Pain – Advice and Support

Pain is one of the most common reasons people contact a GP practice. It can affect sleep, mood, work, relationships, confidence, mobility, and enjoyment of everyday life. When pain lasts for more than 3 months, it is usually described as chronic or persistent pain. Long-term pain is real, but it is also complex: it is influenced not only by the body, but also by the nervous system, sleep, stress, activity levels, and emotional wellbeing.

Many people hope there will be one treatment that makes the pain disappear. Unfortunately, this is not usually how persistent pain works. For many people, the most helpful approach is learning how to manage pain in a way that improves quality of life, function, confidence, and control. Medicines may sometimes have a role, but they are often only one part of the picture, and for many types of long-term pain they are not the main answer.

Our aim is to support you with good information, practical self-management advice, and trusted resources.

Understanding persistent pain

Persistent pain is different from the short-term pain you get after an injury or illness. Acute pain acts as a warning signal. Chronic pain can continue long after tissues have healed, and sometimes the nervous system becomes over-sensitive, so pain signals continue even when there is no ongoing damage. This does not mean the pain is “imagined” or “all in your head” — it means the pain system itself can become more protective and reactive.

Long-term pain can also create unhelpful cycles. Pain may lead to poor sleep, low mood, worry, less movement, or doing too much on a “good day” and then paying for it afterwards. These patterns can increase distress and make pain harder to live with.

That is why good pain care looks at the whole person, not just the painful body part. NICE recommends a person-centred assessment that looks at what may be contributing to pain and how pain is affecting daily life.

Keep moving, but pace yourself

One of the most important things in persistent pain is to keep as active as you safely can. This can feel difficult, especially if movement seems to increase pain, but becoming less active often makes pain worse over time. Underactivity can lead to stiffness, weakness, reduced fitness, poorer sleep, and lower confidence.

At the same time, doing too much on a better day can trigger a flare-up. This is where pacing helps. Pacing means planning a manageable amount of activity and trying to keep it steadier across both good days and bad days, rather than letting pain completely dictate what happens each day. NHS Inform describes pacing as doing things within your limits, taking breaks before symptoms become too much, and adding small amounts over time as your body adapts.

Helpful ideas include:

  • breaking jobs into smaller steps
  • alternating activity and rest
  • setting a realistic “baseline” you can do regularly
  • increasing gradually, rather than suddenly
  • stopping before you are completely exhausted

The goal is not to do nothing, and it is not to push through everything. It is to find a sustainable middle ground.

Activity and exercise

Exercise does not need to mean the gym. Any movement can count. NHS Inform suggests options such as walking, dancing or moving to music, pool-based exercise, exercise classes, and gentle yoga or tai chi. The best exercise is usually something you can keep doing and, ideally, something you enjoy.

When you start moving more, some discomfort can happen. That does not always mean harm. Starting low and building slowly is often the safest and most effective approach. NICE recommends supervised group exercise programmes for chronic primary pain and encourages people to remain physically active for long-term health benefits.

It can help to set small goals, such as:

  • walking for 5 to 10 minutes three times a week
  • doing gentle stretches every morning
  • standing up and moving regularly if you sit a lot
  • gradually returning to hobbies or household activities

Small, steady gains often matter more than dramatic effort.

Managing flare-ups

Flare-ups are common in persistent pain. A flare-up does not necessarily mean damage has been done or that your condition is getting worse. NICE advises reassessment if symptoms change, but also recognises that a clear cause for a flare-up may not always be found.

During a flare-up, it can help to:

  • reduce activity a little, without stopping completely
  • return to gentle movement as soon as you can
  • use your pacing plan
  • focus on simple routines
  • use relaxation or breathing techniques
  • check sleep, stress, and recent overactivity

Trying to “catch up” after a flare often makes the boom-and-bust cycle worse. Gentle consistency is usually more helpful than either strict bed rest or forcing yourself through too much. NHS guidance on living with chronic pain warns that underactivity can worsen pain in the longer term.

Relaxation, stress, and the nervous system

Pain often causes muscle tension, irritability, and stress, and stress can in turn make pain feel worse. Relaxation is not about pretending the pain is not there. It is a practical skill that can calm the body, reduce tension, and improve your sense of control. The RUH booklet highlights relaxation as useful for reducing muscle tension, producing a calming effect, and promoting sleep.

