Chronic Pain
Pain is the body's natural warning system, helping to protect us from injury. However, when pain continues for months after tissues have healed, it becomes a condition in its own right. Chronic pain can affect movement, sleep, mood, work and everyday life, even when scans or tests no longer show an obvious cause.
Learn about the different mechanisms of chronic pain, how it is diagnosed, current evidence-based treatments and how Rowan Health provides personalised support to help improve function, quality of life and long-term wellbeing.
This information is intended for educational purposes and should not replace professional medical advice. If you have new, severe or worsening symptoms, always seek advice from your GP or specialist healthcare team.
KEY FACTS
✔ Medical name
Chronic Pain
✔ Also known as
Persistent Pain
✔ What it affects
The nervous system, muscles, joints and other body systems depending on the underlying cause.
✔ Common symptoms
Persistent pain, stiffness, fatigue, disturbed sleep, reduced mobility, hypersensitivity, reduced concentration and limitations in daily activities.
✔ Who can be affected?
Anyone. Chronic pain affects people of all ages and backgrounds and may develop after an injury, surgery, illness or without an obvious continuing cause.
✔ How is it diagnosed?
Through a comprehensive clinical assessment combining your medical history, physical examination and, where appropriate, investigations to identify the underlying pain mechanisms.
✔ Can it be treated?
Although chronic pain cannot always be completely eliminated, many people experience meaningful improvements in pain, function and quality of life through an individualised management programme.
✔ Associated conditions
Fibromyalgia, osteoarthritis, rheumatoid arthritis, chronic low back pain, migraine, peripheral neuropathy, CRPS, endometriosis, persistent post-surgical pain, cancer-related pain, Long COVID and ME/CFS.
✔ When should I seek urgent medical advice?
If pain is associated with sudden weakness, loss of bladder or bowel control, unexplained weight loss, fever, severe trauma or rapidly worsening neurological symptoms.
UNDERSTANDING THE CONDITION
Pain is an essential part of the body's natural defence system. It alerts us to actual or potential injury, encouraging us to protect an affected area while healing takes place.
In most situations, pain gradually improves as tissues recover.
Chronic pain is different.
It is generally defined as pain that persists or recurs for more than three months, beyond the expected period of normal tissue healing. More importantly, chronic pain often reflects changes in how the nervous system processes pain rather than simply indicating ongoing tissue damage.
For some people, chronic pain develops because an underlying disease continues to affect the body, such as osteoarthritis or inflammatory arthritis. For others, the original injury has healed but the nervous system remains unusually sensitive, causing pain to persist even though there is little or no ongoing tissue damage.
Modern pain medicine recognises that chronic pain is a genuine medical condition. Pain without obvious structural damage is not imaginary, exaggerated or "all in the mind". Instead, it reflects measurable biological changes within the nervous system that influence how pain signals are generated, amplified and interpreted.
Understanding these different mechanisms is one of the most important steps towards developing an effective, personalised treatment plan.
COMMON SYMPTOMS
Chronic pain affects far more than the area that hurts.
Many people experience a combination of physical, emotional and functional symptoms that can fluctuate over time.
Common symptoms include:
Persistent or recurring pain lasting longer than three months
Aching, burning, stabbing, throbbing or shooting pain
Pain that seems disproportionate to the original injury
Stiffness or reduced movement
Muscle weakness or guarding
Increased sensitivity to touch, pressure or temperature
Fatigue and reduced energy levels
Poor sleep or unrefreshing sleep
Difficulty concentrating or "brain fog"
Reduced participation in work, exercise or hobbies
Anxiety or low mood related to living with persistent pain
Symptoms vary considerably depending on the underlying pain mechanism and the conditions contributing to the pain experience.
CAUSES, MECHANISMS AND DIAGNOSIS
Why Does It Happen?
The Three Main Types of Chronic Pain
One of the most important advances in pain medicine has been recognising that not all chronic pain develops in the same way.
At Rowan Health, understanding the underlying pain mechanism helps guide assessment and personalised management.
Nociceptive Pain
Nociceptive pain arises when pain receptors respond to ongoing tissue injury or inflammation.
