Persistent Pain

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Overview

Persistent pain (sometimes called chronic pain) is described as pain that lasts for 3 months or more despite standard medical treatment.

It is surprisingly common and affects 1 in 5 people and the cause for the ongoing pain is no longer related to tissue damage, but due to an over sensitive pain protective system. This system can be influenced by multiple things including thoughts, feelings and beliefs as well as confidence to move the painful area again.

Persistent pain can be in specific part of the body like the back, shoulder or legs, or throughout the whole body. Pain may be constant or vary in its level. It can flare up or become worse very quickly and often for no obvious reason. You can often experience other symptoms as well as pain, including numbness, burning or electric shocks.

Although persistent pain can be more complex, it can still be improved through understanding pain better and changing the way you approach it. Start tackling your persistent pain today by learning more about pain, how to cope better and treat it yourself.

Watch this 5-minute video for starters and then learn even more about your pain and ways to improve things in the other sections.

Types of persistent pain

Unlike the other body regions, you cannot divide persistent pain into different types as the reason for ongoing pain is less related to tissue damage and more as a result of an over sensitive pain system, which can often be due to many factors.

Persistent pain can be experienced anywhere in the body although the most common areas are the back and neck regions.

We all have experienced pain at some point in our life and it is an essential function of the nervous system, providing the motivation for us to act and protect the body.

It is a very unique experience to each of us and your pain will not be same as your family and friends.

Our understanding of persistent pain has increased over recent years and it is important that people living with pain also learn about these scientific findings as this has been proven to help reduce pain and give you more control over things.

The Self Help section has lots of information that will guide you in different ways to cope with symptoms and improve your functional ability so you follow the path to recovery below:

Is my pain likely to persist?

This quick questionnaire can help you identify how likely your pain is to persist over the next 6 months and whether you may need some extra support. It has been developed by a team of experts from Keele University – Click here for more information about the tool.

The tool has been shown to be very useful for people with common Musculoskeletal pain to profile individual risk of having a poor recovery and to use as a guide in conjunction with support from a healthcare professional if necessary.

Try out the questionnaire for yourself to see how you score and to get further help and advice. It will also be useful to retake the questionnaire after you have learned more key facts about your pain, either from this website or from a healthcare professional, to re-assess in time whether your persistent pain problem is improving.

For question 1 – 9, think about just the last two weeks:
Pain intensity
1. On average, how intense was your pain? [where 0 is “no pain”, 10 is “pain as bad as it could be”]











Select one of the options for each question below Yes No
2. Do you often feel unsure about how to manage your pain condition?
3. Over the last 2 weeks, have you been bothered a lot by your pain?
4. Have you only been able to walk short distances because of your pain?
5. Have you had troublesome joint or muscle pain in more than one part of your body?
6. Do you think your condition will last a long time?
7. Do you have other important health problems?
8. Has pain made you feel down or depressed in the last two weeks?
9. Do you feel it is unsafe for a person with a condition like yours to be physically active?
10. Have you had your current pain problem for 6 months or more?

High Risk

This test suggests you have some serious concerns about how well you will recover and this could be part of the reason your pain is persisting.

This may be related to feeling low and anxious generally or by being afraid that you might have done something serious, which is rarely the case.

It might help to discuss your concerns with a doctor or physiotherapist if things are still not improving over the next few weeks after following the advice and exercise in the Self Help.

Allowing yourself to move normally, without too much worry, will help you to return to normal.

If you are feeling low or anxious, whether this I related to your persistent pain or not, and you would like further help and support, visit NHS website – Health in Mind.

Alternatively, Click Here for an interactive online self-help programme to help manage symptoms of depression and anxiety.

Medium Risk

This test suggests you may have some doubts about how well you will recover.

This may be related to feeling low and anxious generally or by being afraid that you might have done something serious, which is rarely the case.

It might help to discuss your concerns with a doctor or physiotherapist if things are still not improving over the next few weeks after following the advice and exercise in the Self Help.

Allowing yourself to move normally, without too much worry, will help you return to normal.

You might also want to access the Essex Lifestyle Service for further support and help on making healthy lifestyle choices and live healthier lives as this could be contributing to your persistent pain.

Low Risk

Congratulations! You most likely have the right ideas about your pain, and feel in control of how you manage your recovery.

