Chronic pain | Mamaenga roa

Key points about chronic pain

  • Chronic pain (mamaenga roa) is pain that lasts longer than 3 months. It's also called persistent pain or long-term pain.
  • There may be many different biological mechanisms involved in chronic pain, but it's always a whole person experience. 
  • About 1 in 6 New Zealanders live with chronic pain and nobody is affected in the same way.
  • Chronic pain intensity can range from mild to severe and can continue day after day or come and go.
  • Chronic pain is complex and can be difficult to treat. The aim of treatment is to find ways to support the person with pain and reduce the impact of the pain on your life. 
  • The impact of chronic pain can also vary, but many people live well in the presence of their pain.
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Everyone feels pain differently and your experience of chronic pain will be unique to you. There are many different biological mechanisms involved in chronic pain, but it's always a whole person experience involving sensations, emotions, thoughts and impacts on activity. The quality of pain can vary from deep aching, shooting, burning, electrical shock to unpleasant tingling, cramping and stabbing.

Pain is often associated with not wanting to move, and people can feel stiff and heavy. Having ongoing pain can be distressing and may involve other symptoms, for example:

  • fatigue
  • trouble sleeping
  • not being active
  • worry, low mood and feelings, eg, stress and frustration
  • difficulty doing daily life activities including not being able to go to work or school or perform other daily activities.

Some chronic pain can be related to inflammatory conditions, eg, rheumatoid arthritis. Some chronic pain develops after damage to the nerves (neuropathic pain, eg, diabetic neuropathy, post-stroke pain). A final group of chronic pains arise from alterations to the way your nervous system processes sensory information (nociplastic pain). In all cases, the relationship between pain and tissue damage is not straightforward and movement is safe – 'sore but safe'.


Chronic pain cycle

Chronic pain may involve a negative cycle where your pain causes feelings of anxiety, low mood, fatigue and sleeplessness – which results in increased pain. The increased pain then causes you to have more low mood, tiredness and stress, so you get caught in an endless cycle.

Cycle of pain, anxiety, low mood, fatigue and sleeplessness

Image credit: Healthify He Puna Waiora

 

Often when pain increases it's tempting to stop daily life activities, increasing the impact of pain on your enjoyment and quality of life. The good news is that there are ways you can approach managing chronic pain to get a better quality of life. 

Watch a video about the idea of chronic pain and how it can be accepted and worked with.

Video: Pain and Me – Tamar Pincus talks about chronic pain, acceptance and commitment

 (Royal Holloway Psychology, UK, 2017)

Effective management of chronic pain requires a comprehensive assessment of your pain and its impact on your life. This may include assessments by a pain medicine specialist, movement therapist (eg, physiotherapist,  osteopath) occupational therapist and psychologist.

Tests or scans help diagnose underlying disease or damage that can be part of chronic pain, but no test or scan can show your pain. Identifying the factors that can influence your pain can take time.

To help with the diagnosis, your healthcare provider will want to know about:

  • when your pain started
  • where you feel the pain
  • what your pain feels like
  • when it's worse and what, if anything, makes it feel a bit better. 

See describing your pain for more information.

Chronic pain is complicated and often doesn't respond to treatments aimed at reducing pain. Where possible, treatments to reduce pain may be offered, but the focus is always on increasing your ability to do the things you want to do. Medicines can be part of your pain management plan, but in general they’re not very effective for reducing chronic pain and often have unpleasant side effects. Some types of chronic pain don't respond to medicines that are helpful for acute pain. Fortunately, there are a number of other strategies to help you live well with pain.


Video: Tips for managing chronic pain

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(Healthify He Puna Waiora, NZ, 2018)


Understand what affects your pain

Being informed about pain, and any disease or injury processes involved, and learning about what affects your pain helps you build a personal understanding of what might be going on. It helps to know that you're safe to move because your pain and what's going on in your body are not well related. Getting to know what affects your pain means you can make decisions about whether it’s worth doing something that's important to you – even if your pain may increase. Knowing what settles your pain down means you can use these strategies at times when your pain flares up.

 

Learn to make room for pain

It can be tempting to look for ways to reduce your pain, but doing this can make it difficult to keep involved in what matters in your life. It helps to weigh up the good (and not so good) in both the short-term and long-term when deciding how much effort to put into reducing or controlling pain intensity. Making room for pain doesn't mean giving up, but it acknowledges the reality that pain is currently part of your life. If you know that you're not doing harm to your body, you can judge whether doing something is worth it even if your pain may increase. Learning ways to calm your nervous system down can help you deal with times when your pain fluctuates.


