We all will have some muscle or joint pain or injury at some stage on in our lives.  The information below should help you understand and manage your symptoms. It will also offer guidance on when to ask for help.

Localised injuries and pain

Information when you have sustained an injury or have pain or stiffness in a specific area of your body.

Back problems are very common and will affect many of us at some stage of our lives.  Your back problem may start for no obvious reason, which you could find very frustrating. The spine is strong and back problems are very rarely due to any serious disease or damage.

What symptoms would I have?

Back problems can cause a range of symptoms, including:

  • Stiffness.
  • Muscle spasms.
  • Hot, burning, shooting or stabbing pains in your back and sometimes into one or both of your leg.

 You may also feel pins and needles in the legs, this may be due to nerve irritation.

You don't normally need to see a healthcare professional. New or flare-up of longstanding back problems should begin to settle within 6 weeks.  For most back pain problems, you'll not normally need an X-ray or MRI scan.

What may be the cause of my back problem?

Although most back problems start for no obvious reason, back pain can be caused by:

  • Staying in one position too long.
  • Lifting something awkwardly.
  • A flare-up of an existing problem.

As well as the things listed above, there are also specific conditions which are linked with pain felt in the back. It's important to remember that severe pain doesn't necessarily mean there's a serious problem.

What can I do to help manage my back problem?

Keeping active is an essential part of your treatment and recovery and is the single best thing you can do for your health. Exercising can really help your back and reduce the pain you feel.

Try not to:

  • Brace or hold yourself still - your back is designed to be mobile.
  • Sit down or rest for too long - resting in bed doesn't help back pain, and often makes it harder to get going again.

If you have to sit or rest, try to change positions regularly and find one that reduces any pain in your back or legs.

Being physically active throughout your recovery can:

  • Prevent a recurrence of the problem.
  • Maintain your current levels of fitness - even if you have to modify what you normally do, any activity is better than none.
  • Keep your other muscles and joints strong and flexible.
  • Help you aim for a healthy body weight.

It is recommended you stay at or return to work as quickly as possible during your recovery. You don't need to be pain or symptom-free to return to work.

What can I do to help manage my pain?

Pain medication can help to reduce the pain and help you move more comfortably, which can help your recovery.

Speak to your community pharmacist about taking medication or other methods of pain relief. It is important that you take the medication as prescribed/advised.​

Stay positive

It's easy to start worrying about all the possible things that could be wrong, but research has shown that most back pain settles with time. Keeping as active as possible helps you to cope better and recover more quickly.

What are the warning signs of a problem?

If you experience any of the following, speak to your GP as soon as possible:

  • Generally feeling unwell
  • Back pain that starts when you're ill with other problems - such as rheumatoid arthritis or cancer
  • Unsteadiness when you walk

Help and support

If, after following the above advice, your back problem hasn't improved within 6 weeks a referral to a physiotherapist may be of benefit.

Patients whose GP's are in Durham, the Dales or Easington, can refer themselves to our Integrated MSK Service by downloading a self-referral form.

Other useful support and resources

Your calf problem can present with a combination of symptoms, including:

  • Pain: normally felt around the calf, and sometimes referring into the foot.
  • Bruising: along the calf and into the ankle.
  • Swelling or Tightness: normally noticed at the back of the calf.

What may be the cause of my calf problem?

Calf problems are very common and can be caused by injury or normal use. This could happen due to a direct hit, due to a trip or a fall or sporting activity.

Are there any other causes for calf pain?

Yes. Calf pain can also be caused by circulatory complaints:

  • If your calf is hot, swollen, red and tender and tense to touch, please seek medical attention immediately.

Occasionally, problems felt in your calf can be due to a back problem, even though you may not feel pain in your back. People with this sort of problem often describe the pain as sharp or burning, usually in the back of the calf, and with or without pins and needles in the calf and/or foot.

What can I do to help manage my calf problem?

  • Keeping your calf moving is an essential part of your treatment and recovery.  Keeping active is the single best thing you can do for your health.

Being physically active throughout your recovery can:

  • Prevent a recurrence of the problem.
  • Maintain your current levels of fitness - even if you have to modify what you normally do, any activity is better than none.
  • Keep your other muscles and joints strong and flexible.
  • Help you aim for a healthy body weight.

It's recommended you stay at or return to work as quickly as possible during your recovery. You don't need to be pain or symptom-free to return to work.

What can I do to help manage my pain?

Pain medication can help to reduce the pain and help you move more comfortably, which can help your recovery.

