Living with chronic pain: and coping strategies
What is chronic pain?
A typical definition of chronic or persistent pain is pain that continues for longer than 12 weeks despite medication or treatment. Described by the charity Versus Arthritis as an invisible condition, chronic pain is also one of the biggest causes of disability in the UK (i). Doctors often call persistent pain like this chronic pain syndrome or CPS.
Chronic pain isn’t just physically uncomfortable. It can have a significant effect on your well-being and your ability to have a normal life, not to mention the lives of those around you. It can, in fact, affect just about every aspect of your life. For instance, chronic pain can get you down emotionally, making you less happy and hopeful for the future. And it can affect your mood even at times when you’re not in a lot of pain, because just the threat of severe pain returning at any moment can have a significant impact on your mental well-being .
What causes chronic pain syndrome?
Doctors aren’t always certain what the root cause of chronic pain syndrome is but it often starts as the result of an injury or surgery. It can also affect people living with a medical condition such as:
Post-herpetic neuralgia (this can affect people who’ve had shingles)
Sometimes chronic pain happens for no obvious reason – this is called primary chronic pain. Because there’s no clear cause for primary chronic pain it can be difficult to understand and diagnose – though that doesn’t make the pain any less real.
How common is chronic pain?
Chronic pain is thought to affect millions of people in the UK, though there aren’t any definitive statistics showing exactly how many people experience chronic pain as there are several different criteria for and definitions of chronic pain. However, the most recent published Health Survey for England, which was carried out in 2017, suggests 34 per cent of adults experience chronic pain (ii).
Results of the Health Survey for England and another survey carried out by Versus Arthritis (i) have highlighted how common chronic pain is, and who is most likely to be affected by it:
Of the 34 per cent of adults with chronic pain, around 5.5 million (12 per cent) have high-impact chronic pain (this means severe pain that has an impact on your ability to carry out daily activities)
10 million people (22 per cent) have low-impact chronic pain
38 per cent of women have chronic pain compared with 30 per cent of men (14 per cent of women have high-impact chronic pain compared with nine percent of men)
30 per cent of people with high-impact chronic pain live in the most deprived areas, compared with 15 per cent in the least deprived areas
44 per cent of Black people have chronic pain compared with 34 per cent of white, 35 per cent Asian, 34 per cent mixed/multiple ethnicities and 26 per cent any other ethnic background
53 per cent of people aged 75 or older experience chronic pain compared with 18 per cent of those aged 16 - 34
High-impact chronic pain may, however, be becoming more common in young people, with 32 per cent affected in 2017 compared with 21 per cent in 2011
29 per cent who are a healthy weight experience chronic pain compared with 39 per cent of people who are obese and 54 per cent of those who are very obese
45 per cent of people who do less than 30 minutes of moderate or vigorous activity a week experience chronic pain compared with 31 per cent of those who do 30 minutes of exercise or more per week
What are the risk factors for chronic pain?
Besides your age, your gender, your ethnicity, where you live and your weight, the following are some of the other risk factors that can increase your likelihood of experiencing chronic pain:
Doing lots of heavy manual work
Smoking (smokers are more likely to develop certain conditions that cause chronic pain)
Injuries (having a previous injury could lead to chronic pain in the future)
Stress (chronic pain may be linked to extreme stress and post-traumatic stress disorder)
Family history (some conditions that cause pain can be genetic)
Ways to manage chronic pain
There’s no cure for chronic pain but your GP may recommend you take painkillers such as paracetamol or ibuprofen whenever you need them (though stronger painkillers may be prescribed if you have severe pain). There’s more information about these and other pain medicines in our article Pain relief remedies.
Other treatments you may be offered on the NHS include physical therapy, cognitive behavioural therapy and even acupuncture (treatments often depend on what’s available in your area).
There are, however, lots of other things you can do yourself to help stop chronic pain from completely dominating your life:
Resting is often important if you have short-lived (acute) pain – after a sprain or a strain, for instance – but avoiding activity can lead to more pain if you have the chronic variety. Being inactive in the long term can make your joints stiff and your muscles tight and weak, plus it can also lead to other problems like poor posture, lack of stamina, digestion problems, poor balance and poor coordination , and even lead to weight gain.
Staying active, on the other hand, can help prevent all these problems as well as improve your sense of wellbeing, as exercise is widely believed to help combat a low mood.
Ask your GP to recommend some gentle activities you could get involved with – the type of activity that would suit you may depend on any medical condition you have, for instance.
Staying active may be important but it’s also essential to not do too much, especially if you haven’t been very active lately. Pacing yourself simply means doing little but often, so you can keep doing a certain amount of activity even on bad days. Try to work out how much time you can realistically spend doing basic activities – this means the amount of time you can spend doing something before your pain or discomfort gets too bad. Stick to your limits until your fitness and stamina have improved, when you can try doing a little more (but not so much that you overdo it and make yourself worse).
