Chronic pain

Chronic pain can follow an injury or surgery, come with a condition like arthritis, or appear without a clear cause. Sometimes the original injury has healed, but the nervous system keeps sending pain signals. That does not mean the pain is “in your head”. It means the body’s alarm system has become extra sensitive.

Common kinds

• Back and neck pain
• Headaches and migraine
• Joint pain, such as arthritis
• Nerve pain (burning, tingling, shooting)
• Pain after an injury or operation that never fully settled
• Widespread pain with tiredness, as in fibromyalgia

Short-term (acute) pain is a useful warning. It tells you to protect an injury while it heals, then it fades. Chronic pain keeps going past the normal healing time, often for months or years.

Pain usually has a protective job. When it lasts a long time, though, it can get in the way of daily life, work, friendships and well-being.

The International Association for the Study of Pain says pain is always a personal experience. Biology, thoughts and feelings, and life circumstances all play a part. People also learn what pain means through their own life experiences.

What this means for you

• Two people with the same injury can feel very different pain
• Pain can be real even when tests look normal
• Stress, sleep and mood can turn pain up or down
• Your own description of your pain matters

In 2023, about 1 in 4 U.S. adults had chronic pain. It was more common in older age groups and slightly more common in women than men. About 12 in 100 adults aged 18 to 29 had it too.

Around the world, conditions like low back pain, neck pain and osteoarthritis are the leading contributor to disability.

With long-term pain, the nervous system can become over-sensitive. It sounds the alarm more easily and more loudly, even when there is little or no new damage. Learning about this can make pain less frightening and movement feel safer.

Things that can turn the alarm up

• Fear that pain means harm
• Long periods of not moving
• Poor sleep
• Stress and worry

When you are stressed, breathing gets fast and shallow and muscles tighten. Slow, deep breathing helps switch the body toward “rest” mode, which can soften tension and help you stay in control when pain is strong.

Try this

1. Sit or lie in a comfortable position.
2. Breathe in gently through your nose for a count of 4.
3. Breathe out slowly through your mouth for a count of 6.
4. Let your shoulders drop as you breathe out.
5. Repeat for 2 to 5 minutes.

The brain has limited attention. When you are absorbed in music, a game, a craft, a show or a good conversation, there is less room for pain to take center stage. This is not pretending the pain is gone. It is giving your brain something else to hold.

Ideas

• Calling a friend
• Listening to a favourite playlist or podcast
• Puzzles, drawing, knitting or building something
• Watching birds, clouds or the sky

Thoughts like “This will never get better” or “I can’t cope” are very understandable when you hurt. But they can raise stress and make pain feel bigger. Learning to spot these thoughts and answer them more kindly is a key part of talking therapies for pain.

Kinder ways to talk to yourself

• “Hurt does not always mean harm.”
• “I can do one small thing right now.”
• “This is a flare. I have got through flares before.”

People with a long-term health condition, including pain, have a higher risk of depression. When both happen together, each can make the other feel worse.

Chronic pain is also linked with anxiety, irritability and mood swings. Being in pain wears down your patience and your coping reserves, just like being very hungry or tired does.

Pain can make it hard to get comfortable, and it can wake you in the night. Then, after poor sleep, the brain is less able to dial pain down, so the next day can hurt more. This loop is one of the most common parts of living with pain.

Gentle sleep habits

• Go to bed and get up at about the same times
• Keep naps short, or skip them if they keep you up at night
• Keep the bedroom cool, dark and quiet
• Try pillows or positions that support sore areas
• Wind down with slow breathing or a calm activity

Pushing yourself too hard or too fast, or suddenly starting a new activity or exercise, is a common reason for a flare. But doing too little matters too. Long stretches of rest can leave the body stiffer and weaker, so everyday tasks hurt more.

What helps

• Break tasks up with short, frequent rests
• Build up new activities slowly
• Keep up gentle activity during a flare instead of long bed rest
• See “Pacing and flare plans” for how to find your baseline

Emotional stress is one of the most common flare triggers. Research reviews also link ongoing stress with more severe chronic pain. Stress tightens muscles and keeps the nervous system on alert, so pain signals feel louder.

What helps

• A therapist can teach skills for living with pain and stress (see “Approaches that can help”)
• Plan extra rest around stressful events
• Talk it through with someone you trust
• Use slow breathing or a short body scan when you notice tension

Not getting enough sleep, or changing your sleep schedule, can set off a flare. Poor sleep is also one of the key things researchers say keeps chronic pain going. Pain can make sleep hard too, so the two can feed each other.

What helps

• Keep a steady wake-up time, even after a bad night
• Keep naps short and early
• Tell your clinical provider if pain often keeps you awake. The Sleep & mental health guide has more ideas.
• Wind down with something calm in the hour before bed

Weather or temperature changes are listed as a flare trigger for some long-term pain conditions. Not everyone notices this, and the science is still unclear, but many people say a cold snap or a stormy week makes them ache more.

What helps

• Check the forecast and plan lighter days when bad weather is coming
• Dress in warm layers, and keep a heat pack handy
• Move indoors when it’s too cold or wet to walk outside
• Note the weather in your pain diary to see if it’s a pattern for you

Being ill or injured, or a big change to your daily routine, such as travel, a new job or a house move, can bring on a flare. The body is already working hard, and the usual habits that keep you steady can slip.

What helps

• Ask your clinical provider before changing anything in your treatment plan
• Keep a few anchors in place: meal times, a short walk, bedtime
• Lower your expectations while you recover
• When you travel, pack the things that soothe you, like a heat pack or a favourite pillow

It makes perfect sense to want to catch up when you feel better. But pushing too hard often leads to a flare, then days of rest, then even more to catch up on. Over time, the good days can get fewer and the bad days longer.

Signs you might be in this pattern

• You avoid activity for days, then do a lot at once
• You often feel much worse a day or two after a busy day
• You stop only when the pain forces you to

Steps

1. Pick one activity, like walking, cleaning or computer work.
2. Notice how long you can do it on a typical day without a flare afterward. That is your baseline.
3. Start a little below that amount.
4. Take a short break before you need one.
5. Every week or two, add a small amount if your body allows.
6. Do roughly the same on good days and bad days.

Helpful tricks

• Break big jobs into parts across the week
• Plan rest as an activity, not a failure
• Swap between sitting, standing and moving
• Use a timer so you stop before the pain stops you

Some people, for example with ME/CFS or long COVID, get much worse 12 to 48 hours after physical or mental effort. This is called post-exertional malaise. For them, pacing means staying inside a personal “energy envelope” first, rather than adding more each week.

Flares can be scary, and it is hard to think clearly when you are in a lot of pain. Writing a plan ahead of time means you don’t have to make big decisions in the middle of it.

A flare plan might include

• Early warning signs that a flare is starting
• Kind words to read to yourself
• Tasks you can drop or hand off
• Things that usually soothe you (heat, rest positions, breathing, a calm playlist)
• What your clinical provider has advised for flares
• When to call your provider or get urgent help
• Who to tell, and what to ask them for

Cognitive behavioral therapy (CBT) for pain teaches practical skills: spotting thoughts that raise stress, pacing activity, solving problems, relaxing the body and slowly returning to things you value. It does not say your pain is imaginary. It helps you handle real pain with less suffering.

Honest evidence: a large 2020 review of research found CBT gives small benefits for pain, disability and distress compared with usual care. Small can still matter in daily life, and some people benefit much more than others.

What it can look like

• Homework like activity diaries and practicing skills
• One-to-one, in a group or online
• Weekly sessions for a set number of weeks

ACT helps people stop fighting every moment of pain, which can be exhausting, and instead focus on living by their values. It uses mindfulness, noticing thoughts without being ruled by them, and setting small, meaningful goals.

Honest evidence: ACT is widely used for chronic pain, but a large 2020 review found the research quality was still too low to be sure how much it helps. More good studies are needed.

Mindfulness means paying attention to the present moment, including body sensations, without judging them. With pain, it can help you notice the difference between the raw sensation and the worry layered on top of it.

Honest evidence: research suggests mindfulness meditation may improve people’s ability to cope with pain. In a trial of adults with chronic low-back pain, a mindfulness-based stress reduction program improved function and pain compared with usual care.

A 3-minute body check-in

1. Sit or lie comfortably and close your eyes if you like.
2. Notice your breath without changing it.
3. Gently scan from head to toes, noticing what you feel.
4. If you meet pain, describe it in plain words: hot, tight, dull, sharp.
5. Breathe toward that area, then widen your attention to the whole body.

When you hurt, resting can feel safest. But too much rest can make muscles weaker and joints stiffer, which can add to pain. Gentle movement, built up slowly, is safe for most people and can ease pain over time.

Honest evidence: yoga and tai chi have reasonable support for some conditions, such as low-back pain and knee arthritis. Evidence varies by condition and is still limited for some.

Ideas to try

• Beginner yoga or tai chi classes
• Chair-based stretches
• Short walks, adding a minute or two each week
• Swimming or exercises in warm water

Pain neuroscience education teaches how the nervous system creates pain and how it can become over-sensitive. Understanding this can make pain less frightening and movement feel safer.

Honest evidence: reviews of studies suggest it can help with pain, understanding, function and worry about pain, especially when combined with exercise or physical therapy.

Relaxation methods like slow breathing, guided imagery and progressive muscle relaxation can help calm the stress response and lower tension. Many people also find comfort in warmth, gentle massage, music or time in nature.

Try

• A guided relaxation recording before bed
• A warm (not hot) bath or a heat pack, if your provider says it’s okay
• Music you love
• Sitting outside for a few minutes

Pain without a clear physical cause is often linked to changes in how the nervous system processes signals. The pain is real. Emotional and psychological factors can affect it, just as they affect all pain, but that does not make it imaginary.

Short rests during a flare are fine. But long periods of rest can weaken muscles and stiffen joints. Building up gentle activity slowly, with pacing, is safe for most people. Check with your clinical provider about what suits your condition.

Pain affects mood, sleep and relationships, and talking therapies are one way to ease that load. They work alongside medical care, not instead of it.

People with long-term health conditions, including pain, have a higher risk of depression, but it is not something you just have to accept. Getting help for low mood can also make it easier to manage your physical health.

Chronic pain becomes more common with age, but it affects younger adults too. In 2023, about 12 in 100 U.S. adults aged 18 to 29 had chronic pain.

Pain experts say a person’s own report of pain should be respected, and that words are only one way of showing pain. Many people with chronic pain learn to keep going and look “fine” on the outside.

Pain experts say a person’s own report of pain should be respected. You don’t need to see it to believe it.

Helpful things to say

• “I believe you.”
• “That sounds really hard.”
• “What would help most today?”
• “You don’t have to explain. I’m here.”

Things to avoid

• “But you look fine.”
• “Have you tried just…?” (unless they asked for ideas)
• “My cousin had that and got better with exercise.”
• Comparing their pain to yours or others’

• “I’m going to the store. What can I pick up for you?”
• Cook a meal that freezes well
• Drive them to an appointment and help take notes
• Help with paperwork or phone calls
• Plan low-energy hangouts, and don’t take cancellations personally

Boom-and-bust patterns are common with chronic pain. On a good day, it is tempting for everyone to pack in as much as possible. Steady, planned activity usually leads to fewer crashes.

Ways to help

• Build breaks into outings and family plans
• Celebrate small, steady progress
• Don’t pressure them to “make the most” of a good day
• Offer to take over a task when they need to stop

Supporting someone long-term can be tiring and lonely. You may grieve changes in your relationship or your own plans. Looking after yourself is not selfish. It helps you keep going.

What helps

• Join a caregiver support group
• Keep up your own friendships and interests
• Take regular breaks and accept help from others
• Talk to a counselor if you feel overwhelmed

Support groups bring people together to share experiences, tips and encouragement. Many are run by condition-specific charities or hospitals. Group therapy for pain is also offered by some clinics.

Finding one

• Ask your clinical provider, hospital or pain clinic
• Check libraries, community centers and faith groups
• Look for a national organization for your condition
• Try online groups if travel is hard

Online groups can be a lifeline when leaving home is hard. They can also bring misinformation or products that promise cures. Stay curious and careful.

Stay safe online

• Be wary of anyone selling a “cure”
• Check health advice with your clinical provider
• Protect your personal details
• Take breaks if scrolling makes you anxious

Self-management courses teach day-to-day skills like pacing, goal-setting, relaxation and talking with providers. They are often run in small groups, which adds the benefit of meeting others.

Yoga, tai chi and water exercise have some support for certain pain conditions. Doing them in a class adds friendship, routine and encouragement.

Ideas

• A beginner or chair-based class at a community center
• A walking group that goes at an easy pace
• Warm-water classes at a local pool

Appointments can feel rushed, and it is easy to forget what you meant to say. Speaking up for yourself is called self-advocacy, and it is a skill anyone can learn.

Bring

• A short pain diary (when pain is worse or better, sleep, mood)
• How pain affects daily life: work, sleep, chores, family
• Questions you want answered
• What you have tried and how it went
• Your top 2 or 3 concerns, in order of importance

Pain scores from 0 to 10 are useful, but they don’t show the whole picture. Telling your provider what you can’t do anymore helps them understand how serious things are.

For example

• “I can’t sit for more than 20 minutes, so I had to stop driving to work.”
• “I haven’t been able to pick up my grandchild in months.”
• “I wake up 4 or 5 times a night from pain.”

• What do you think is causing this?
• What are my options, including non-drug options?
• What are the pros and cons of each?
• What should I do during a flare?
• When should I contact you, and when should I get urgent help?
• Could talking therapy or a pain management program help me?
• Can you write that down for me?

Pain and tiredness can make it hard to listen and remember. A trusted friend or family member can take notes, remind you of your questions and help you speak up.

Before you go, agree

• Anything private you’d rather talk about alone
• What you want from the visit
• Whether they should speak, or just listen and take notes

Many people only talk about the body at medical visits. But low mood, worry and poor sleep are common with long-term pain, and they can be treated. In some places, primary care and mental health providers work together as a team, which is called collaborative care.

You could say

• “Could I talk to someone about how I’m coping?”
• “I’m worried all the time about my health.”
• “The pain is getting me down. I’ve been feeling low most days.”