The surprising ways to deal with chronic pain

Chronic pain is on the rise in the UK, affecting an estimated 28 million people, or over 40 per cent of the population, compared to one in five worldwide. The term is used to apply to a number of persistent conditions, with the International Classification of Diseases defining pain as chronic if it continues or recurs for more than three months.  

It is more commonly reported among certain groups, including women (who account for more than 70 per cent of sufferers, according to some studies) and older people. Those who are overweight or obese, or who have had an injury, are more likely to be afflicted too. Sadly, there is no agreed cure for chronic pain as yet.

Types of chronic pain conditions 

The most common chronic pain condition in the UK is backache, which affects around 5.5 million adults in the UK and accounts for 12 million lost work days each year, according to Unison, the UK’s largest union. Osteoarthritis is another common one – Jane Fonda suffers from it, and in 2019 opened up about living with constant pain. “The fact that I hurt a lot – my body hurts – is a surprise to me,” she said.

Joint pain is also experienced by many chronic pain sufferers, which can be a result of conditions such as fibromyalgia, which causes pain all over the body. High profile sufferers include Kirsty Young, who stood down as the host of Desert Island Discs in 2018 because of her chronic pain. “A chronic long-term pain condition is an absolute pain, literally and metaphorically, to deal with,” she said in 2022. “It grinds you away, you lose your personality, you lose your sense of humour, you lose your sense of self. There’s all sorts of things that go with it.” 

Other common causes include headaches or migraines, chronic fatigue syndrome, endometriosis (when tissue similar to the uterine lining grows outside the uterus) and inflammatory bowel disease, which is a group of conditions that cause inflammation in the digestive tract. 

How to get a diagnosis for chronic pain

The NHS suggests contacting your GP for a chronic pain diagnosis if you’ve been struggling with pain for more than 12 weeks. Possible recommended courses of action might include staying active, which is to manage pain and improve wellbeing. They might also recommend complementary therapies, such as acupuncture and meditation, pain management techniques, support groups and a referral to a specialist pain clinic.

What are the causes and triggers of chronic pain?

“The cause of chronic pain, and why it varies so wildly across individuals, is still not known,” explains Richard Harrison, co-lead at the Centre for Integrative Neuroscience and Neurodynamics at the University of Reading. “It is frequently associated with an injury or a disease, however the severity of an injury correlates poorly with the intensity or duration of subsequent pain.”

Risk factors for chronic pain can be based on demographics such as gender, along with the “psychological, neurological and biological”, Harrison adds. Triggers for chronic pain can include nerve pain caused by an injury, and damage to the spinal cord and brain, but pain can also be caused without a physical explanation. “Psychological factors, such as stress, depression or pain catastrophising [a psychological reaction where you believe you’re in more pain than you are], can frequently be identified as significant predictors of the development of chronic pain following surgical interventions.”

In 2022, Harrison co-authored a study which found that adverse childhood events and trauma are, he says, a “critical influence in the development, maintenance and treatment response within chronic pain”. A cross-sectional US review in 2020 found that children who had experienced one adverse event were 60 per cent more likely to suffer chronic pain, while those with four or more faced a 170 per cent greater likelihood. 

It is hoped that further study will reveal more about the causes and triggers of chronic pain. While thinking up to now has suggested that “the worse an injury, the worse the pain”, this is not the case, Harrison says: “The premise that only injury or damage needs to be considered in chronic pain is entirely false.” It can, in fact, be triggered by a psychological or otherwise seemingly unrelated event. A major injury is no guarantee that chronic pain will follow.

Pain management strategies 

According to the NHS, the goal of pain management programmes is not to reduce levels of pain but to find ways to improve your quality of life in spite of it. Typically delivered via group sessions, these programmes can include mindfulness and relaxation, gentle exercise, managing emotions related to pain – which can refer to things like talking therapies and CBT – and group discussion. Depending on the levels of pain you are experiencing, a GP may recommend taking painkillers too. 

Some sufferers of chronic back pain may also seek surgical intervention to correct disc problems or bone spurs (an overgrowth of bone in your joints or in the spine), which affect 80 per cent of men and 60 per cent of women over 50, though this is not advised in most cases.

“The impact of chronic pain can be substantial, and the frequency with which patients will encounter failed treatment is high,” Harrison says. “The medical approach can no longer be focused on simply treating an injury and must employ multi-disciplinary treatments that are personalised to the requirements of each patient.” He believes that the treatment afforded to physical injuries should extend to those affecting our mental health too. Where chronic pain is concerned, he says, “the old adage of ‘take your pills for two weeks, then come and see me’ is not appropriate and is unlikely to be effective”.

Anita Amorim, a senior lecturer at the University of Sydney who researches how mindfulness influences chronic musculoskeletal pain, adds that different things work for different people, and bespoke treatment for every patient is the only way to help chronic pain. “A one-size-fits-all approach does not work,” she says. “The most effective approach to pain management is a tailored one based on the type, cause and intensity of the pain. 

A range of treatments may be needed, she adds, “including physiotherapy that focuses on active treatments like exercise, psychological and behavioural therapies like cognitive behavioural therapy, complementary therapies like mindfulness-based stress reduction, and pharmacotherapy when necessary”.

Lifestyle choices 

Far from being a sticking plaster, experts say lifestyle choices can make a real difference. Amorim says that “self-care and lifestyle behaviour change, like losing weight, engaging in physical activity, practising good sleep hygiene and managing stress” can be crucial in mitigating pain conditions.

Harrison adds that nutrition is the “is the top modifiable lifestyle factor” for sufferers of chronic pain, with a healthy diet high in anti-inflammatory foods, such as fatty fish (including salmon and mackerel), dark leafy greens, whole fruits, nuts, legumes, and wholegrains, a key to good immune function. A 2022 study published in the Journal of Clinical Medicine found that “there is a strong link between the underlying mechanisms of chronic pain and nutrition… With this growing evidence base, nutrition assessments and management plans should be incorporated into the care of people experiencing chronic pain.” Still, it remains unclear exactly how nutrition impacts pain. 

This, along with other studies on the subject, shows that a good diet is of vital importance. “This not only positively improves physical health, but by improving the condition of our gut microbiome, we can improve our psychological and neurological health by direct increases in the creation of beneficial neurotransmitters and hormones,” Harrison says.

Exercise is also a crucial part of chronic pain management, experts urge – even if it sounds counterintuitive. “Keep fit and active, and take good care of your physical health,” advises Lance McCracken, professor of clinical psychology at the University of Uppsala in Sweden. “If you’re fit in your muscles and joints and physical health, I think you’re probably in a better place.” 

Multiple studies have shown improvements in chronic pain as a result of physical activity, including a 2017 paper from the University of Iowa, which found that regular exercise promotes pain relief. 

Walking is advised, with increased activity suggested for those not dealing with debilitating pain. Resistance training, with weights, is particularly important as we age and can form a key part of post-injury rehabilitation. 

Studies have also shown that poor sleep can be a risk factor for chronic pain and can work both ways, with pain reducing the propensity to sleep in the first place and pain levels rising as a result of hampered rest. A 2023 review showed that poor sleep significantly increased the likelihood of having lower pain tolerance, while a 2020 paper added that poor sleep “apparently plays a role in enhancing pain in various clinical acute and chronic conditions”. 

Keep the body’s natural circadian rhythm on track by getting some natural light first thing in the morning (or a daylight alarm clock if you can’t get outside) and avoid it at night by limiting your phone use in the evening. This should encourage production of the sleep hormone melatonin, which helps our bodies know when it’s time to rest.

Stress can also be a limiting factor for sleep and increase pain levels. “In patients with chronic pain, stress is generally associated with a worsening of pain symptoms and stress-induced hyperalgesia,” says a 2023 paper published in the Journal of Clinical Medicine. “In fact”, researchers wrote, “stress and pain are highly comorbid and show significant overlap in both conceptual and biological processes.” 

Coping with the mental health challenges 

Up to 45 per cent of chronic pain sufferers are estimated to experience depression, according to the American Psychiatric Association (a 2016 study put this as high as 61 per cent). McCracken says it is “pretty common” for patients to experience chronic pain and depression, as if the discomfort impacts the things that bring you joy or are important, such as friendships and work, and the loss of those things and the uncertainty that can breed can have a knock-on effect. “Naturally you’re going to have a lot of fear, anxiety, sadness or depression [as a result],” McCracken says. And in turn, those feelings “may turn into a separate problem all of its own”. 

The mental health toll can be particularly vast when people are not listened to properly, which can lead to “feelings of frustration and hopelessness”, according to Anita Amorim. “Chronic pain can also lead to emotional distress, depression, anxiety, sleep disturbances, social isolation, cognitive impairments, decreased self-esteem, chronic stress, unhealthy coping mechanisms and, in severe cases, even suicidal ideation.”

This can trigger a “vicious cycle”, she says, in which daily activities, work and relationships are worsened, “ultimately resulting in social isolation and reduced quality of life”.

This rings true for Joe Colling Nutkins, 44, who has been living with myalgic encephalomyelitis (ME) and fibromyalgia for over a decade. “We tend to start feeling bad for having to let people down due to [being in] pain, so then we say no to invitations more and then people stop asking,” she says. As a result, “we become more self dependent, and lose confidence in social situations”.

Chronic pain has also been linked with anxiety, obsessive compulsive disorder, post-traumatic stress disorder, substance abuse and other associated health conditions. Amorim advises that “mental health professionals, such as social workers, psychotherapists, psychologists and psychiatrists, can play a crucial role in supporting individuals with chronic pain” by providing them with tools to manage their social and mental health.

Amorim’s research centres around mindfulness-based stress reduction (MBSR). She says it is effective in managing chronic lower back pain and reducing the associated psychological distress. “MBSR does not propose to ‘fix’ chronic pain,” she says, but encourages people “to focus on the present moment” without the negative associations such conditions often bring. This involves concentrating on what you feel in your body, and where, rather than thinking about the impact this pain might have on your emotions or the day ahead.

Research, including a 2019 paper published in Pain Reports, a journal specialising in pain, shows that this can help. “Certain brain regions, such as the prefrontal cortex, play a crucial role in regulating emotions and promoting equanimity,” says Amorim. “Mindfulness practices have been shown to increase activity in these brain regions and improve an individual’s ability to maintain emotional stability.”

Preventing chronic pain  

Unfortunately, there is no way to safeguard against pain becoming chronic. “There is lots of research into what are the risk factors for the conversion of a short-term pain problem into a long-term pain problem, but our understanding is incomplete,” McCracken says. “So I don’t think there’s an easy way that you can say perfectly in every case who’s going to turn chronic and who’s not.” 

Will chronic pain treatment change in the future?

Personalised approaches that take into account genetic, lifestyle and environmental factors are a key area of research, Amorim says. Other studies are “being directed toward identifying biomarkers, which are traits present in things such as blood and tissues, that can objectively quantify pain and assess its mechanisms using neuroimaging, such as MRI scans”.

Amorim adds that work is also being done to better understand placebo effects and their role in pain mechanisms, along with the influence of empathetic clinician-patient relationships. The working theory is that a sympathetic GP or doctor makes the patient feel as though they are being listened to properly, which in turn would improve health outcomes. 

“There is also ongoing research focusing on identifying factors that lead to the transition from acute to chronic pain and the development of strategies to prevent it.” This includes analysing how genetic, psychological and lifestyle factors can influence pain perception. 

Investigations are also underway into how individual experiences and environmental factors can potentially alter regions in the nervous system that are involved when pain stops being acute and becomes chronic.

“Are things going in a good direction? I just think yes,” says McCracken of the “exciting things” currently afoot in chronic pain research. “In many ways, we’ve been quite successful. We realise now that we probably have to take a new turn; we need to do things differently… we need to identify exactly what each individual person needs to make the changes that will optimise their health and functioning.”