Chronic pain explained

Chronic pain is pain that lasts more than three months or longer than expected. Chronic pain can happen for many reasons, including after surgery or an injury, or as a result of another condition. This information is about chronic pain that is not caused by cancer.

 
0

What is chronic pain?

Chronic pain is pain that lasts more than three months or longer than expected for healing after surgery, an injury or a condition. The cause may also be unknown.

When the cause is not cancer, it is called chronic non-cancer pain. This information focuses on chronic non-cancer pain.

Pain that is temporary and doesn’t last long is often described as acute pain. 

People can experience acute and chronic non-cancer pain in many different parts of their bodies. Read more about different conditions and injuries that can have pain as a symptom.

How does chronic pain happen?

For a lot of people, chronic non-cancer pain has an explainable cause. It could be the result of surgery or an injury, or a symptom of a chronic condition like osteoarthritis or migraine.

But sometimes the cause of chronic pain is harder to identify. This can be frustrating for the person experiencing the pain, and challenging to treat.

How can pain be felt when there isn’t a clear cause? Pain scientists have recently developed a better understanding of chronic pain. This has helped to improve treatment.

We now know that for some people chronic pain changes the way the nerves, spinal cord and brain work together. The changes mean that incorrect messages travel from the nerves and spinal cord to the brain. As a result, the brain sometimes reacts as if there is harm even when there isn’t, and the person feels pain.

Find out more about how pain works

Environment can influence how pain is experienced

In addition to changes to nerves, spinal cord and the brain, chronic pain is also affected and influenced by a person’s environment. This includes emotional health, cultural behaviours and beliefs, and social expectations of how people should manage pain. 

Understanding how these factors can affect pain and learning how to change them can help improve the pain, quality of life and ability to do things.

Watch a video from the Pain Management Network, which explains more about how chronic pain works.

You and your health professional

Your doctor and other health professionals can help you manage chronic non-cancer pain. To do this, they will need to know how pain is affecting your daily life. 

Here are some questions they may ask you. Think about these before you see them.

  • How does chronic pain affect your activities of daily living?
  • How does chronic pain affect your relationships and role in your family?
  • How does chronic pain make you feel?
  • Can you describe what the chronic pain feels like? What brings it on?
  • Is there anything that makes it better, even for a short time?
  • What other symptoms do you have when you are experiencing the pain?
  • How well do you sleep?
  • What would you like to be able to do that the pain is stopping?
  • What medicines and treatments have you tried?

You can use My Health Plan (developed by NSW Agency for Clinical Innovation) to record information about the pain you are experiencing, how the pain affects you and what your personal goals are for treatment. Take a copy with you when you visit your health professional.

Managing chronic pain

Chronic non-cancer pain management has several goals. It aims to improve your quality of life and ability to do things. It also aims to reduce the pain you’re feeling, if possible, rather than trying to stop it completely. 

The idea is to stop pain from disrupting your life.

Medical experts recommend that management should start with a combination of:

  • simple treatments, such as learning about the nature of the pain, self-management strategies, and physical activity that is slowly increased
  • psychological and mind-body treatments that address underlying thoughts, feelings, emotions and behaviours, mindfulness and relaxation
  • familiar pain relief medicines, such as  paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs).

Each of these treatments alone may have a small beneficial effect. But they can be more effective when combined. For example, combine physical activity with learning about chronic pain. Then add identifying unhelpful thinking and learning a coping strategy such as mindfulness.

If you have tried this combination of treatments and not felt enough improvement, you may be prescribed a medicine called an opioid. 

Opioid medicines come with a risk of harm. These harms can be mild (eg, constipation) or significant (eg overdose or death). Careful consideration of a person’s individual needs and health conditions, particularly the benefits and harms, must be part of a decision to prescribe an opioid.

Find out more about opioid medicines and chronic pain

Start with these treatments

Medical experts recommend starting with a combination of treatments when managing chronic pain. These may include:

  • learning about chronic pain
  • self-management
  • physical activity that gradually increases
  • physical techniques
  • psychological treatments.

Learning about chronic pain

Research studies have shown that understanding the pain that you’re feeling can improve your symptoms. 

This approach involves learning that your experience of pain can be affected by many different parts of your life, not just causes of chronic pain. Emotions, cultural and social expectations, and personal beliefs can alter how you feel pain. 

This is called a biopsychosocial approach to pain.

Self-management

Self-management involves developing the skills to manage the pain more independently. This means taking an active role in your treatments and making lifestyle changes yourself with your health professional’s guidance.

Self-management emphasises the importance of talking and working with your health professionals. This two-way relationship involves you in your care, rather than passively receiving or not having a say in your treatment.

Physical activity that gradually increases

When someone is experiencing pain, being active may seem too difficult. But it is achievable if you start at a low level without causing a ‘flare up’ and then gradually increase it. Medical research has found that activity helps to reduce pain.

Read the Pain Management Network for information about physical activity for chronic pain

Physical techniques

Physical techniques can be completely passive (eg, heat packs, massage, mobilisation, manipulation) or partially passive (eg Feldenkrais therapy, a method for improving movement, sensation, posture and breathing). 

Many people find heat packs and massage helpful to begin with. But it’s best that you don’t rely on these long term. Start to increase more active techniques as soon as possible.

Psychological treatments

Psychological treatments for chronic pain include cognitive behavioural therapy (CBT), hypnosis, relaxation, meditation, mindfulness, acceptance and commitment therapies, psychoanalytic and psychodynamic therapies.

They’re all different treatments. But some of them share features such as active listening, reassurance and encouragement. 

Others have specific features such as the CBT approach to pain. It helps you identify thoughts, feelings and behaviours that may be contributing to pain and encourages you to make behaviour changes to address them.

If you need medicines, start with these

It’s unlikely that medicines on their own will be able to completely stop chronic pain.

Medical experts recommend them only in combination with treatments such as self-management, physical activity and psychological approaches.

The following medicines can be considered when starting to treat chronic pain:

  • paracetamol
  • non-steroidal anti-inflammatory drugs (NSAIDs)
  • antidepressants
  • anticonvulsants/antiepileptics.

Paracetamol

Paracetamol can reduce the severity of chronic pain. It is usually recommended in addition to other medicines. If pain levels are not improving with paracetamol, speak with your doctor about changing or stopping this medicine.

Non-steroidal anti-inflammatory drugs (NSAIDs)

NSAIDs, such as ibuprofen and diclofenac, may be able to give short-term relief of pain. 

These medicines should be taken at the lowest dose possible for the shortest period of time because they can affect the heart and blood vessels, with effects ranging from a rise in blood pressure through to severe conditions, including heart attack. 

They may also affect the stomach and intestines, causing problems such as bleeding and ulcers, and lower the ability of the kidneys to work properly.

Antidepressants

Medicines normally used to treat depression, such as tricyclic antidepressants, can help reduce some types of chronic pain, including nerve (neuropathic) pain.

An example is amitriptyline. Lower doses are used to treat pain than to treat depression. But these medicines can have side effects, such as a persistently dry mouth, reduced sex drive and constipation, which can make them hard to tolerate.

Find out more about amitriptyline for nerve pain

Anticonvulsants/antiepileptics

Medicines originally developed to treat epilepsy,  such as pregabalin and gabapentin, may relieve pain for some people with chronic nerve (neuropathic) pain.

Find out more about pregabalin for nerve pain

For more information on your brand of medicine, see the Consumer Medicine Information (CMI), available in the NPS MedicineWise Medicine Finder.

Find out more about pain medicines

Is there a role for opioid medicines?

Opioids can be used to treat acute pain and chronic pain caused by cancer. However their role in the management of chronic non-cancer pain is limited.

If you have tried the treatments and medicines recommended when starting to treat chronic non-cancer pain but have not had enough improvement, you may be prescribed an opioid.

Opioid medicines include:

  • buprenorphine
  • codeine
  • fentanyl
  • hydromorphone
  • methadone
  • morphine
  • oxycodone
  • tapentadol 
  • tramadol.

For more information on your brand of medicine, see the Consumer Medicine Information (CMI) available in the NPS MedicineWise Medicine Finder.

What we know about opioids

Opioids can improve pain and the ability to do day-to-day tasks. But this improvement is small. In fact, it is so small that it may not be important for people with chronic non-cancer pain.

Harms from taking opioids, such as constipation, nausea and sleepiness, are extremely common.

The longer someone takes opioids, the more likely it is that they will experience side effects and need to increase their dose to achieve the same pain relief ( this is called tolerance). Tolerance exposes them to a greater risk of overdose leading to death.

Talk to your health professional

Before taking opioids for chronic non-cancer pain, talk with your health professional. You need to:

  • weigh up the benefits and harms of these medicines
  • develop a health plan
  • discuss treatments that don’t involve medicines, and other pain medicines that may help reduce pain and improve your quality of life and ability to do things.

Read more about opioid medicines and chronic pain

Resources and support