Pain that has lasted longer than about three months behaves differently from fresh injury pain, and treating it as though it were the same is why so many people conclude that nothing works.
The first thing worth saying plainly is that persistent pain is real. Being told that scans look normal is not the same as being told the pain is imagined, and if you have been made to feel that way by anybody, they were wrong.
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What changes with persistent pain
Over time the pain system itself becomes more sensitive, so it produces pain at lower levels of stimulus than it should. The pain becomes a poor guide to how much damage is present. That is why hunting for a structure to fix often leads nowhere, and why more scans usually add anxiety rather than answers.
What actually helps
NICE guidance on chronic primary pain recommends supervised exercise programmes and certain psychological therapies, and specifically advises against starting opioids, because the harms outweigh the benefits in long term pain.
In practice that means graded activity, starting from a level you can genuinely sustain and building steadily, so the system relearns that movement is safe. It means understanding what is happening, which changes outcomes more than most people expect. It means working on sleep and on pacing. And it means having realistic, meaningful goals, which are usually about what you can do rather than about a pain score.
What we will not do
We will not promise to make the pain disappear, and we will not put you through a course of passive treatment that leaves you dependent on appointments. Where a psychological therapy or a pain clinic referral would help more than we can, we will say so and write to your GP.
If pain is affecting your mood significantly, that is common, it matters, and it is worth telling your GP.
Frequently Asked Questions
My scans are normal but I am still in pain. What does that mean?
What treatment works for long term pain?
Will physiotherapy get rid of my pain?
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