Relaxation may include:

  • slow breathing
  • mindfulness
  • guided relaxation
  • progressive muscle relaxation
  • quiet time away from noise and screens
  • stretching, meditation, or prayer if that suits you

NHS Inform notes that relaxation can reduce stress and may improve sleep, and that mindfulness can help people notice thoughts, worries, and emotions without getting completely caught up in them.

Like exercise, relaxation works best when practised regularly, not only when things feel unbearable.

Sleep and pain

Pain and sleep are closely linked. Pain can make it hard to fall asleep or stay asleep, and poor sleep can increase stress and make pain harder to cope with. NHS Inform notes that sleep problems can increase stress levels and make it more difficult to cope with pain.

Common sleep tips include:

  • keeping a regular getting-up time
  • reducing naps where possible
  • limiting caffeine, nicotine, and alcohol in the evening
  • building gentle daytime activity
  • creating a wind-down routine before bed
  • using relaxation before sleep

The RUH booklet also suggests that worry, medication use or withdrawal, under- or over-activity, and irregular routines can all contribute to sleep problems.

You do not need perfect sleep to make progress, but improving sleep habits can make a real difference over time.

Mood, thoughts, and living with pain

Persistent pain affects mental wellbeing, and mental wellbeing affects pain. Many people with long-term pain feel frustrated, low, worried, isolated, or exhausted. Some become fearful of activity because they worry they will make things worse. Others feel guilty because they cannot do what they used to. These reactions are common and understandable.

This is why psychological approaches can be helpful in pain care. NICE recommends considering CBT for pain or acceptance and commitment therapy (ACT) for chronic primary pain. These approaches are not about saying pain is psychological; they are about helping people manage the thoughts, feelings, behaviours, and patterns that can amplify suffering.

You may benefit from support if you notice:

  • fear of movement
  • worsening anxiety
  • low mood
  • loss of confidence
  • avoiding valued activities
  • feeling stuck in a cycle of pain and distress

Goals, routine, and doing what matters

Long-term pain often narrows life. People may stop socialising, stop exercising, stop travelling, or stop doing activities that matter to them. A big part of pain management is slowly rebuilding those parts of life in realistic ways. NHS Inform recommends goal setting that is specific, realistic, measurable, and meaningful to you.

Examples might include:

  • walking to the local shop once a week
  • cooking one meal yourself
  • meeting a friend for coffee
  • returning to a hobby in short bursts
  • sitting out in the garden daily
  • doing school pick-up once a week

These are not “small” things if they matter to you. Improving function and quality of life is often a more useful goal than chasing a pain score alone.

Non-medicines options: what can help

Depending on the cause and type of pain, non-pharmacological support may include:

  • physiotherapy
  • structured exercise
  • pacing support
  • CBT or ACT for pain
  • mindfulness or relaxation practice
  • occupational therapy advice
  • sleep support
  • pain management programmes
  • acupuncture in some cases of chronic primary pain

NICE recommends exercise and physical activity, and suggests CBT/ACT for chronic primary pain. It also says a single course of acupuncture or dry needling may be considered for chronic primary pain in certain settings. NICE does not recommend TENS, ultrasound, or interferential therapy for chronic primary pain because evidence of benefit was lacking.

Pain medicines: a balanced guide

Pain medicines can sometimes help, but they also have limits. NHS Inform states that most people with chronic pain will not benefit from medication alone, and that medicines should usually sit alongside education, activity management, and support for mental wellbeing. It also advises regular review because side effects, dependence, and lack of benefit can become a problem over time.

It is also important to distinguish between chronic primary pain and pain caused by a clear underlying condition. For chronic primary pain, NICE advises not to start opioids, gabapentinoids, benzodiazepines, antipsychotics, or several other medicines, and says antidepressants may sometimes be considered after discussion of benefits and harms.

Below is a general guide to common medicine groups used in pain care.

Paracetamol

Paracetamol is widely used for short-term aches and pains and sometimes alongside other treatments. It usually causes few side effects when taken at the correct dose, but overdose can be very dangerous because it can cause severe liver damage.

Main points:

  • often well tolerated
  • may help some types of short-term pain
  • benefit for long-term pain can be limited
  • taking more than the recommended dose is dangerous

Anti-inflammatory medicines (NSAIDs)

These include ibuprofen, naproxen, and similar medicines. They can be useful for some conditions, especially where inflammation is part of the problem. However, they are not suitable for everyone and can cause significant side effects. NHS notes risks including indigestion, stomach ulcers or bleeding, and in rare cases problems with the kidneys, liver, heart, and circulation.

Main concerns:

  • indigestion or stomach irritation
  • stomach ulcers or bleeding
  • kidney problems
  • possible cardiovascular risks in some people
  • not suitable for everyone, especially some older adults or people with kidney, stomach, or heart conditions

Opioids

These include codeine, tramadol, morphine, oxycodone, and similar medicines. Opioids can be useful for short-term pain, such as after surgery or injury. For many people with long-term pain, however, they become less effective over time and can cause harm. NHS Inform says that for most people in the longer term opioids become ineffective, can be harmful, and can lead to dependency.

Common problems include:

  • constipation
  • nausea
  • dizziness
  • drowsiness
  • memory or concentration problems
  • reduced sex drive
  • sleep problems
  • dependence and withdrawal
  • slow or shallow breathing, especially at higher doses or in combination with other sedating medicines

If opioids are not improving pain and function, they may not be helping overall. They should not usually be continued indefinitely without review.

Gabapentinoids

This group includes gabapentin and pregabalin. These medicines are often used for some kinds of nerve pain, but they are not right for every type of chronic pain. NICE says gabapentinoids should not be initiated for chronic primary pain.

Common side effects include:

  • sleepiness
  • tiredness
  • dizziness
  • headache
  • difficulty concentrating or slower thinking

Important concerns:

  • they can affect driving and alertness
  • some people develop dependence
  • they should usually be reduced gradually rather than stopped suddenly

Antidepressants used for pain

Some antidepressants are also used in pain management, even when a person is not depressed. NICE says antidepressants may help some people with chronic primary pain by improving quality of life, pain, sleep, and psychological distress.

Common examples include:

  • amitriptyline
  • duloxetine

Amitriptyline

Amitriptyline is sometimes used for nerve pain and persistent pain. NHS says it can take 1 to 2 weeks to start helping and up to 6 weeks to work fully as a painkiller. Common side effects include drowsiness, dizziness, dry mouth, constipation, and sweating. It can also cause extra side effects if stopped suddenly, so it is usually reduced gradually.

Duloxetine

Duloxetine is used for some pain conditions, particularly nerve pain. NHS notes it may take 2 to 4 weeks to work, and sometimes longer for nerve pain. Common side effects include nausea, dry mouth, headache, constipation, and sleepiness. It should usually be reduced gradually rather than stopped abruptly because withdrawal symptoms can occur.

Benzodiazepines and sleeping tablets

These are sometimes thought of as ways to calm pain, muscle tension, or insomnia, but they can cause dependency and are generally not a good long-term answer for persistent pain. NICE says benzodiazepines should not be initiated for chronic primary pain.

A few important messages about pain medicines

  • Medicines work best when regularly reviewed.
  • The right medicine for one type of pain may be the wrong medicine for another.
  • Higher doses do not always mean better results.
  • If a medicine is causing more side effects than benefit, it may need rethinking.
  • Do not stop regular pain medicines suddenly unless you have been advised it is safe to do so.
  • Ask for a medication review if you are unsure whether your treatment is still helping.

Useful websites and resources

We have chosen the links below because they offer practical, trustworthy advice for people living with pain:

Please note: some of these websites are not based in Liverpool or NHS funded, but we have selected them because they offer clear, trusted, high-quality advice that may be helpful wherever you live. We are not affiliated with any private services mentioned.

When to contact us

Please contact the practice if:

  • your pain has changed significantly
  • you have new symptoms
  • you think your medication is causing problems
  • pain is affecting your sleep, mood, or ability to cope
  • you would like a medication review or support with pain management

Please seek urgent medical help if you have symptoms such as sudden severe chest pain, signs of stroke, new weakness, loss of consciousness, or other emergency symptoms.

Additional Information

Virtual Practice Tour

Patient Participation Group

Self Referrals/Local Services

Community Involvement

Requesting a letter

Statement of Costs – Non-NHS Work

GDPR / Practice Policies