Chronic pain is pain that lasts or keeps coming back for more than three months. For most people it can’t be switched off completely, but it can be turned down and made to interfere much less, mainly through graded exercise, psychological therapies such as CBT, pacing your activity and careful use of medicines.
That’s less exciting than a miracle oil or a single injection, but it’s what the evidence supports. Here’s how the different types of chronic pain are handled, what helps, where painkillers fall short, and when pain is a sign of something that needs urgent care.
Primary and secondary chronic pain
The UK’s National Institute for Health and Care Excellence (NICE) splits chronic pain into two groups in its 2021 guideline:
- Chronic secondary pain: an underlying condition explains the pain. Osteoarthritis of the knee, rheumatoid arthritis, a slipped disc pressing on a nerve, diabetic nerve damage and pain after cancer treatment are examples. Treating the condition is part of treating the pain.
- Chronic primary pain: no underlying condition fully accounts for the pain or how much it affects you. Fibromyalgia, many cases of long-term low back pain without a clear cause, and some chronic headaches fall here. The nervous system itself has become more sensitive.
Many people have both. A doctor’s first job is to look for a treatable cause, so don’t skip the check-up even if you’ve had pain for years. If your pain runs down the leg, our guides to sciatica and a slipped disc explain those causes.
Exercise is treatment, not a reward for feeling better
It feels backwards to move more when you hurt, but for chronic primary pain NICE recommends a supervised group exercise programme and encourages people to stay physically active in the long term. Exercise is also a mainstay for osteoarthritis and long-term back pain.
How to start without a flare-up:
- Pick something you can repeat: walking, cycling, swimming, gentle yoga or a physiotherapist’s home exercises.
- Start well below what you think you can do, such as 5 to 10 minutes of walking.
- Add a little each week, not each day.
- Expect some soreness at first. Hurt doesn’t always mean harm, but sharp, new or worsening pain needs checking.
A physiotherapist can tailor a programme to your body and your pain. If you like yoga, our guide to practising yoga at home covers the basics; tell your teacher about your pain so poses can be adapted.
Pacing: getting off the boom-and-bust cycle
On a good day, it’s tempting to clean the whole house or finish every errand. Then you pay for it with two or three days in bed. The Royal National Orthopaedic Hospital calls this “boom” followed by “bust”, and pacing is the fix.
- Find your baseline. Work out how long you can do a task (standing to cook, sitting at a desk, walking) on a good or bad day without a flare.
- Break tasks into chunks. Chop vegetables sitting down, then take a break before cooking. Sweep one room, not three.
- Balance demanding and easy activities through the day rather than bunching the hard ones together.
- Build up slowly. Once your routine feels steady, increase activity in small steps and let each change settle before adding more.
Psychological therapies: CBT and ACT
Suggesting therapy for pain can sound like being told it’s “all in your head”. It isn’t. Long-term pain changes sleep, mood, concentration and how the nervous system processes signals, and those changes feed back into the pain.
NICE recommends considering cognitive behavioural therapy (CBT) or acceptance and commitment therapy (ACT) for chronic primary pain, delivered by trained professionals. These therapies teach you to handle flare-ups, reduce fear of movement, set realistic goals and get back to things that matter to you.
If pain has left you low, anxious or hopeless, India’s free Tele-MANAS helpline, 14416, offers 24×7 counselling in 20 Indian languages.
Medicines: what they can and can’t do
Painkillers have a place, but long-term pain is where their limits show most. Always take medicines only as your doctor or the pack leaflet advises, and ask your doctor or pharmacist before combining them.