If you’re in pain a lot of the time you may not want to eat much at all. But having a well-balanced, healthy diet can help in many ways – it can, for instance, help keep your digestive system in good working order, keep your weight down and help when you start to feel burnt out. Try to have at least five portions of fruit and vegetables every day as well as starchy carbs to give you energy, some protein, some dairy foods and a small amount of healthy fats. Having a sugary or fatty treat every now and then is fine, but try not to survive on heavily processed foods as they could make you feel worse in the long run.
Make time for relaxation
Sometimes pain can stop you relaxing, but you may be able to find something that both relaxes you and reduces the stress of your pain. Try to set aside some time every day to practise a relaxation technique – meditation, for instance, or deep breathing or listening to some soothing music. It may not be that easy at first, but the more you practise relaxing the easier it will become.
Find things you enjoy doing
Hobbies and other interests often fall by the wayside when people have chronic pain, but they can be effective ways of distracting yourself from how you feel and help you feel more in control of your life (doing things you enjoy can also boost your production of endorphins, which are your body’s own natural painkillers). If there was something you enjoyed doing before you developed chronic pain, try getting involved in it again, or start something fresh that will absorb you without putting any extra pressure on your mind or body.
It’s not always easy to stay involved with family and friends when you’re in pain, but isolating yourself can make you feel worse — especially if it persists for a long period. Try to keep up contact with the people you’re close to, even when you don’t feel like it.
Get a good night’s sleep
Many people with chronic pain find it difficult to sleep well, and you may find it hard to get to sleep or wake up frequently during the night because you feel pain. However, there are lots of things you can do to try sleeping better – read our guide to sleep and insomnia for advice and tips.
You may think having a glass or two of alcohol will ease your pain and make you feel more normal. But it’s not the answer to your condition. In fact, it could make things worse since alcohol can affect your quality of sleep. Try to cut down or stop drinking alcohol altogether until you’re on top of things again – find more information in guide to alcohol misuse.
Try to be more positive
This may be easier said than done, but many experts believe positive thinking can help you cope with chronic pain. The American Psychological Association, for instance, says it’s a powerful tool, and that by focusing on the positive things in your life and the improvements you’re making – instead of just telling yourself you can’t deal with your pain – you can actually make a difference in your perceived comfort level (iii).
Manage your mental health
Chronic pain can cause problems with your mental well-being , with many affected people also experiencing stress, anxiety and depression. Speak to your GP if you think your mental health is suffering, as they should be able to refer you to a mental health professional who can help. A psychologist or counsellor, for instance, may be able to help you cope with the psychological and emotional impact chronic pain may be having on you. There’s also information you may find helpful in our articles on stress, anxiety depression and where to find support.
Chronic pain support groups
If you’re living with chronic pain it can affect your day-to-day life even more acutely if you try to go it alone. You may find that it helps to talk to people you trust about your experiences, or you could try getting support from charities and organisations that are set up to help people with pain, such as:
Dealing with a chronic pain flare-up
Some people experience constant chronic pain, but for many others, it can come and go, or it may simply be worse at some times than others. When you have a period of severe pain that’s worse than your usual day-to-day experience, it’s called a flare-up.
Flare-ups are common in people with chronic pain and can last for hours, days or weeks, often starting quickly without warning. Sometimes increasing your activity levels when you’re not very fit can cause a flare-up, but a lot of the time there’s no reason why it happens.
Your first reaction when you get a flare-up may be to avoid being active in any way. However, it’s important to resist the urge to hibernate until the worst of it has passed. You may not be able to do much exercise while you’re having a flare-up, but try to keep moving – just a little and at regular intervals – then slowly start being more active again when you feel you can.
There are also a few other things you can do, including:
Make sure you’re taking any medicines your doctor has prescribed for you correctly – if you’re not sure about how you should be taking them, speak to your GP or a pharmacist
If you’re already taking pain medication, try using other methods of pain relief such as heat pads (a hot water bottle is just as good) or a TENS machine (these little devices are available at pharmacies and online)
Try not to sleep much during the day as it could stop you getting the right amount of sleep the following night (having a good night’s sleep is really important when you’re having a flare-up)
Remind yourself that, while you may be experiencing more pain than usual right now, it’s a flare-up and it won’t last forever.
Natural support for chronic pain
Eating healthily is important for people with chronic pain, just as it is for all of us. But there are several nutritional supplements that could give you a little extra support in a variety of ways too, including:
PEA – short for palmitoylethanolamide – is a fatty acid produced naturally by the body and found in all cells, tissues and fluids including the brain. You can also get it in foods such as soya beans, peanuts, eggs, flaxseed and milk. An endocannbinoid-like chemical that belongs to a family of fatty acid compounds called amides, PEA is often described as an alternative to CBD, as both substances are thought to have similar properties including the ability to reduce pain and inflammation. Researchers, however, suggest PEA is safer than CBD, since it has been studied more extensively and has a more robust safety profile (iv) with no known side effects (v). A review of 16 clinical trials and meta-analysis also confirms PEA has painkilling actions (vi).
