Living With Long-Term Pain in the UK: Who Can Help

The NHS says your first stop should be a GP so you can discuss your pain in all its forms. The GP may carry out a physical examination, discuss your pain history, try to identify where the pain is coming from, record your level of pain, check for signs of an illness that could be causing or worsening it, and ask how it affects your life. The NHS says painkillers are generally not considered a primary way to manage long-term pain, and that you should be offered advice on managing your pain day to day, including self-help techniques. Source: NHS: how to get NHS help for your pain.

If the pain is new, changes, or comes with other symptoms, tell your GP. For back pain specifically, see our guide to back pain and physiotherapy.

The NHS says that if you are having difficulty managing your pain you can ask the GP for a referral to a specialist pain clinic. Pain clinics offer a wide range of treatments and support, which may include medicine, pain-relief injections, manual therapy, exercise, complementary therapy and psychological therapy. Some people are offered a pain management programme (PMP): a series of group sessions with other people with persistent pain. The NHS says the aim is to improve your quality of life despite your pain, rather than to reduce the pain, and sessions may include gentle exercise, relaxation and mindfulness, how to manage emotions related to long-term pain, group discussion and learning to pace yourself to avoid flare-ups.

The NICE guideline NG193 covers chronic pain in people over 16, meaning pain that persists or recurs for more than 3 months. For chronic primary pain (where no underlying condition adequately accounts for the pain or its impact), NICE recommends offering a supervised group exercise programme and encouraging people to stay physically active. It says to consider acceptance and commitment therapy (ACT) or cognitive behavioural therapy (CBT) for pain, delivered by healthcare professionals with appropriate training, and to consider a single course of acupuncture or dry needling under certain conditions. It also covers medicines, and says to talk through the benefits and harms with your prescriber. This is a summary for guidance, not advice for your situation. Source: NICE guideline NG193: chronic pain (primary and secondary).

The NHS lists these self-help steps for pain:

• gentle regular exercise, such as walking, swimming, gardening or dancing, built up gradually (the NHS says that if you become more active gradually it is unlikely you will cause damage)
• slow, deep breathing and regular relaxation practice
• keeping to a normal sleep routine, with the same bed and wake times, and seeing a GP if sleep problems persist
• pacing your activities every day rather than overdoing things on good days
• talking to others with similar pain: Pain Concern, Action on Pain and Arthritis UK have telephone helplines staffed by people with long-term pain
• free self-management courses, such as pain management programmes and Pain Toolkit workshops, and the Pain Toolkit booklet

The NHS also says some people find it useful to get help from a psychologist to deal with their emotions in relation to their pain. Source: NHS: 10 ways to reduce pain.

Pain is both physical and emotional, so people often see more than one practitioner. Each of these professions works with long-term pain in different ways:

• Physiotherapists offer tailored exercise, manual therapy and advice on pacing; see how to find a physiotherapist.
• Occupational therapists help you adapt tasks, equipment and routines so you can keep doing what matters to you; see how to find an occupational therapist.
• Practitioner psychologists and CBT therapists offer psychological therapies such as CBT and ACT, with training in pain where they say so; ask about their experience.
• Counsellors and psychotherapists can support you with the emotional side of living with pain.
• Arts therapists (art, music, drama and dance movement) offer another way to express feelings when words are hard.

Because pain can have a medical cause, start with your GP rather than going straight to a private practitioner. See also physiotherapy for pain and mental health.

Whoever you choose, check their register and ask about fees, session length and how you will review progress together. See questions to ask before you book and how much therapy costs. On Therapist Circle, each practitioner's registration is checked when they join, and their profile shows the register and number so you can check it yourself.