Speak to your community pharmacist about taking medication or other methods of pain relief​. It is important that you take the medication as prescribed/advised.​

Should I rest it or keep it moving?

Within the first 24 to 48 hours after a calf injury you should try to:

  • Rest your calf in an elevated position, but avoid long spells of not moving at all.
  • Move your ankle and knee gently for 10 to 20 seconds every hour when you are awake.

After 48 hours:

  • Try to use your leg more - exercise really helps your calf and can relieve pain.
  • Do whatever you normally would and stay at, or return to work - this is important and is the best way to get better. You may need to adapt how you do things initially.

You may find using the stairs difficult:

  • When going upstairs: you can reduced the strain on your calf by leading you're your good leg
  • When going downstairs: you can reduced the strain on your calf by leading with your problem leg. If there is a handrail or bannister, use it to support your leg.
  • Avoid sports or heavy lifting until you have less discomfort and good movement.

When should I ask for help?

You should present to your GP, local Urgent Care Centre or A&E when:

  • When your calf is hot, swollen and tender and tense to touch, especially if you can't recall an injury.
  • You have difficulty putting any weight through your sore leg.
  • When you can't lift your heel of the floor.

Most other calf problems should settle within 6 weeks without seeing a healthcare professional. If your calf problem does not improve within 6 weeks, and/or the pain is getting worse, it is recommended that you seek the advice of a physiotherapist.

Patients whose GP's are in Durham, the Dales or Easington, can refer themselves to our Integrated MSK Service by downloading our self-referral form.

Elbow problems are very common and can happen with or without any trauma.


What symptoms could I have?
Your elbow problem can present with a combination of symptoms, including:

  • Pain: normally felt around the elbow into the lower upper arm and down the forearm.
  • Swelling: around the elbow joint and forearm.
  • Stiffness: the elbow feels 'stuck' or 'stiff'.

What causes elbow problems?
Elbow problems are common and are usually the result of:

  • Repetitive movement of the elbow, for example when painting a room.
  • A flare-up of an existing condition.
  • Direct injury, for example a trip or fall onto the elbow.

What can I do to help manage my elbow problem?

  • Keeping your elbow moving is an essential part of your treatment and recovery.  Keeping active is the single best thing you can do for your health.
  • Being physically active throughout your recovery can:
  • Prevent a recurrence of the problem.
  • Maintain your current levels of fitness - even if you have to modify what you normally do, any activity is better than none.
  • Keep your other muscles and joints strong and flexible.

It's recommended you stay at or return to work as quickly as possible during your recovery. You don't need to be pain or symptom-free to return to work.

What can I do to help manage my pain?
Pain medication can help to reduce the pain and help you move more comfortably, which can help your recovery. Speak to your community pharmacist about taking medication or other methods of pain relief​.  It is important that you take the medication as prescribed/advised.​

Should I rest it or keep it moving?
Within the first 24 to 48 hours after an elbow injury you should try to:

  • Rest your elbow but avoid long spells of not moving at all.
  • Move your elbow gently for 10 to 20 seconds every hour when you are awake.

After 48 hours:

  • Try to use your arm more - exercise really helps your elbow and can relieve pain.
  • Do whatever you normally would and stay at, or return to work - this is important and is the best way to get better. You may need to adapt how you do things initially.
  • Avoid sports or heavy lifting until you have less discomfort and good movement.

When should I ask for help?
You should present to your GP, local Urgent Care Centre or A&E when:

  • There has been significant trauma - for example a fall from height or direct blow to the elbow.
  • You can't move your elbow at all.
  • When you have persistent tingling or numbness in the forearm or hand.

Most other elbow problems should settle within 6 weeks without seeing a healthcare professional. If your elbow problem does not improve within 6 weeks, and/or shows no sign of improvement, it is recommended that you seek the advice of a physiotherapist or doctor.

Patients whose GP's are in Durham, the Dales or Easington, can refer themselves to our Integrated MSK Service by downloading a self-referral form.

Other useful support and resources 

Foot and Ankle problems are very common and can happen with or without any trauma.

What symptoms would I have?

Your foot or ankle problem can present with a combination of symptoms, including:

  • Pain: normally felt around the ankle and into the foot.
  • Swelling: normally noticed at the outside and front of the ankle, and/or over the top of the foot.
  • Stiffness: the ankle and foot feels 'stuck' or 'stiff'.
  • Limping: due to difficulty moving or putting your weight through your foot.

What causes foot or ankle problems?

Ankle problems are very common and can be caused by injury or normal use. This could happen when you either trip or go over your ankle and can also be due to weakness in the muscles surrounding the ankle itself. 