Turmeric contains an active antioxidant substance called curcumin, which is widely thought to have anti-inflammatory properties. Since inflammation plays a part in several conditions that cause pain – including arthritis and other joint health conditions – turmeric is often recommended by natural health practitioners as an option for pain relief. Scientists are also discovering more about turmeric’s possibilities for pain relief – one review of 10 studies, for instance, concludes turmeric may be beneficial for pain caused by arthritis of the knee, and that the effects of taking it are similar to those of taking anti-inflammatory painkillers (vii).
High-strength fish oils
DHA and EPA – omega-3 fatty acids found in oily fish – may help with reducing pain and inflammation too, with numerous studies since the 1980s suggesting fish oils provide a degree of pain relief. One study, for instance, has found omega-3 fish oil supplements appear to be a safer alternative to anti-inflammatory pain medicines for the treatment of neck or back pain (viii). Other studies suggest omega-3s may work in a similar way to over-the-counter painkillers (ix).
You can add more EPA and DHA to your diet by eating fish such as salmon, mackerel, fresh tuna, sardines and pilchards – the NHS recommends eating at least a portion a week, though girls and women of reproductive age should limit themselves to two portions a week (x). You can also top up your omega-3 levels with a good-quality high-strength fish oil supplement. If you’re a vegan or vegetarian you can also buy supplements that source omega-3s from marine algae instead of fish.
Some of the B vitamins may help with a specific type of pain – neuropathic pain – as they help support a healthy nervous system. Some studies, for instance, suggest taking B vitamins (particularly vitamins B1, B6 and B12) may be useful because they may help repair damaged or irritated nerves, and that being deficient in these vitamins may lead to permanent nerve degeneration and pain (xi). They’re found in a range of foods, but a handy way to top-up your Bs is to take a B complex supplement (though you can take many of the B vitamins individually if you wish).
Several studies suggest there may be a link between vitamin D and chronic pain, since many people with chronic pain have been found to have vitamin D deficiency (xii). Having low vitamin D levels is common, however, including in the UK. This is why Public Health England advises all adults and children over the age of one year old to consider taking a daily 10mcg supplement of vitamin D, especially during the autumn and winter months (xiii).
The recommended supplement form of vitamin D is vitamin D3 or cholecalciferol, as it’s the natural form of vitamin D the body makes when it’s exposed to sunlight. Vitamin D3 supplements are available in capsule form, plus you can get them in veggie-friendly drops too. Most vitamin D3 supplements are made from the fat of lamb’s wool, however, which means they’re unsuitable for vegans. But vegan vitamin D3 supplements – sourced from algae – are now available.
Magnesium is found naturally in the body and is needed for more than 300 biochemical reactions, including muscle and nerve function. It’s also been studied in a variety of pain conditions, with researchers finding it may help with the pain of conditions including fibromyalgia, headaches, migraines, period pain, post-herpetic neuralgia, diabetic neuropathy and back pain (xiv) – though experts admit research is still at an early stage and more large-scale studies are needed to better understand how magnesium may help manage chronic pain.
If having chronic pain is putting you under too much stress, making you anxious and robbing you of a good night’s sleep, a calming supplement such as theanine may be useful. Found almost exclusively in green, black, oolong and pekoe tea, theanine is a non-protein amino acid that’s thought to help your brain produce calming alpha waves. The advantage of theanine is that it helps you relax but it doesn’t make you feel drowsy (xv).
Vitamin C is well known for helping with wound healing, maintaining healthy skin and blood vessels, and protecting our cells. But it may have a role in pain management too, say researchers writing in the Journal of Translational Medicine (xvi). In their paper The role of vitamin C in the treatment of pain: new insights, the experts suggest there’s evidence vitamin C may help in a number of pain conditions including post-herpetic neuralgia, chronic regional pain syndrome and cancer.
Vitamin C may also help if you’re feeling stressed or anxious. Experts have found that people with anxiety who take vitamin C supplements may experience reduced stress and anxiety levels (xvii). One of the reasons this may happen is that vitamin C’s antioxidant properties help control levels of the stress hormone cortisol in the body.
For more information on managing pain
If you need more details about pain in general our pharmacy health library has a section on pain that includes articles on a range of different pain conditions, with advice on how they are treated plus self-care and support suggestions.
Available online: https://www.apa.org/topics/pain/chronic
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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.
Christine Morgan has been a freelance health and wellbeing journalist for almost 20 years, having written for numerous publications including the Daily Mirror, S Magazine, Top Sante, Healthy, Woman & Home, Zest, Allergy, Healthy Times and Pregnancy & Birth; she has also edited several titles such as Women’ Health, Shine’s Real Health & Beauty and All About Health.