Examples include:
Osteoarthritis
Rheumatoid arthritis
Tendon injuries
Mechanical back pain
Neuropathic Pain
Neuropathic pain results from injury or disease affecting the nervous system itself.
People often describe:
Burning pain
Electric shock sensations
Tingling
Numbness
Increased sensitivity to touch
Examples include diabetic neuropathy, shingles, nerve compression and some persistent post-surgical pain.
Nociplastic Pain
Nociplastic pain develops when the nervous system becomes overly sensitive, amplifying pain even though there is no continuing tissue damage sufficient to explain the severity of symptoms.
This mechanism is commonly seen in:
Fibromyalgia
Chronic widespread pain
Some forms of persistent low back pain
Certain long-term pain conditions
Many people experience a combination of these mechanisms, which is why a personalised assessment is essential.
Why Can Pain Continue After an Injury Has Healed?
One of the most common questions people ask is:
"If my scan is normal, why am I still in pain?"
The answer lies in understanding that pain is produced by the nervous system, not by damaged tissues alone.
After an injury, pain normally acts as a protective alarm. It encourages us to rest, protect the injured area and avoid further damage while healing takes place.
As tissues recover, the alarm gradually becomes less active and pain usually settles.
Sometimes, however, this process does not happen as expected.
The injury may heal, but the nervous system remains unusually sensitive. Instead of returning to its normal level of activity, it continues sending pain signals more easily than before.
In these situations, the pain is still real, but it no longer reflects the amount of tissue damage present. Instead, it reflects changes in how the nervous system processes pain.
Understanding the Pain Alarm
A helpful way of thinking about chronic pain is to imagine the body's pain system as a fire alarm.
When a fire starts, the alarm sounds to warn us of danger.
If the fire is extinguished, the alarm should stop.
With chronic pain, the alarm system can become overly sensitive.
Instead of responding only to genuine danger, it may begin reacting to much smaller triggers—or sometimes without any obvious trigger at all.
Like a smoke detector that sounds when someone burns toast, the alarm is still working, but its sensitivity has changed.
This does not mean the alarm is imaginary.
It means the nervous system has become more responsive than it should be.
Changes Within the Nervous System
Researchers now know that persistent pain can lead to changes at several levels of the nervous system.
These may include:
Increased sensitivity of pain receptors around an injury
Greater responsiveness within the spinal cord
Changes in the way the brain processes pain signals
Reduced activity of the body's natural pain-control systems
Together, these changes make pain easier to trigger and harder to switch off.
Pain Is More Than Tissue Damage
Many factors influence how pain is experienced.
These include:
The original injury or illness
Sleep quality
Fatigue
Physical activity
Stress
Previous pain experiences
Mood
Overall health
This does not mean pain is psychological.
Rather, it reflects the way the brain and nervous system integrate information from throughout the body before producing the experience of pain.
Understanding these influences helps explain why improving sleep, increasing physical activity gradually and managing stress can all reduce pain sensitivity for some people. These interventions support the nervous system's own pain-regulating pathways rather than simply distracting from the pain.
Why Pain Can Spread
Some people notice that pain gradually spreads beyond the original area of injury.
For example, pain that began in one shoulder may eventually affect the neck, back or opposite shoulder.
This does not necessarily mean the underlying condition is worsening.
Instead, it may reflect increasing sensitivity within the nervous system, making neighbouring areas more responsive to normal movement or everyday activities.
Recognising this process can be reassuring, helping explain why symptoms sometimes change over time without indicating new damage.
Breaking the Cycle
Persistent pain often creates a self-perpetuating cycle.
Pain may lead people to reduce activity in an understandable attempt to protect themselves.
Reduced activity can result in muscle weakness, loss of fitness and reduced confidence in movement.
As physical function declines, everyday activities may become more difficult, increasing pain and reinforcing the cycle.
One of the main goals of modern pain management is therefore not simply to reduce pain, but to gradually improve function, confidence and quality of life while helping the nervous system become less sensitive over time.
This approach is supported by current international guidance and underpins personalised rehabilitation programmes for many people living with chronic pain.
How It Is Diagnosed
There is no single test that confirms chronic pain.