Foot problems are also fairly common.  This may be because of an injury or due to normal use.  Sometimes the pain is due to a flare-up of either an existing condition or normal age-related changes.

In most cases foot and ankle pain will settle by itself without seeing a healthcare professional.

What can I do to help manage my foot or ankle problem?

Keeping your foot and ankle moving is an essential part of your treatment and recovery.  Keeping active is the single best thing you can do for your health.

Being physically active throughout your recovery can:

  • Prevent a recurrence of the problem.
  • Maintain your current levels of fitness - even if you have to modify what you normally do, any activity is better than none.
  • Keep your other muscles and joints strong and flexible.
  • Help you aim for a healthy body weight.

It's recommended you stay at or return to work as quickly as possible during your recovery. You don't need to be pain or symptom-free to return to work.

What can I do to help manage my pain?

Pain medication can help to reduce the pain and help you move more comfortably, which can help your recovery.

Speak to your community pharmacist about taking medication or other methods of pain relief. It is important that you take the medication as prescribed/advised.​

Should I rest it or keep it moving?

Within the first 24 to 48 hours after a foot or ankle injury you should try to:

  • Rest your foot or ankle in an elevated position, but avoid long spells of not moving at all.
  • Move your foot and ankle gently for 10 to 20 seconds every hour when you are awake.

After 48 hours:

  • Try to use your leg more - exercise really helps your ankle and can relieve pain.
  • Do whatever you normally would and stay at, or return to work - this is important and is the best way to get better. You may need to adapt how you do things initially.

You may find using the stairs difficult:

  • When going upstairs: you can reduced the strain on your foot and ankle by leading you're your good leg.
  • When going downstairs: you can reduced the strain on your foot and ankle by leading with your problem leg. If there is a handrail or bannister, use it to support your leg.
  • Avoid sports or heavy lifting until you have less discomfort and good movement.

When should I ask for help?

You should present to your GP, local Urgent Care Centre or A&E when:

  • When there has been significant trauma, for example a fall from a height or direct blow to the ankle.
  • When the ankle is misshaped.
  • When your calf is hot, swollen and tender.
  • You have difficulty putting any weight through your sore leg.
  • Your pain is getting worse.

Most other ankle problems should settle within 6 weeks without seeing a healthcare professional. If your foot or ankle problem does not improve within 6 weeks, and/or the pain is getting worse, it is recommended that you seek the advice of a physiotherapist or doctor.

Patients whose GP's are in Durham, the Dales or Easington, can refer themselves to our Integrated MSK Service by downloading our self-referral form.

Other useful support and resources

Your wrist, hand and finger problem can present with a combination of symptoms, including:

  • Pain
  • Swelling
  • Stiffness
  • Pins and needles or numbness

What may be the cause of my wrist, hand and finger problem?

Wrist, hand and finger problems are very common and can be caused by simple things like repetitive daily activity, a fall, or an injury during sport.

As you get older, the normal wear can cause your symptoms to flare-up now and again, often for no reason.

What can I do to help manage my wrist, hand and finger problem?

Keeping your wrist, fingers and thumb moving is an essential part of your treatment and recovery.  Keeping active is the single best thing you can do for your health.

Being physically active throughout your recovery can:

  • Prevent a recurrence of the problem.
  • Maintain your current levels of fitness - even if you have to modify what you normally do, any activity is better than none.
  • Keep your other muscles and joints strong and flexible.
  • Help you aim for a healthy body weight.

It's recommended you stay at or return to work as quickly as possible during your recovery. You don't need to be pain or symptom-free to return to work.

What can I do to help manage my pain?

Apart from staying moving and active, you may try pain medication as this may help you move more comfortably, speeding up your recovery.

Speak to your community pharmacist about taking medication. It is important that you take the medication as prescribed/advised.​

Should I rest it or keep it moving?

Within the first 24 to 48 hours after a wrist, hand or finger/thumb problem developing you should try to:

  • Rest your wrist, hand or finger/thumb but avoid long spells of not moving at all.
  • Move your wrist, hand or finger/thumb gently for 10 to 20 seconds every hour when you're awake.

After 48 hours:

  • Try to use your arm more - exercise really helps you hand.
  • Do whatever you normally would and stay at, or return to work - this is important and is the best way to get better.
  • Avoid sports or heavy lifting until you have less discomfort and good movement. Remember to warm up fully before you start sporting activities.

When should I ask for help?

You should present to your GP, local Urgent Care Centre or A&E when:

  • Your wrist or fingers are misshaped following an injury.
  • You cannot move your wrist or fingers at all.
  • You develop pain and stiffness in the small joints in your hand in the mornings that takes more than 30 minutes to settle.
  • If your wrist, hand and finger problem does not improve within 6 weeks, and/or the pain is getting worse, it is recommended that you seek the advice of a physiotherapist.

Patients whose GP's are in Durham, the Dales or Easington, can refer themselves to our Integrated MSK Service by downloading a self-referral form.

Other useful support and resources 

Hip problems are very common and can happen with or without any trauma.

What symptoms would I have?

Your hip problem can present with a combination of symptoms, including:

  • Pain: normally felt around the hip, and sometimes referring down the groin and thigh.
  • Weakness: e.g. you may find getting up from a chair more difficult.
  • Stiffness: the hip feels 'stuck' or 'stiff'.

What causes hip problems?

Hip problems are very common and can be caused by injury or normal use. As you get older, normal wear and tear can cause your hip problem to flare-up now and again, often for no reason.  In most cases hip pain will settle either by itself or without seeing a healthcare professional.

What can I do to help manage my hip problem?

  • Keeping your hip moving is an essential part of your treatment and recovery. Keeping active is the single best thing you can do for your health.

Being physically active throughout your recovery can:

  • Prevent a recurrence of the problem.
  • Maintain your current levels of fitness - even if you have to modify what you normally do, any activity is better than none.
  • Keep your other muscles and joints strong and flexible.
  • Help you aim for a healthy body weight.

It's recommended you stay at or return to work as quickly as possible during your recovery. You don't need to be pain or symptom-free to return to work.

What can I do to help manage my pain?

Pain medication can help to reduce the pain and help you move more comfortably, which can help your recovery.

Speak to your community pharmacist about taking medication or other methods of pain relief​. It is important that you take the medication as prescribed/advised.​

Should I rest it or keep it moving?

Within the first 24 to 48 hours after a hip injury you should try to:

  • Rest your hip but avoid long spells of not moving at all.
  • Move your hip gently for 10 to 20 seconds every hour when you are awake.

After 48 hours:

  • Try to use your leg more - exercise really helps your hip and can relieve pain.
  • Do whatever you normally would and stay at, or return to work - this is important and is the best way to get better. You may need to adapt how you do things initially.

You may find using the stairs difficult:

  • When going upstairs: you can reduced the strain on your hip by leading you're your good leg
  • When going downstairs: you can reduced the strain on your hip by leading with your problem leg. If there is a handrail or bannister, use it to support your leg
  • Avoid sports or heavy lifting until you have less discomfort and good movement.

When should I ask for help?

You should present to your GP, local Urgent Care Centre or A&E when:

  • When there has been significant trauma, for example a fall from a height or direct blow to the hip
  • You have difficulty putting any weight through your sore leg
  • If you have a lump in your groin, this may be a hernia.  Please discuss this with your GP.
  • If you are male and notice pain or swelling in the testicles, please discuss this with your GP.

Most other hip problems should settle within 6 weeks without seeing a healthcare professional. If your hip problem does not improve within 6 weeks, and/or the pain is getting worse, it is recommended that you seek the advice of a physiotherapist or doctor.

Patients whose GP's are in Durham, the Dales or Easington, can refer themselves to our Integrated MSK Service by downloading our self-referral form.

Other useful support and resources

Knee problems are very common and can happen with or without any trauma.

What symptoms would I have?

Your knee problem can present with a combination of symptoms, including:

  • Pain: normally felt around the around the knee, and sometimes referring down the shin.
  • Swelling: around the knee joint, above the kneecap or in the back of the knee.
  • Stiffness.

What causes knee problems?

Knee problems are very common and can be caused by injury, growth spurts or normal use. As you get older, normal wear and tear can cause your knee problem to flare-up now and again, often for no reason.  In most cases knee pain will settle either by itself or without seeing a healthcare professional.

What can I do to help manage my knee problem?

  • Keeping your knee moving is an essential part of your treatment and recovery.  Keeping active is the single best thing you can do for your health.

Being physically active throughout your recovery can:

  • Prevent a recurrence of the problem.
  • Maintain your current levels of fitness - even if you have to modify what you normally do, any activity is better than none.
  • Keep your other muscles and joints strong and flexible.
  • Help you aim for a healthy body weight.

It's recommended you stay at or return to work as quickly as possible during your recovery. You don't need to be pain or symptom-free to return to work.

What can I do to help manage my pain?

Pain medication can help to reduce the pain and help you move more comfortably, which can help your recovery.

