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Pain lasting longer than 3 months duration is defined as chronic.
Guidance on acute pain (pain lasting less than 3 months duration) can be found here.
Chronic pain sometimes begins with an acute injury but the pain does not resolve as expected; often it is not clear how a chronic pain has started. Common types of chronic pain include low back pain (refer to management of low back pain and sciatica), pain related to arthritis and pain related to injury to a nerve or other part of the nervous system (refer to management of neuropathic pain). Pain can range from mild or severe.
Chronic pain can cause low mood, irritability, poor sleep and mobility impairment. Unlike acute pain, chronic pain is difficult to treat with most types of treatment helping less than a third of patients. Most treatments aim to help patients self-manage their pain and improve function in a number of domains. Different treatments work for different patients.
Medicines generally and opioids in particular are often not very effective for chronic pain and are usually a small part of the pain management plan (see below). Other non-drug treatments may be used including advice about activity and increasing physical fitness, and psychological therapies such as Cognitive Behavioural Therapy (CBT) and meditation techniques such as mindfulness. When medicines are prescribed they should be used in combination with other treatment approaches to support improved physical, psychological and social functioning. See pharmacological treatment of chronic non-malignant pain below.
Helping a patient understand about chronic pain is important and in particular helping him or her understand that physical activity does not usually cause further tissue damage and is therefore safe. Patients may be directed to the Torbay and South Devon NHS Foundation Trust pain service resource: ReConnect2Life, an interactive programme to aid patients understanding of their pain.
Fibromyalgia is a long-term condition that causes pain all over the body. See here for further guidance in West Devon and here for further guidance in South Devon.
Cancer pain is usually described separately and may be short or long lasting. The pain can relate to the cancer itself or the cancer treatment. Cancer pain is usually associated with an obvious source of tissue damage and may be acute or chronic. Neuropathic pain occurs in relation to cancer diagnoses and treatments (such as radiotherapy). Because cancer pain treatment, particularly at the end of life, is often for a short duration, it is usually more successful than chronic pain treatment. Patients who recover from cancer or who survive a long time with cancer may have pain that is more difficult to treat. Additionally, patients with cancer may experience acute or chronic pain unrelated to their cancer. Refer to 16.2 Treatment of pain in palliative care.
See also section on pharmacological treatment of chronic non-malignant pain below and Management of Opioids page.
Key points:
See section 4.7.1 Non-opioid analgesics and compound analgesic preparations
Stop and review before moving to step 2.
See section 10.1.1 Non-steroidal anti-inflammatory drugs (NSAIDs)
Notes
Stop and review before moving to step 3.
See section 4.7.1 Non-opioid analgesics and compound analgesic preparations
Notes
Stop and review before moving to step 4.
See section 4.7.2 Opioid analgesics
Notes
Review regularly: