Chronic pain

Chronic pain is pain that persists or keeps coming back for more than three months. That is the definition in the World Health Organization’s ICD-11 classification, drawn up with the International Association for the Study of Pain, and the one NICE uses (Treede et al., 2019; NICE). Persistent pain and long-term pain mean the same thing.

It is common. Pooling seven UK population studies, researchers estimated that 43.5% of adults live with chronic pain, just under 28 million people, and that for 10.4 to 14.3% it is moderately to severely disabling. It became more common with age and was more common in women (Fayaz et al., 2016).

Chronic primary and chronic secondary pain

ICD-11 splits chronic pain into two kinds (Treede et al., 2019):

• Chronic primary pain is treated as a condition in its own right. Examples include fibromyalgia and non-specific low back pain. NICE describes it as pain with no clear underlying condition, or pain whose impact is out of proportion to any visible injury or disease (NICE).
• Chronic secondary pain comes from an underlying cause, such as cancer, nerve damage, an injury or an operation, where the pain can at least at first be seen as a symptom.

The two can exist together. Non-specific low back pain sits in the primary group: by definition, there is no clear underlying condition to find.

How does desk-related pain become chronic?

Often more gradually, and for more reasons, than people expect:

• Neck pain lingers. Across seven studies of people with a new episode of neck pain, average pain fell from 64 out of 100 at the start to 35 after about six weeks, then stayed at 42 a year later (Hush et al., 2011).
• It comes back. Between half and three quarters of people with neck pain report it again one to five years later. Psychological health and coping were among the strongest predictors of how it went (Carroll et al., 2009).
• Life outside posture matters. In 5,277 middle-aged municipal employees who were free of chronic neck pain at the start and were asked again five to seven years later, earlier neck pain and chronic low back pain predicted new chronic neck pain in both sexes. In women, so did workplace bullying, frequent sleep problems and higher body weight; in men, work-related emotional exhaustion and manual work (Kääriä et al., 2012).

These are the factors clinicians call yellow flags, and they are covered further in Can stress cause back pain? Fear of movement, called kinesiophobia, is another.

What helps chronic pain?

For chronic primary pain, NICE recommends offering a supervised group exercise programme and encouraging people to stay physically active. It suggests considering acceptance and commitment therapy or cognitive behavioural therapy, a single course of acupuncture in some settings, and certain antidepressants. It advises against starting paracetamol, anti-inflammatories, opioids, gabapentinoids or benzodiazepines for chronic primary pain, and against TENS and ultrasound (NICE). Low back pain and sciatica have their own NICE guideline, which recommends self-management advice, carrying on with normal activities and considering a group exercise programme (NICE).

For office workers with chronic neck pain, a review of eight trials found low-certainty evidence that strengthening the neck, shoulder and shoulder-blade muscles reduces pain and disability. All eight trials had a high risk of bias (Jones et al., 2024). See neck pain from desk work and Will back pain go away on its own?

When to see a doctor

Long-lasting pain deserves a proper assessment, and NICE asks clinicians to look at what is contributing to it and how it affects your life (NICE). For back pain, see a GP if it isn’t improving after a few weeks, you’re struggling to cope, you’ve lost weight without trying, it is worse at night, or your back has changed shape. Call 999 for pain, tingling or weakness in both legs, changes in bladder or bowel control, chest pain, or pain after a serious accident (NHS). More warning signs are listed under red flags.