Stay active

For most types of pain, moving more and doing regular movement practices (eg, walking, swimming, dancing and stretching) can help you keep doing what you value. Short movement 'snacks' throughout the day can be more sustainable than trying to do a larger amount of movement once a week. Using different types of movement activities means you can choose what works for you depending on what else is going on in your life. Ask a member of your healthcare team to help you create a plan for regular movement practices. See our care planning and care plans page to learn how your team and whānau can work with you to make a plan.


Pace yourself

Chronic pain can lead you to re-evaluate your priorities, and create opportunities to think about your pace of life. It can be helpful to look at your week to find ways to have a consistent level of activity. Over-doing things on a day when you feel well can lead you to under-doing the next day, making it hard to make plans. Breaking your daily activities into ‘chunks’ gives you opportunities to change the intensity, movements, and positions you’re in.


Identify strategies to help you manage stress

Stress can affect your pain and, because pain is stressful, even small stresses can be more difficult to deal with. Healthy stress management practices can help you to cope more effectively with your chronic pain. Problem-solving, communicating your needs, using movement practices, working on sleep, eating healthily, connecting with others and having fun all help with stress. Read more about managing stress


Do things you enjoy

Doing activities you enjoy can help reduce stress, tension and anxiety, and keep you involved in life. Having a range of activities from relaxing to energetic – alone and with others – gives you options even in times when your pain fluctuates.


Learn about mindfulness

Mindfulness reduces stress, tension and anxiety. People who practice mindfulness can find they worry less about their pain, and can find ways to calm their nervous system down. Read more about mindfulness.


Have a support network

Engage whānau and friends to help you manage your pain. Join a support group or find a hobby that makes you feel good and helps you connect with family, friends or other people. Connecting with healthcare providers who know and understand about chronic pain, and who you feel comfortable with, can be helpful – especially when navigating the health system. Being engaged and connected can help you feel more positive and experience less pain.


Do a pain-management programme

Doing a pain-management programme is a useful way to learn about your pain. Ask your healthcare team if there's a self-management or pain programme in your area. Or you could do an online course, eg, the free Retrain Pain course(external link) from the Retrain Pain Foundation. You can also view the New Zealand version of the Pain Self-Care Toolkit or visit the Pain Toolkit website(external link) and app for more resources.


Apps

Read about some pain management apps that have been reviewed by Healthify. 


Consider non-medicine treatments

Chronic pain is best managed with a person-centred approach that takes into account the physical, psychological and environmental factors that influence your experience of pain. This usually involves the use of self-management strategies. Often people find they develop these strategies best when supported by a team of health professionals from different backgrounds (a multidisciplinary team or MDT). 

There are a variety of non-medicine-based treatment options to manage pain, including massage, acupuncture, TENS and psychological therapies. Some have limited scientific evidence about their effectiveness and not all of these will be suitable for everyone. Read more about non-medicine treatments for chronic pain.

If your pain persists and is affecting what you can do, ask your healthcare provider about a referral to your local pain service, a pain specialist or pain programme.


Pain relief medicines

Most pain relief medicines are not very effective in treating chronic pain and when used long-term, can have more side effects. However, there are some medicines that can be used alongside self-management strategies. Read more about medicines for chronic pain.

Apps reviewed by Healthify

You may find it useful to look at some Pain management apps and Physiotherapy and exercise apps.

Pain can affect you in many ways and can stop you doing the things that you want to do. It's common to feel frustrated and sad about having chronic pain and the impact this has on you.

Depending on the cause of the pain and the impact that it has on your life, one or more of the following support options might be helpful in addition to the appointments that you have with your healthcare provider or specialist.

  • Family and friends: The support, reassurance and assistance with daily activities you can get from whānau and friends can be very helpful while you recover.
  • Peer coaches and peer-led support: While there's no standard training or regulation, pain coaches, peer-led support workers or groups can offer guidance and encouragement as you use self-management strategies in your daily life. They can also help you set goals for what you want in your life.
  • Counselling: This can be especially helpful if your pain arose from a trauma, eg, a car accident. Talk to your healthcare provider about counselling services available through your medical practice. You could also phone:

Video: Managing chronic pain, Gemma’s story

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(NHS, UK, 2018)


Video: Chronic pain – from survival to support

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(Tedx Talks, 2019)

Brochures

Pain management plan
BPAC, NZ, 2022

Navigating pain
New Zealand Pain Society

reducing chronic pain what you can do to help yourself

Reducing chronic pain – what you can do to help yourself

Healthify He Puna Waiora, NZ and PHARMAC, NZ, 2018

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Credits: Healthify editorial team. Healthify is brought to you by Health Navigator Charitable Trust.

Reviewed by: Dr Bronwyn Lennox Thompson, Senior Lecturer, Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago

Last reviewed: