Pain is one of the commonest reasons people see a doctor, and over 10 million people in the UK live with chronic pain. Chronic pain often begins as acute pain that doesn’t switch off. So what does living with chronic pain really mean, and what strategies genuinely help?
Acute pain vs chronic pain
Pain is your body’s alarm system. It warns your brain about potential harm so you can protect yourself. Your brain constantly scans for danger — and once the alarm switches on, it can be reluctant to switch off.
Acute pain is the alarm working as it should — the pain you feel when you break a bone, fall, or develop appendicitis. It tells you something’s wrong so you can act.
Chronic pain is different. When pain continues for a long time, the alarm system can start to malfunction and become over-sensitive — like a home alarm that goes off when a leaf blows across the gate. The alarm keeps firing even though there’s no real danger.
Why does acute pain become chronic?
If acute pain isn’t well controlled, the constant firing of the alarm can change the wiring of the nervous system — a process called neuroplasticity. Even after the original injury has healed, the nerve pathways keep firing, and the brain strengthens them, making the alarm harder to switch off.
Chronic pain can also develop without an original injury, alongside conditions such as osteoarthritis, multiple sclerosis, trapped nerves such as sciatica or carpal tunnel syndrome, and inflammatory or autoimmune arthritis.
How does chronic pain present?
Chronic pain varies with its cause — it can be sharp, dull, stabbing, burning, or shooting. Two particular patterns are worth naming:
- Hyperalgesia — the volume is turned up, so even mild damage produces high levels of pain.
- Allodynia — pain from something that isn’t normally painful, such as light touch on the skin.
Chronic pain also commonly comes with other symptoms — anxiety, low mood, poor appetite, fatigue, and disturbed sleep.
One thing to be clear about: chronic pain is not “all in your head”. People genuinely feel it. It’s a malfunctioning alarm system, not imagined pain — and understanding it this way is the first step to managing it.
How is chronic pain diagnosed?
The key question is whether your pain comes from ongoing damage — such as active inflammation or infection — or from an over-sensitive alarm system. It’s important to see your doctor to work this out, because the answer shapes the whole approach.
Your doctor will assess you and arrange basic investigations where needed — blood tests, X-rays, or MRI — to check whether damage is still occurring.
Chronic pain management: treatment options
Treating chronic pain is often complex, and it helps to start with the right expectations.
The first, and most important, step is understanding what chronic pain is. When you understand that the pain is an overactive alarm rather than ongoing damage, you can begin to “turn down the volume” by reframing it. It also means being realistic: there’s rarely a quick fix from a single treatment, injection, or operation — and it’s wise to be wary of any practitioner who promises a cure for chronic pain.
Medication
Several types of medication can calm the firing of the nerves:
- Nerve stabilisers — antidepressants and anticonvulsants such as amitriptyline, duloxetine, gabapentin, and pregabalin reduce the excitability of the alarm system and are a mainstay of chronic pain treatment.
- Topical treatments — gels and patches such as Voltarol gel, lidocaine patches, or capsaicin cream calm the nerves locally.
- Simple painkillers — paracetamol and ibuprofen help some people, alone or with other medicines (mind ibuprofen’s side effects).
- Opioids — codeine, oxycodone, and morphine work well for acute pain but are much less useful for chronic pain, and carry a real risk of addiction. We aim to reduce opioid use and start with non-opioid options.
Desensitisation and other techniques
Massage, exercise therapy, acupuncture, and counselling can all help calm the alarm system. Skin desensitisation techniques retrain the sensory nerves — for example:
- Regularly massaging and touching the painful area every 2–3 hours
- Using different textures (velvet, wool, sponge), building from ones you can tolerate
- Immersing the hand or foot in dried beans, rice, or lentils and moving the fingers through for a few minutes daily
- Mirror therapy — watching yourself move in a mirror, to show the brain there’s no injury
A recent JAMA study found that a programme called RESTORE — combining education, sensory massage and touch, and mirror-based movement — improved chronic pain compared with placebo.
Lifestyle and mental wellbeing
Losing weight, stopping smoking, eating well, and improving sleep all help. And because anxiety and low mood turn the volume up, looking after your mental health — with relaxation techniques and psychological support — genuinely improves your ability to live with chronic pain.
Frequently asked questions about chronic pain management
Is chronic pain all in your head?
No. People with chronic pain genuinely feel it — it’s a malfunction of the pain alarm system, not imagined pain. Why some people develop it, and others don’t, isn’t fully understood, but it may relate to genetics and factors such as co-existing anxiety or depression.
Is my pain a sign of more damage?
Not necessarily. In acute pain, more pain usually means more damage. In chronic pain, that link has broken down — so high levels of pain can occur with little or no ongoing damage. This is why an assessment to rule out active damage is reassuring and useful.
Exercise causes pain — should I stop?
It depends on the level. Low-level pain during and after exercise is usually fine to continue, and exercise itself helps calm the alarm system. But if the pain is high-level, don’t push through, as that can further sensitise the system. A graded, guided programme strikes the balance.
What happens if chronic pain is left untreated?
It tends to worsen, and the knock-on effects — anxiety, low mood, poor sleep — make the alarm system more sensitive still, lowering quality of life. This is why an early, active, multidisciplinary approach matters.
Does being overweight increase chronic pain?
It appears to. Excess abdominal fat is strongly associated with chronic tendon and joint pain — an effect that seems stronger in women — probably through increased body-wide inflammation. Losing body fat may reduce chronic musculoskeletal pain.
Final word from Sport Doctor London about living with chronic pain
Chronic pain is best understood as a malfunctioning pain alarm system, rather than a sign of ongoing damage. There’s rarely a quick fix, so be wary of anyone promising a cure — but there’s a great deal that helps. A multidisciplinary approach, combining medical assessment, the right medication, desensitisation, exercise, and psychological support, gives the best chance of turning the volume down and living well.
If you’re living with persistent pain, Dr Masci can assess you in London and help coordinate the right care. Contact the team here or call +44 (0) 203 488 0350.
If chronic pain is severely affecting your mood, please speak to your GP — and if you ever feel unable to keep yourself safe, contact the Samaritans (free, 24/7) or your local emergency services.
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