Part of the Access Doctor pain guide.
Chronic Pain Treatment UK: Causes, Types & Prescription Options
A clinically reviewed UK guide to chronic pain — how it differs from acute pain, the main types (nociceptive, neuropathic, nociplastic), what drives it, and the prescription and non-prescription treatment options available.
▶ Overview
Chronic pain is pain lasting longer than 3 months — beyond the expected healing time of an acute injury or illness. It affects approximately 28 million adults in the UK (Fayaz et al., BMJ Open 2016) to varying degrees. Chronic pain is not simply acute pain that has gone on longer — it involves changes in the nervous system that require a different treatment approach.
28M
UK adults living with chronic pain (NICE 2021 estimate)
3+ months
IASP definition of chronic pain: pain persisting beyond expected healing time
3 types
Nociceptive, neuropathic, and nociplastic — each responds differently to treatment
What Is Chronic Pain?
The International Association for the Study of Pain (IASP) defines chronic pain as pain lasting more than 3 months, beyond the expected healing period of an injury or disease. Importantly, chronic pain is not simply a prolonged version of acute pain — it represents a distinct physiological state in which the nervous system itself has undergone changes.
In acute pain, pain is a protective signal. The signal resolves as the injury heals. In chronic pain, the alarm system has become sensitised or dysregulated — continuing to fire after the original injury has healed, or amplifying signals out of proportion to any ongoing tissue damage.
Acute vs Chronic Pain: A Clinically Important Distinction
| Acute pain | Chronic pain | |
|---|---|---|
| Duration | Hours to weeks; resolves with healing | More than 3 months; may persist after healing |
| Function | Protective — signals tissue damage, motivates rest | Often serves no protective function |
| Pathophysiology | Peripheral nociceptors responding to injury | Often involves central sensitisation; neuroplastic changes |
| Treatment focus | Analgesia, rest, treat underlying cause | Multimodal — pain science education, physiotherapy, psychology, medication |
| Role of NSAIDs | First-line for inflammatory acute pain | Limited role in non-inflammatory chronic pain; more important in inflammatory arthritides |
This distinction matters for treatment. Using acute pain analgesics (NSAIDs, opioids) long-term for chronic non-inflammatory pain is often ineffective and carries significant risks. Chronic pain typically needs a different therapeutic framework.
Types of Chronic Pain
Nociceptive pain
Caused by ongoing activation of peripheral pain receptors (nociceptors) by tissue damage or inflammation. The pain signal accurately reflects ongoing tissue pathology. Examples: osteoarthritis, inflammatory arthritis, cancer pain. NSAIDs and paracetamol are relevant here — they address the ongoing peripheral inflammation or nociceptor sensitisation.
Neuropathic pain
Caused by damage or disease affecting the somatosensory nervous system itself — peripheral nerves, dorsal root ganglia, or central pain pathways. The pain is not driven by ongoing tissue damage but by abnormal nerve signalling. Features include burning, shooting, or electric-shock pain, allodynia (pain from normally non-painful stimuli), and hyperalgesia. Examples: diabetic peripheral neuropathy, postherpetic neuralgia (shingles pain), sciatica, carpal tunnel syndrome.
NSAIDs are generally not effective for neuropathic pain. First-line treatments include tricyclic antidepressants (amitriptyline), SNRIs (duloxetine), and gabapentinoids (pregabalin, gabapentin) — all of which require specialist or GP prescription and assessment.
Nociplastic pain (central sensitisation)
Defined by IASP as pain arising from altered nociception without clear evidence of tissue damage or nerve damage. The nervous system itself has become sensitised, amplifying pain signals. Examples: fibromyalgia, widespread chronic musculoskeletal pain, chronic widespread pain syndrome. Treatment is primarily non-pharmacological — pain science education, physiotherapy, psychology, graded exercise. Opioids and NSAIDs are largely ineffective.