We all know an episode of pain is very annoying, and at times extremely painful. Carrying on as normal and continuing to move allows the quickest recovery, and stops you stiffening up.

Keep going as you are, although read this short leaflet for more information and advice to get better even quicker.

You might also want to access the Essex Lifestyle Service for further support and help on making healthy lifestyle choices and live healthier lives as this could be contributing to persistent pain.

Please select all options.

Self help

Evidence has shown that people who understand their Musculoskeletal health problem and take an active involvement to help themselves have a much better outcome.

Here are some really helpful leaflets, videos and useful links to other websites that have been approved by our physiotherapists so that you can start getting better with your persistent pain today!

This information is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment if required. All content is for general information purposes only.

leaflets

Persistent_pain
Source: Healthshare Clinical Services
Explaining_pain
Source: My Live Well With Pain
footsteps
Source: My Live Well With Pain
your_journey
Source: My Live Well With Pain
Source: Beefree

Videos

Understanding Pain in less than 5 minutes, and what to do about it!
PlayPlay

This is a great, easy to follow 5-minute video about persistent (chronic) pain. It helps you understand what current research has been saying about persistent pain and the role of the brain and nervous system.
Source: Live Active

A short 90 second video on how pain is influenced by a number of factors using the cup analogy for pain
PlayPlay

A short 90 second video on how pain is influenced by a number of factors using the cup analogy for pain
Source: Greg Lehman – Movement Optimism

Persistent pain - BeeFree
PlayPlay

Learn ways to make changes today that will improve your mind and movement for persistent pain and mental health issues. Watch this video support which has been put together by people with persistent pain working with experts at Keele University, Mind and the NHS.
Source: BeeFree

Tame The Beast — It's time to rethink persistent pain
PlayPlay

It’s time to rethink persistent pain and take a new approach to dealing with and reducing your pain. Watch this excellent 5-minute video where leading pain scientists explain new discoveries - like how you think about your pain can change the way it feels.
Source: Tame the Beast – It's time to rethink persistent pain

Neuro Orthopaedic Institute NOI
PlayPlay

Do you have any thought viruses related to your pain? Check out this short video to learn more about these thought viruses and how these might unknowingly be contributing to your persistent pain.
Source: Neuro Orthopaedic Institute NOI

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Useful Links

  • Public health campaign to change the way you think about, talk about and treat persistent pain to improve the lives of you and your loved ones forever.
  • Excellent resource for people with persistent pain to help you understand your pain better, listen to real stories of people sharing their lived experience of recovering from pain and start learning how to retrain your pain system.
  • You are not alone! A support guide for mind and movement for people with persistent pain and mental health issues. Learn the Top 5 Tips for feeling better.
  • Visit here for more resources for people living with persistent pain to support your long term effective self-management.
  • Learn 10 ways to reduce your pain. Get some useful pain-relieving tips today – no tablets required!
  • A comprehensive resource for people who live with persistent pain and healthcare professionals who support them. The Pain Toolkit helps people all over the world self-manage and cope with persistent pain.
  • How protective are you about your pain? Visit this website for more information, including the Protectometer handbook and app, if you want to learn more.
  • Discover ways to manage persistent (chronic) pain better.
  • Further support for people living with persistent pain including UK-based patient organisations.
  • Read about real patient’s positive stories of how they regained control of their pain and their lives by understanding and addressing the factors involved in their persistent pain problem.
  • If you feel your mental health is the cause or is being affected by your persistent pain, visit NHS Website – Health in Mind for further help and support including online self-referral if you require access to talking therapy treatments and live in the appropriate Essex region.
  • MoodGym is an interactive online self-help programme designed to help people prevent and manage symptoms of depression and anxiety whether related to their persistent pain or not.

Further Support

If your persistent pain or ability to do thing things is still not improving despite following the advice and guidance provided on the website for up to 6 weeks, you may require further help and support from your GP, Physiotherapy Service or other healthcare professional you may already be seeing for your pain.

Seek medical help if your symptoms have not been assessed by a healthcare professional and you’re struggling to manage the pain yourself to check whether investigations are required.

Blood tests, X-rays and scans are rarely needed although sometimes pain medication may be required for a short period whilst you get moving and gradually return to normal activities.

