Chronic pain (lasting over 3 months) often doesn't respond to the approach used for acute pain. The UK healthcare system is slowly adapting to a more multidisciplinary approach, but access is inconsistent.
The pain system: what's actually happening
Chronic pain isn't simply a damaged tissue reporting signals. Your nervous system becomes sensitized—it starts amplifying normal signals, interpreting harmless sensations as pain. This is why imaging (MRI, X-rays) often shows minimal abnormality despite severe pain, and why painkillers alone rarely work well.
Understanding this matters because it shifts treatment from "fix the tissue" to "restore normal nervous system function." This means physiotherapy, structured activity, psychological approaches, and specific pain medications work better than repeated scans or injections.
NHS pain management
Access to specialist pain services varies wildly across the UK. Some areas have comprehensive pain management programmes; others have minimal services. Your GP should refer you if pain is affecting daily life.
Pain management programmes typically include physiotherapy, pain education, cognitive behavioural therapy, and medication optimization. These programmes (usually 6-12 weeks) improve function and reduce pain better than surgery or injections for most chronic pain.
Wait lists are long (often 6-12 months). If you're on the list, don't wait passively. Start self-management now: gentle movement, stress management, sleep optimization. These improve outcomes when you reach specialist services.
Medications for chronic pain
Paracetamol and NSAIDs provide temporary relief but don't address nervous system sensitization. Long-term use (daily for months) is not recommended due to side effects without proportional benefit.
Neuropathic pain medications (gabapentin, pregabalin) work for nerve pain (sciatica, post-surgery pain, diabetic neuropathy). Doses build slowly—start low, increase gradually. Many people need 1,800-3,600 mg daily for benefit.
Antidepressants (amitriptyline, duloxetine) work for pain by stabilizing pain signals in the spinal cord, not through mood effects. They're particularly useful for widespread pain or when you have depression alongside pain.
Opioids are increasingly avoided for chronic pain due to addiction risk, poor long-term outcomes, and side effects (constipation, cognitive effects). If a doctor suggests long-term strong opioids for chronic non-cancer pain, seek a second opinion.
Injections and procedures
Joint injections (cortisone, hyaluronic acid) can reduce pain temporarily (weeks to months) for arthritis. They're useful when you need pain relief to engage in physiotherapy. Repeated injections have risks (infection, joint damage), so don't rely on them long-term.
Nerve blocks can help specific neuropathic pain conditions. If a pain specialist recommends them, they've usually excluded other causes first. Single blocks or a limited series (2-3) sometimes break the pain cycle.
Spinal cord stimulators are implantable devices that send electrical signals to interrupt pain. Evidence is reasonable for specific conditions (failed back surgery, complex regional pain syndrome). They're not first-line but an option when conservative approaches fail.
Psychological approaches
Cognitive behavioural therapy (CBT) specific to chronic pain is evidence-based and helps many people. It's not dismissing your pain—it's changing how you respond to it, reducing catastrophizing, and improving function.
Mindfulness and meditation reduce pain perception. Regular practice (10-20 minutes daily) produces measurable benefit. Apps like Calm or Headspace have chronic pain programs.
Acceptance and commitment therapy (ACT) helps you accept pain while pursuing valued activities. This sounds counterintuitive but reduces suffering even when pain persists.
Red flags in pain management
If you're repeatedly sent for imaging for chronic pain that's been stable, request referral to pain management instead. More imaging doesn't improve outcomes.
If offered repeated injections without an overall plan for reducing injection dependence, ask for a structured programme combining injections with physiotherapy and self-management.
If your doctor dismisses pain as "all in your head" when imaging is normal, get a second opinion. Nervous system sensitization is real, not psychological, but requires different treatment approach.