| Medicine type | Where it fits | Main cautions |
|---|---|---|
| Paracetamol | Often used for secondary pain such as osteoarthritis; NICE says not to start it for chronic primary pain | Taking too much can damage the liver; may not suit people who drink heavily |
| NSAIDs (ibuprofen, diclofenac, naproxen) | Inflammatory and joint pain, short courses; not to be started for chronic primary pain | Stomach ulcers and bleeding, kidney problems, interactions with blood thinners and BP tablets |
| Some antidepressants (amitriptyline, duloxetine and others) | NICE says they can be considered for chronic primary pain, even without depression | Side effects vary; need a doctor’s prescription and review |
| Nerve-pain medicines (gabapentin, pregabalin) | Used for nerve pain such as diabetic neuropathy; NICE advises not starting them for chronic primary pain | Drowsiness, dizziness, risk of misuse and dependence |
| Opioids (tramadol, tapentadol, morphine) | Short-term or specialist use only | Dependence, overdose, constipation, drowsiness; risks rise with dose |
The NHS lists stomach ulcers or bleeding and kidney problems as serious side effects of NSAIDs. In India these tablets are easy to buy without a prescription, which makes it easy to take them daily for months without anyone checking your stomach, kidneys or blood pressure.
Why opioids are a poor long-term answer
The US Centers for Disease Control and Prevention’s 2022 guideline says nonopioid therapies are preferred for chronic pain. It notes increased risk of serious harms, including opioid use disorder and overdose, with long-term opioid therapy, a risk that rises with dose without a clear safe threshold. NICE likewise advises against starting opioids for chronic primary pain. If you already take an opioid such as tramadol daily, don’t stop suddenly. Ask your doctor about a plan to review and, if appropriate, reduce it slowly.
NICE also advises against TENS machines, ultrasound and interferential therapy for chronic primary pain, because there’s no evidence they help. It allows a single short course of acupuncture to be considered in certain settings.
Everyday things that make pain worse or better
- Sleep: pain disturbs sleep, and tired days make pain harder to cope with. A fixed wake-up time and no screens in bed are a good start.
- Weight: extra weight loads the knees, hips and back.
- Smoking and alcohol: neither relieves pain in the long run, and alcohol mixes dangerously with many painkillers and sleeping tablets.
- Posture and work set-up: long hours bent over a phone or laptop strain the neck and back. Get up and change position often.
- Heat or cold packs: simple, cheap and safe for short-term relief if you protect the skin.
When to see a doctor, and when to go to hospital
See a doctor about any pain lasting more than a few weeks, and go back if it changes. Get urgent medical help, or call 112, if pain comes with any of these red flags:
- Numbness or tingling around the genitals or anus, or new trouble passing urine or controlling your bladder or bowels
- Weakness, numbness or tingling in both legs
- Chest pain
- Pain after a serious fall or accident
- Pain that’s sudden and severe, or getting worse quickly
- Fever, shivering or feeling generally unwell with back pain
- Unexplained weight loss along with the pain (see a doctor soon)
These are based on the emergency and urgent signs the NHS lists for back pain. The NHS treats the first four as emergencies that need a hospital straight away.
Pain clinics
If your pain isn’t improving with your GP’s or physician’s care, ask for a referral to a pain clinic. Many large hospitals run them through their anaesthesiology and pain medicine departments; AIIMS Bathinda, for example, lists a pain clinic running Monday to Saturday. Pain specialists can use image-guided diagnostic nerve blocks to find where some pain comes from, review your medicines and coordinate physiotherapy and psychological support.
Frequently asked questions
Can chronic pain be cured?
Sometimes, when the cause can be fixed, such as a joint replacement for severe arthritis. More often the aim is to reduce pain and get back to normal life, and many people achieve that with exercise, pacing and therapy.
Is it safe to exercise if it hurts?
Usually yes, if you start gently and build up. Stop and see a doctor if pain is sharp, new, spreading down a limb with numbness, or much worse the next day.
Why would a doctor prescribe an antidepressant for pain?
NICE says some antidepressants may help pain, sleep and quality of life in chronic primary pain even if you’re not depressed. They act on how the nervous system handles pain signals.
Is it okay to take a painkiller every day?
Not without a doctor’s review. Daily NSAIDs can harm the stomach and kidneys, and daily opioids carry a risk of dependence. Ask your doctor to check whether the benefit is worth it.
Do pain-relief oils and massage help?
Massage and warm packs may ease muscle tension for a while and are generally safe. Oils marketed as cures for arthritis or nerve pain lack good evidence, so don’t let them delay a proper assessment.
This article is for general information and is not a substitute for advice from a doctor. If you have symptoms or a health condition, please consult a qualified healthcare professional.
