC) painkillers you can get from a pharmacy.

Over the counter painkillers for chronic pain include:

  • Paracetamol
  • Non-steroidal anti-inflammatory medicines (NSAIDs), such as aspirin, ibuprofen or naproxen
  • Co-codamol, which contains codeine and paracetamol
  • Codeine with ibuprofen

A pharmacist will be able to advise you on which over the counter painkiller is right for your chronic pain. If you need to use OTC painkillers regularly or find that they’re no longer helpful, you should see your doctor for advice and to get different medicines.

You can see a doctor that specialises in treating chronic pain or try going to a pain clinic for chronic pain treatment.

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There’s some evidence that chronic pain can be hereditary. This means it’s caused by genes that you get through your parents and there’s a higher chance that you’ll have chronic pain at some point in your life.

One condition which might cause hereditary chronic pain is fibromyalgia. Fibromyalgia is often experienced as widespread body pain with other symptoms, such as tiredness and concentration problems. Having a close relative with fibromyalgia makes it more likely that you’ll have it and get chronic pain as a result.

There is less evidence for other chronic pain conditions being hereditary at the moment, but more research is being done by scientists to find out more.

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To help you sleep when you have chronic pain, you can try:

  • Setting an alarm an hour before bed to get ready to sleep
  • Having a bedtime routine, such as having a shower, brushing your teeth and then reading a few pages of a book
  • Going to sleep and waking up at a regular time every day
  • Meditating before bed to help you relax, even if it’s just for a couple of minutes
  • Writing down any thoughts on your mind into your journal or a notepad
  • Time your chronic pain medication around your sleep time, so it lasts all night
  • Listen to calming music or podcast
  • Gentle stretching to relieve tension in the area you’re experiencing chronic pain

If you find it difficult to sleep throughout the night and wake up every few hours, you may want to consider seeing a specialist doctor. A pain clinic can offer you advice and chronic pain treatment options.

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You can manage your chronic pain naturally, which means without taking medications or having medical interventions. As with all chronic pain treatments and management techniques, what may work for you may not work for someone else.

Here are some suggestions on how you can manage chronic pain naturally:

  • Physiotherapy, including exercises and manipulation of painful areas
  • Psychological therapies, such as cognitive behavioural therapy (CBT) or acceptance and commitment therapy (ACT)
  • Exercise, which is gentle enough that it does not make your pain worse
  • Acupuncture, may be available in pain clinics

You can also try keeping a chronic pain journal to keep track of:

  • What’s working for you
  • What you’d like to improve
  • Anything you’d like to speak to a healthcare professional about
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Pain is classed as chronic when you have pain that lasts longer than three months.

This does not mean that you should wait to see a doctor if you are in pain. If your pain has not gone away after an injury or is getting worse then you should get medical attention.

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The best way to find out how to support someone with chronic pain is simply to ask them what they need help with. Each person with chronic pain is an individual, with needs as unique as they are.

Here are some ways that you can support someone with chronic pain:

  • Communication – talking with them, and not just about pain, is one of the most helpful things you can do
  • Socialising – spend time together over the phone, or visit them regularly and help them visit others too if you can, as chronic pain can be very isolating
  • Purpose – help them set and achieve goals, and celebrate special occasions together
  • Independence – help them live their life on their own terms
  • Seek help – get advice from chronic pain communities, or a chronic pain charity such as Pain UK
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Chronic pain can be cured in some people, depending on the cause and the treatments available for their condition.

In cases where chronic pain cannot be cured, it can be managed. There are many ways to relieve chronic pain, so you can live life the way you want to.

There are a lot of healthcare professionals and scientists around the world that research chronic pain to find new and effective chronic pain treatments.

At Sapphire Medical Clinic, we have created the UK Medical Cannabis Registry to support research into chronic pain treatment.

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