Persistent (Chronic) Pain

Persistent pain is pain that lasts longer than three months. Sometimes the cause of the pain is apparent but often there is no evidence of tissue damage. Persistent pain can significantly interfere with quality of life and can be made worse by the anxiety, stress, despair and anger that often accompany the pain.

Pain can affect just about every aspect of people’s lives. It can affect:

  • the way people move
  • how much they do
  • how far they go
  • how able they are to take part in activities
  • how confident and optimistic they feel
  • relationships with others
  • how well they sleep or concentrate
  • how they manage work or college
  • how much they enjoy life
  • As time goes on the effects of pain become more complicated.

Pain management is not trying to cure pain but aims to explain and reduce the effects above by giving people information and helping them develop coping skills that enable them to live well alongside ongoing pain.

What causes persistent pain?

Sometimes persistent pain is due to more obvious causes, such as severe hip osteoarthritis. Often the cause is poorly understood. Sometimes pain seems to persist beyond the time at which tissues would have healed. It is thought that persistent pain is often due to nerve sensitisation, whereby the nerves which pass pain information to the brain become over sensitised, and pass pain signals to the brain even where there is no tissue damage (a bit like the car alarm, which is set at too sensitive a level, and just goes off in a gentle breeze). This can lead to changes in nerve pathways, including in the brain. This concept is well explained in these videos, and forms much of the basis of helping us deal with persistent pain syndromes.

Tame the Beast Chronic Pain -You Tube link

Common persistent pain syndromes include:

  • Chronic low back pain (please see the back pain pages)
  • Persistent widespread pain such as fibromyalgia
  • Chronic headaches and migraine
  • Persistent pelvic pain syndromes
  • Chronic hip pain (please see the hip pages)
  • Chronic knee pain (please see the knee pages)

When to seek help

If you have persistent pain this should always be assessed by a health professional.

Back Pain

Please go to the back pain pages for more specific information on back pain.

Please also look at this video on low back pain:

Fibromyalgia

This consists of at least 3 months of:

  • Very widespread pain (usually above and below the waist, and on both sides of the body, as well as in the spine)
  • Waking unrefreshed
  • Cognitive symptoms ‘brain fog’
  • Many other body symptoms including irritable bowel, headaches, dizziness, indigestion, urinary symptoms, insomnia, numbness and tingling.
  • There is often significant psychological distress and low mood. Symptoms are often worse with stress, and sleep is frequently disturbed.

This leaflet explains more about fibromyalgia: https://bnssg.icb.nhs.uk/library/leaflet-people-fibromyalgia/

This will need to be diagnosed by a doctor or health professional.

Psychological help for low mood

Persistent pain can clearly have a profound effect on our feeling of wellbeing and mood. Our mood and wellbeing can also have a significant impact on how much pain we feel, and on how much it affects us. VitaMinds will see people with chronic pain and offer online and some face to face groups. You can self-refer for this (you do not need to involve a GP referral):

NHS Talking Therapies – Bristol, North Somerset & South Gloucestershire (vitahealthgroup.co.uk)

Pain Clinic  

Some people feel they need more help with managing their persistent (chronic) pain. This might involve your GP referring you to a specialist pain clinic. This is provided at Southmead and BRI hospitals and is for where conservative management has failed (including self-help, physiotherapy, analgesia) AND where patients are prepared to accept a holistic approach. It can be helpful when surgery is felt to be inappropriate.

Patients who are not prepared to accept a chronic pain diagnosis, and who are not prepared to engage in a holistic  assessment, will gain little benefit from a referral to the pain service.

If you wish to consider this option, you will need to have looked at the below information before seeing your GP, to see whether you feel it will be appropriate:

Pain Clinic Patient Information Leaflet 

It will also be worth filling in this patient pain questionnaire, to then bring to your GP. It is also worth looking at this link to Pain Clinic Frequently Asked Questions

 

Useful Links and Resources

Chronic Pain self-help resources Versus Arthritis Exercises for Healthy Joints Live Well With Pain Website UHBW Movement and Exercise Videos Tame the Beast Chronic Pain Video