Instead, diagnosis is based on a comprehensive clinical assessment that aims to understand why pain is occurring, how it affects daily life and which mechanisms are contributing to ongoing symptoms.
At Rowan Health, assessment begins before your first appointment. Patients complete a structured series of questionnaires exploring pain intensity, pain distribution, sleep, fatigue, mood, function and possible features of central sensitisation or neuropathic pain. This information helps build a clearer picture of your symptoms before the initial consultation.
Medical History
Your clinician will ask about:
When the pain started
How it has changed over time
Previous injuries, surgery or illnesses
Factors that worsen or relieve symptoms
Previous investigations and treatments
The impact of pain on work, sleep and everyday life
Your personal goals and expectations
Understanding your own experience of pain is a key part of developing an effective management plan.
Physical Examination
The examination is tailored to your symptoms and may include assessment of:
Joint and muscle function
Movement patterns
Strength and flexibility
Neurological function where appropriate
Areas of tenderness or altered sensation
Functional limitations during everyday activities
The aim is not only to identify structural problems but also to understand how pain is affecting movement and function.
Understanding Your Pain Mechanism
Modern pain assessment goes beyond identifying where pain is located.
It also aims to understand how pain is being generated.
Your symptoms may predominantly reflect:
Nociceptive pain, arising from ongoing tissue injury or inflammation.
Neuropathic pain, resulting from injury or disease affecting the nervous system.
Nociplastic pain, where the nervous system has become more sensitive and amplifies pain signals.
Many people have a mixed pain presentation, with more than one mechanism contributing to their symptoms. Identifying this pattern helps guide a personalised management plan rather than applying a one-size-fits-all approach.
Screening Questionnaires
Depending on your symptoms, validated questionnaires may be used to assess:
Pain severity and daily impact
Pain distribution
Central sensitisation
Neuropathic pain
Sleep quality
Fatigue
Mood and anxiety
Functional ability
These tools do not replace clinical assessment, but they provide useful baseline information and help monitor progress over time.
HOW IS IT USUALLY MANAGED?
Management depends on the diagnosis, symptom severity, underlying mechanisms and each person's individual circumstances.
There is no single treatment that works for every person with chronic pain. The most effective approach depends on the underlying pain mechanism, the conditions contributing to symptoms and how pain affects daily life.
Modern pain management aims to improve function, quality of life and long-term wellbeing, rather than focusing solely on reducing pain intensity. For many people, combining several approaches provides better results than relying on a single treatment. This multidisciplinary, personalised approach is recommended by major international organisations, including the International Association for the Study of Pain (IASP), NICE and the European Pain Federation.
Education
Understanding why pain persists is often one of the most valuable parts of treatment.
Learning how pain works can reduce uncertainty, improve confidence and help people engage more effectively with rehabilitation.
Modern pain education explains that persistent pain reflects changes within the nervous system rather than simply ongoing tissue damage. This understanding can help reduce fear of movement and encourage gradual return to everyday activities.
Physical Activity and Rehabilitation
Current evidence supports regular, appropriately graded physical activity as one of the most effective components of chronic pain management.
Rather than encouraging complete rest, rehabilitation focuses on gradually rebuilding strength, flexibility, movement confidence and physical function.
Exercise programmes should always be individualised. The most suitable approach depends on your underlying condition, current level of function and personal goals.
Many people benefit from gradual progression that allows the nervous system to adapt without provoking excessive symptom flare-ups.
Sleep Optimisation
Sleep and pain influence one another in both directions.
Persistent pain commonly disrupts sleep, while poor-quality sleep increases pain sensitivity by reducing the effectiveness of the body's natural pain-control systems.
Improving sleep is therefore considered an important part of comprehensive pain management rather than a separate issue.
Depending on your circumstances, this may involve sleep education, behavioural strategies, reviewing contributing medical conditions and establishing healthy sleep routines.
Medication
Medication may help some people manage chronic pain, particularly during periods of increased symptoms or where specific pain mechanisms are present.
The most appropriate medication depends on the underlying cause of pain.
For example:
Anti-inflammatory medicines may help inflammatory conditions.
Medicines targeting nerve pain may benefit some people with neuropathic pain.
