Understanding persistent pain

What is persistent pain?

Persistent (chronic or long-term) pain is pain which does not go away, despite medication, medical treatments or surgery.

For some people, there is a clear trigger, such as an illness, injury or surgery.

For others, nerve damage or arthritis is causing the pain but for many people no obvious cause can be found, despite extensive investigation.

This is known as primary pain and is sometimes called complex pain if it causes problems in a number of areas.

Complex primary pain is surprisingly common but can be difficult for patients and healthcare professionals to understand. Experiments and tests are constantly being used in research centres around the world, helping us to understand pain better.

You will find more information about the types of pain by visiting the websites listed in the ‘Further information’ section at the end of this page.

Understanding pain

What all these conditions have in common is that the pain is real (not imagined), due to the nervous system not working as it should do. The nerves in the area(s) of pain are overactive and the brain is receiving high levels of pain signals, making the painful area more sensitive. The result is often an unhelpful, exaggerated response within the whole nervous system, worsening the pain.

The body has natural mechanisms to try to overcome pain. Other areas of the brain and nervous system will try to dampen down and reduce the pain signals. However, the nervous system does not work so well if the areas of the brain which normally reduce pain are already ‘busy’ such as when the person is stressed or unwell. This can turn up the volume or intensity of the pain.

The whole nervous system, including the brain, is not behaving normally, meaning that pain becomes persistent or long term and does not go away.

Persistent pain is a long-term health condition, just like diabetes or asthma and is definitely not made up or ‘in your head’. Just like the other conditions, pain can be managed but will not go away.

The sensation of pain is affected by many things and is often unrelated to any abnormalities that might be seen on scans or X-rays. We often consider pain as a jigsaw, with a variety of different things making up the whole picture. By understanding all the parts of the jigsaw, you can learn new skills to help manage some of the aspects of the jigsaw and therefore turn the volume or intensity of the pain down.

The body’s response to pain

The body’s natural response is to try to protect the area of pain, often by avoiding the use of affected areas, or by adapting ways of doing things, to avoid making the pain worse. This means that a person’s activity levels often change, reducing in the area of pain or even in the whole body. Areas of the body which are not moved or used in the normal way then become painful.

As pain increases it is common to become more fed up, depressed or anxious and have difficulty sleeping. Work and social activities often suffer.

This is a simplified way of thinking about pain but explains the vicious cycle which leads to the wide range of problems caused by persistent pain. It highlights the importance of considering multiple areas of management and why these are more likely to be helpful when done together.

Pain Management Service

You can get more information about managing persistent pain from your GP or you can ask your GP to refer you to the Pain Management Service.

To find out more about the Pain Management Service please visit:

Website: www.gloshospitals.nhs.uk/our-services/services-we-offer/pain

Further information

Here are some resources to explain persistent pain further: 'Understanding Persistent Pain' is a document written by the Tasmanian Department of Health & Human Services (2014) Website:

www.gloshospitals.nhs.uk/media/documents/tazzypersistentpainbooklet.pdf

Type ‘Understanding pain in less than 5 minutes’ into your web browser to view a short video on YouTube.