FAQs

You can continue to experience persistent pain long after the initial injury has healed.
It is not a simple problem. There is no dividing line between skin, muscles, nerves, the spinal cord, the brain and thoughts, beliefs and emotions – it is the nervous system as a whole that produces your pain experience.
The fact that environmental and emotional factors can influence pain does not make it any less real.
See rest of ‘Persistent Pain’ section to learn more about why you still hurt.
Not necessarily - Persistent pain often reflects a problem with the pain system itself rather than damage in a particular part of your body. It's a bit like a fire alarm that sounds without a fire.
Persistent, or chronic, pain is a valid diagnosis. Just because you haven't been given a specific diagnosis, such as a torn ligament or compressed nerve, doesn't make your persistent pain any less real.
No - Not in the majority of cases and can actually do more harm than good.
Pain is poorly correlated with x-rays and scans and many changes seen are part of the natural ageing process and are not predictive of pain and are not a reason to avoid activity. Many people will have these appearances on imaging, whether they have pain or not. See this link.
Remember that persistent pain is less to do with local tissue damage and more due to an over sensitive pain protective system so an X-ray or scan will not help with guiding further management. You can still be experiencing pain with a ‘normal’ x-ray or scan.
Don’t worry if you’ve already had these types of investigations and have been told you have ‘degeneration’, this finding is not a reason to stop activity or to just accept being in pain. Go to Self Help section for more information.
Stronger medication is not necessarily more effective and can result in unpleasant side effects.
You might even become dependent on the medication. People can develop a tolerance to medication they use regularly, meaning they need stronger and larger doses to get the same pain relief.
Also, the drugs that are often used for acute pain are not usually effective for persistent pain.
No – Persistent pain is less to do with an injury to your body and more to do with the brain and nervous system. Pain is like an alarm system that occurs when the brain perceives threat of damage to the body and wants us to act. Therefore, pain can still be felt even after the body tissue has healed and the longer pain persists, the weaker the link between damage and pain.
Hurt is rarely equal to harm with persistent pain so it’s still safe to move even if you are feeling pain but do this in graded way so that you slowly build up a tolerance. This gradual exposure to movement can in fact reduce the threat value to the nervous system and slowly reduce pain as well as build confidence to be more active.
Yes, absolutely.
The sensitivity of the nervous system can be turned up or down by many factors so stress can certainly make the system more sensitive and wound up, which in turn can increase pain and muscle tension. This can then lead to more stress due to pain which sets up a vicious cycle that can be difficult to get out of sometimes. See Self Help section for more useful strategies to break this cycle.
Ongoing stress has also been shown to have physical effects on body tissues that can make people more susceptible to injuries or episodes of pain in the first place. This can sometimes explain why you can suddenly feel pain one day when carrying out a movement or activity you’ve down a thousand times before without any problem.
Therefore, it’s really important you develop ways to help manage your stress, if necessary, to help manage your persistent pain better. Watch this short video to learn the single most important thing you can do for your stress. If you are feeling stressed, anxious or low in mood and you would like further help and support, visit NHS website - Health in Mind website for more information.
No – No one asks for a persistent pain problem to develop, and no one deserves the suffering that can come with it.
In the UK it is estimated that one in 5 people experience persistent pain, so there are many people like you living with pain. However, pain does not need to lead to long term suffering if you can learn new ways to understand pain and manage the problem better.
See the Self Help section for further information.
Yes and No – We now know that every pain experience we have is produced 100% of the time by the brain. This includes acute pain, such as twisting your ankle or stubbing your toe, when there is a clear injury to local tissue as well as persistent pain where the ongoing pain experienced is less to do with tissue damage. However all pain, including persistent pain, is still felt in the body.
It is common for people with persistent pain to feel like others doubt that their pain is real. Persistent pain may not be visible on a scan or to others around you, but it is a recognised condition that is based in the central nervous system (brain and spinal cord).
When you have been appropriately investigated and have been diagnosed with a persistent pain condition, it may be time to look at the ways you can manage this condition.
It is important however, to know that giving up trying to find a cure does not mean giving up on the problem entirely – it simply means that you may have to take a different approach. This will likely mean enhancing your ability to self-manage the pain. See Self Help section for further information.