Chronic pain — defined as pain lasting longer than 3 months beyond expected healing time — affects approximately 28 million UK adults. It’s not just acute pain that has persisted; it’s a fundamentally different condition involving changes in the nervous system itself. Understanding this changes how it should be managed.

How Chronic Pain Differs from Acute Pain

Acute pain is a warning signal — pain that serves its biological purpose of alerting you to tissue damage. Chronic pain involves central sensitisation: the pain processing system in the spinal cord and brain becomes amplified and hypersensitive, transmitting pain signals even in the absence of ongoing tissue damage. This is why imaging findings often don’t correlate well with pain levels in chronic conditions like back pain and fibromyalgia — the pain is real, but it’s generated by a sensitised nervous system rather than active tissue damage.

Why Standard Analgesics Often Disappoint in Chronic Pain

Paracetamol and NSAIDs target peripheral inflammatory mechanisms and are most effective for nociceptive (tissue damage) pain. For central sensitisation or neuropathic pain, these drugs have limited effect. Long-term use of opioid analgesics for chronic non-cancer pain is associated with tolerance, dependence, hormonal effects, opioid-induced hyperalgesia (worsening pain sensitivity), and poor long-term functional outcomes. NICE guidance on chronic primary pain (updated 2021) recommends against opioids, NSAIDs and paracetamol as long-term treatments for chronic primary pain and instead prioritises exercise, psychological therapies and selected antidepressants (amitriptyline, duloxetine).

Multi-Modal Management: What Works

Exercise — the most consistently evidence-based intervention for virtually all chronic pain conditions. It reduces central sensitisation, improves mood, builds capacity. Start gently and progress gradually. CBT-based pain management — acceptance and commitment therapy (ACT) for pain has strong evidence. Pain management programmes are available on NHS referral. Pacing — activity management to avoid the boom-bust cycle (overactivity when feeling better leading to flare and complete rest). Sleep optimisation — poor sleep amplifies pain; addressing sleep can reduce pain significantly. Topical agents — diclofenac gel, capsaicin cream and lidocaine patches can provide localised relief with minimal systemic effects.

Browse Pain Relief at Huncoat Pharmacy. For persistent or severe chronic pain, seek medical assessment. Related: Sports Injuries Guide, OTC Pain Guide.

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