Long-term opioid treatment is not appropriate for many forms of chronic primary pain because potential risks may outweigh the benefits.
Medication should always be reviewed regularly to ensure it continues to provide meaningful improvements in pain and function.
Psychological Support
Persistent pain affects more than the body alone.
Living with chronic pain can influence confidence, mood, relationships, work and overall quality of life.
Psychological approaches do not suggest that pain is psychological or imaginary.
Instead, they help people develop practical strategies to reduce distress, improve coping and support participation in everyday life.
Where appropriate, structured approaches such as cognitive behavioural therapy (CBT) or acceptance and commitment therapy (ACT) may be recommended as part of a multidisciplinary programme.
Multidisciplinary Care
Many people benefit from support provided by different healthcare professionals working together.
Depending on individual needs, management may involve:
Primary care clinicians
Physiotherapists
Pain specialists
Occupational therapists
Psychologists
Rheumatologists
Neurologists
Other medical specialists
Coordinating care helps ensure that different aspects of persistent pain are addressed together rather than in isolation.
Self-Management
Because chronic pain is often a long-term condition, developing self-management skills plays an important role in ongoing care.
This may include:
Understanding your own pain patterns
Recognising flare-up triggers
Pacing activities appropriately
Maintaining regular movement
Supporting healthy sleep
Managing stress
Setting realistic functional goals
These strategies help many people regain confidence and reduce the impact pain has on everyday life.
LIVING WELL WITH THE CONDITION
Impact on Daily Life
Living with chronic pain often involves much more than coping with physical discomfort.
Many people describe constantly weighing up everyday decisions—whether to walk a little further, return to work, meet friends or simply complete household tasks. Pain can affect sleep, concentration, relationships, confidence and emotional wellbeing, making even routine activities feel unpredictable.
One of the greatest challenges is that chronic pain is frequently invisible. Family members, colleagues and even healthcare professionals may struggle to understand symptoms that cannot always be seen on scans or blood tests.
Receiving an explanation for why pain persists can therefore be an important turning point. Understanding that persistent pain reflects genuine changes within the nervous system—not simply ongoing tissue damage—helps many people make sense of their experience and engage more confidently with rehabilitation.
Although recovery looks different for everyone, meaningful improvement is often possible. Many people experience better function, increased confidence and an improved quality of life through a combination of education, rehabilitation and personalised long-term management.
Rather than aiming simply to eliminate pain, modern care focuses on helping people return to the activities that matter most to them.
HOW ROWAN HEALTH SUPPORTS YOU
At Rowan Health, we look beyond the location of your pain to understand the mechanisms contributing to your symptoms and how they affect your movement, sleep, energy levels and everyday life. Your assessment considers the physical, neurological and functional aspects of pain to build a personalised picture of your health.
Following a comprehensive evaluation, we develop an individualised care plan tailored to your needs and goals. Depending on your presentation, support may combine education, rehabilitation strategies and selected evidence-informed integrative approaches alongside your conventional medical care.
Our aim is to improve function, reduce the impact of persistent pain, enhance confidence in movement and support your long-term health, independence and quality of life.
When to Seek Medical Advice
Although chronic pain itself is common, certain symptoms may indicate a serious underlying condition requiring urgent medical assessment.
Seek immediate medical advice if you develop:
Sudden loss of bladder or bowel control.
Numbness around the buttocks or genital area (saddle anaesthesia).
Rapidly progressive weakness in one or both legs.
Severe pain following significant trauma, particularly if a fracture is suspected.
New pain associated with unexplained weight loss.
Fever, chills or signs of systemic infection.
A hot, swollen or red joint with fever.
A sudden, severe ("thunderclap") headache.
Headache associated with fever, neck stiffness or neurological symptoms.
New pain in someone with a history of cancer.
Progressive numbness or weakness.
Unexplained rectal bleeding or persistent night-time gastrointestinal symptoms.
These symptoms do not necessarily mean something serious is occurring, but they should never be ignored and require prompt medical assessment.
If you develop severe or rapidly worsening symptoms, contact your GP, NHS 24 or emergency services as appropriate.
If your symptoms are severe, rapidly worsening or causing immediate concern, contact NHS 24 on 111. In a medical emergency, call 999 or attend your nearest Accident & Emergency department.
FAQs
Is chronic pain the same as pain after an injury?
No.
Acute pain following an injury is a normal protective response and usually improves as healing occurs. Chronic pain persists beyond the expected healing period and often involves changes within the nervous system itself.
Does chronic pain mean there is ongoing damage?
Not necessarily.
Some chronic pain results from ongoing inflammation or structural disease, while other forms reflect changes in how the nervous system processes pain. Persistent pain does not always indicate continuing tissue damage.
If my MRI or X-ray is normal, why am I still in pain?
Scans are useful for identifying structural problems but cannot measure how sensitive the nervous system has become.
Many recognised chronic pain conditions involve changes in pain processing rather than visible tissue damage.
Is chronic pain psychological?
No.
Chronic pain is a genuine biological condition involving the nervous system.
Stress, sleep, mood and emotions can influence pain sensitivity, just as they influence blood pressure or asthma, but they are not the sole cause of chronic pain.
Can chronic pain improve?
Yes.
Although complete resolution is not always possible, many people experience meaningful improvements in pain, physical function and quality of life through personalised management.
Why am I so tired?
Persistent pain requires constant processing by the nervous system and frequently disrupts sleep.
Reduced activity, muscle deconditioning and associated conditions may also contribute to fatigue.
Should I stop exercising?
Usually not.
Appropriately graded activity is considered one of the most effective long-term strategies for improving function in many chronic pain conditions.
The most suitable programme depends on your individual circumstances and should be progressed gradually.
How can Rowan Health help?
Our assessment aims to identify the mechanisms contributing to your pain rather than focusing solely on where it hurts.
Following a comprehensive evaluation, we develop a personalised care plan designed to improve function, confidence and long-term wellbeing alongside your conventional medical care.
Sources & references
International Association for the Study of Pain (IASP). IASP Terminology: Pain Definition. Updated 2020.
World Health Organization. International Classification of Diseases 11th Revision (ICD-11): Chronic Pain.
National Institute for Health and Care Excellence (NICE). Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain (NG193). 2021.
National Institute for Health and Care Excellence (NICE). Low Back Pain and Sciatica in Over 16s (NG59).
European Pain Federation (EFIC). Core Curriculum for Pain Management.
Treede R-D, et al. Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the ICD-11. Pain. 2019.
Fitzcharles M-A, et al. Chronic primary musculoskeletal pain: a new concept from ICD-11. Pain Reports. 2022.
Cohen SP, Vase L, Hooten WM. Chronic pain: an update on burden, best practices, and new advances. The Lancet. 2021.
Geneen LJ, et al. Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database of Systematic Reviews. 2017.
Clinical Review
Clinical content reviewed by
Rowan health
Last reviewed:
28 July 2026
Related Resources
Related Conditions
Chronic Low Back Pain (coming soon)
Neuropathic Pain (coming soon)
Migraine (coming soon)
Osteoarthritis (coming soon)
Hypermobility Spectrum Disorder >
Chronic fatigue ME/CFS >
Chronic & Complex Conditions Hub >
Symptoms and Mechanisms
Understanding Chronic Pain (coming soon)
Central Sensitisation (coming soon)
Nociplastic Pain (coming soon)
Neuropathic Pain (coming soon)
Fatigue (coming soon)
Sleep Difficulties (coming soon)
Treatment and Support
What Is Integrative Medicine? >
Our Personalised Care Approach >
Laboratory-Supported Personalised Care
If you found this information helpful, you may wish to share it with a family member, friend or someone else who is going through cancer treatment.Better understanding helps people feel more informed and prepared.
Share this page
Would You Like Personalised Support?
At Rowan Health, we look beyond the location of your pain to understand the mechanisms contributing to your symptoms and how they affect your daily life.
Following a comprehensive assessment, we develop a personalised care plan tailored to your needs and goals. Depending on your presentation, support may combine education, rehabilitation strategies and selected evidence-informed integrative approaches alongside your conventional medical care.
Our aim is to improve function, reduce the impact of persistent pain and support your long-term health and quality of life.