Common Causes of Chronic Pain in the UK
- Musculoskeletal conditions — osteoarthritis, rheumatoid arthritis, and back pain are the most common causes of chronic pain in the UK
- Neuropathic conditions — diabetic neuropathy, postherpetic neuralgia, multiple sclerosis-related pain
- Widespread pain syndromes — fibromyalgia, chronic widespread pain
- Post-surgical or post-traumatic pain — pain persisting after surgery or injury beyond the expected healing period
- Headache disorders — chronic migraine (15+ headache days/month), persistent tension-type headache
- Cancer-related pain — direct tumour involvement, treatment effects, or nerve involvement
Treatment Approaches
NICE guidance on chronic primary pain (NG193, 2021) marked a significant shift in recommended practice. For chronic primary pain (pain without identified underlying pathology), NICE recommends:
- Pain science education — understanding the neuroscience of chronic pain significantly improves outcomes; changing the way patients conceptualise pain is therapeutically active
- Exercise and physical therapy — graded exercise, physiotherapy, and movement are among the most evidence-based interventions for chronic pain across multiple types
- Psychological approaches — cognitive behavioural therapy (CBT), acceptance and commitment therapy (ACT); evidence base for both in chronic pain
- Supervised group programmes — pain management programmes (PMPs) combining physical, psychological, and educational components
NICE 2021 guidance recommends against the use of opioids, gabapentinoids, antidepressants (for chronic primary pain specifically), and many other medicines for chronic primary pain where the evidence does not support benefit. If you are currently taking opioids for chronic pain, do not stop abruptly — discuss with your prescriber.
Prescription Options for Chronic Pain
| Pain type | Prescription options | Notes |
|---|---|---|
| Inflammatory arthritis / OA flares | Naproxen, ibuprofen 600mg, diclofenac gel | NSAIDs are appropriate for ongoing inflammatory joint disease; lowest effective dose with PPI; regular renal/CV review |
| Neuropathic pain | Amitriptyline, duloxetine, pregabalin, gabapentin | These require specialist or GP assessment; Access Doctor can prescribe via consultation for appropriate patients |
| Migraine prevention | Propranolol, topiramate, amitriptyline | For 4+ migraine days/month; separate clinical pathway |
| Chronic primary pain | Limited evidence for pharmacological treatment; NICE recommends against most medicines | Pain management programmes and psychological approaches are first-line per NICE NG193 |
Get Prescription Pain Relief Online
For ongoing inflammatory pain conditions, prescription NSAIDs are available at Access Doctor following a short online consultation. GPhC pharmacy #9011198.
View Pain Relief Treatments →When to See a Doctor About Chronic Pain
You should seek a GP assessment if you have:
- Pain lasting more than 3 months that is not responding to OTC analgesia
- Pain significantly affecting your sleep, mobility, work, or quality of life
- New neurological symptoms alongside pain — weakness, numbness, loss of bladder or bowel control (the last warrants emergency assessment)
- Pain associated with unexplained weight loss, fever, or night sweats — these require urgent investigation
- Pain that is rapidly worsening without explanation
Seek emergency care immediately if you develop new-onset severe back pain with loss of bladder or bowel control, or weakness in both legs. These may indicate cauda equina syndrome, a surgical emergency.
Frequently Asked Questions
What is chronic pain?
Chronic pain is pain lasting more than 3 months — beyond the expected healing period of an injury or illness. It affects approximately 28 million UK adults. Unlike acute pain, chronic pain often involves changes in the nervous system itself (central sensitisation) rather than simply ongoing tissue damage.
What is the difference between nociceptive and neuropathic pain?
Nociceptive pain is caused by ongoing activation of peripheral pain receptors by tissue damage or inflammation (e.g. osteoarthritis, inflammatory arthritis). Neuropathic pain is caused by damage or disease affecting the somatosensory nervous system itself — producing burning, shooting, or electric-shock pain. These types respond differently to treatment: NSAIDs help nociceptive pain but are generally not effective for neuropathic pain.
Are NSAIDs effective for chronic pain?
NSAIDs are effective for chronic pain with an ongoing inflammatory component — such as osteoarthritis and inflammatory arthritis. For chronic neuropathic pain or chronic primary pain (without identifiable pathology), NSAIDs are generally ineffective and NICE does not recommend them as first-line.
What does NICE recommend for chronic pain?
NICE NG193 (2021) recommends pain science education, graded exercise, physiotherapy, and psychological therapies (CBT, ACT) for chronic primary pain. NICE recommends against opioids, gabapentinoids, and antidepressants for chronic primary pain where evidence does not support benefit. For specific conditions such as neuropathic pain or inflammatory arthritis, NICE has condition-specific guidance.
When should I see a doctor about chronic pain?
See a GP if pain has lasted more than 3 months and is not responding to OTC analgesia, if it is significantly affecting your quality of life, or if you have new neurological symptoms. Seek emergency care immediately if you have severe back pain with loss of bladder or bowel control.
References
- NICE. Chronic pain (primary and secondary) in over 16s. NG193. 2021. nice.org.uk/guidance/ng193
- IASP. IASP taxonomy — Chronic Pain. 2017.
- Fayaz A et al. Prevalence of chronic pain in the UK: a systematic review and meta-analysis. BMJ Open. 2016.
- NHS. Chronic pain. nhs.uk/conditions/chronic-pain
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional before starting or changing any treatment. In a medical emergency, call 999.