Chronic (Persistent) Pain

Overview

Pain is described as chronic, or persistent, when it has lasted longer than three months — beyond the time most tissues take to recover. It can follow an injury, surgery or illness, or appear gradually without an obvious cause. Common examples include long-standing back or neck pain, pain after a whiplash injury that has not settled, and pain that persists after a fracture has united.

Modern pain science helps explain why this happens. Pain is produced by the nervous system as a protective response, and it does not always match the state of the tissues. After a period of pain, the nervous system can become more sensitive — rather like a smoke alarm that goes off when you make toast. Movements that are safe begin to hurt, the body guards and stiffens, activity levels fall, sleep and mood suffer, and the cycle reinforces itself. Understanding this is not about saying the pain is "in your head"; it is real pain, and knowing how it works is the first step to changing it.

Persistent pain is common, affecting somewhere between a third and a half of adults in the UK to some degree. It usually cannot be switched off, but it can be managed. The aim of treatment is to reduce the impact of pain on your life, rebuild confidence in movement and get you back to the activities that matter to you.

Causes and risk factors

• An injury, surgery or illness that triggered the pain, even if it has since recovered
• A nervous system that has become sensitised over time
• Low activity levels, deconditioning and fear of movement
• Poor sleep, which lowers pain thresholds
• Stress, anxiety or low mood, which amplify pain processing
• Beliefs that pain always means damage, leading to avoidance
• Other long-term conditions such as arthritis, fibromyalgia or migraine

How we may be able to help

Your first appointment is a thorough, unhurried assessment. We take a full history, examine your movement and strength, screen for any medical causes that need investigating, and — importantly — understand what the pain stops you doing. Where a medical review or imaging would be useful, we can arrange an online private GP consultation.

Physiotherapy for persistent pain centres on three things. First, pain education: understanding why pain persists and what it does and does not mean, which research shows reduces fear and improves outcomes on its own. Second, pacing: finding your current baseline for activities and increasing it in small, planned steps rather than the boom-and-bust pattern most people fall into. Third, graded activity and exercise: gradually reintroducing movements you have been avoiding, in a way the nervous system can tolerate, so that confidence and capacity rebuild together.

Hands-on treatment — manual therapy, mobilisation and soft-tissue techniques — and, for spinal pain, chiropractic care may help you feel more comfortable and move more freely in the short term, which supports the exercise programme. Dry needling may be used for specific tight muscles in the limbs. A 3D posture scan can be useful where posture or muscle imbalance is contributing. Interferential therapy is sometimes used as a short-term adjunct for pain relief where a specific tissue source has been identified; UK guidance does not support it for pain with no identifiable tissue cause, so it is never the core of the plan. We work alongside your GP, who may discuss medication or referral to a pain management programme or psychological support.

What you can do at home

• Find your baseline: how long can you walk, sit or stand before pain increases? Start just below that and build up by 10% a week
• Keep moving every day, even when pain is higher — gentle, regular movement is safer than rest for persistent pain
• Prioritise sleep: a consistent routine and winding down without screens
• Practise relaxation or breathing exercises; a calmer nervous system is a less sensitive one
• Plan enjoyable activities into your week, not only "necessary" ones
• Notice unhelpful thoughts such as "I'll damage myself" and test them gently with small steps