Speak to your community pharmacist about taking medication or other methods of pain relief. It is important that you take the medication as prescribed/advised.​

Should I rest it or keep it moving?

Within the first 24 to 48 hours after a knee injury you should try to:

  • Rest your knee but avoid long spells of not moving at all.
  • Move your knee gently for 10 to 20 seconds every hour when you are awake.

After 48 hours:

  • Try to use your leg more - exercise really helps your knee and can relieve pain.
  • Do whatever you normally would and stay at, or return to work - this is important and is the best way to get better. You may need to adapt how you do things initially.

You may find using the stairs difficult:

  • When going upstairs: you can reduced the strain on your knee by leading you're your good leg.
  • When going downstairs: you can reduced the strain on your knee by leading with your problem leg. If there is a handrail or bannister, use it.
  • Avoid sports or heavy lifting until you have less discomfort and good movement.

When should I ask for help?

You should present to your GP, Physiotherapist, local Urgent Care Centre or A&E when:

  • When the knee becomes immediately swollen after injuring or twisting your knee.
  • You have difficulty putting any weight on your sore leg.
  • Your knee locks or gives way.

Most other knee problems should settle within 6 weeks without seeing a healthcare professional. If your knee problem does not improve within 6 weeks, and/or the pain is getting worse, it is recommended that you seek the advice of a physiotherapist or doctor.

Patients whose GP's are in Durham, the Dales or Easington, can refer themselves to our Integrated MSK Service by downloading our self-referral form.

Other useful support and resources

Neck problem can present with a combination of symptoms, including:

  • Pain: normally felt around the neck, and may go down your arm.
  • Stiffness: normally felt around the neck and shoulders
  • Pins and needles or numbness: this is commonly felt in the forearm and hand.

What may be the cause of my neck problem?
Neck problems are very common and normally caused by an accident, poor posture habits and normal wear. In most cases the pain will start for no specific reason. Neck problems are rarely due to any serious injury or damage.

What can I do to help manage my neck problem?

  • Keeping your neck moving is an essential part of your treatment and recovery. Keeping active is the single best thing you can do for your health.
  • Being physically active throughout your recovery can:
  1. Prevent a recurrence of the problem.
  2. Maintain your current levels of fitness - even if you have to modify what you normally do, any activity is better than none.
  3. Keep your other muscles and joints strong and flexible.
  4. Help you aim for a healthy body weight.

It's recommended you stay at or return to work as quickly as possible during your recovery. You don't need to be pain or symptom-free to return to work.

What can I do to help manage my pain?
Apart from staying moving and active, you may try:

  • Pain medication: this may help you move more comfortably, speeding up your recovery.
  • A heat pack: especially helpful for muscle ache associated with neck problems
  • Speak to your community pharmacist about taking medication. It is important that you take the medication as prescribed/advised.​

Should I rest it or keep it moving?
If you have a neck pain or problem:

  • Keep moving, even if you move slowly at first.
  • Change positions regularly: you may find a comfortable position that reduces your pain for a short while.  The key is to change positions often to make the effect last.
  • Try to stay as active as your pain allows.
  • Do whatever you normally would and stay at, or return to work - this is important and the best way to get better.
  • Use of a collar isn't recommended.

When should I ask for help?
You should present to your GP, local Urgent Care Centre or A&E when:

  • Feel numbness, pins and needles or weakness in one or both arms that's getting worse.
  • Have problems with your balance or walking since your neck pain started.
  • Develop blurred vision, ringing in your ears or dizziness that doesn't go away within 48 hours.

Most other neck problems should settle within 6 weeks without seeing a healthcare professional. If your neck problem does not improve within 6 weeks, and/or the pain is getting worse, it is recommended that you seek the advice of a physiotherapist.

Patients whose GP's are in Durham, the Dales or Easington, can refer themselves to our Integrated MSK service by downloading a self-referral form.

Other useful support and advice

Shoulder problems are very common and can happen with or without any trauma.

What symptoms would I have?

Your shoulder problem can present with a combination of symptoms, including:

  • Pain: normally felt across the shoulder and down the upper arm.
  • Weakness: difficulty lifting the arm or an object.
  • Stiffness: the arm feels 'stuck' or 'stiff'.

What causes shoulder problems?

Shoulder problems are common and can be caused by simple movements such as:

  • Taking off your coat.
  • Lifting something awkwardly.
  • Doing DIY
  • Trip or a fall onto the arm.

As you get older, normal wear and tear can cause your shoulder problem to flare-up now and again, often for no reason.

What can I do to help manage my shoulder problem?

Keeping active is an essential part of your treatment and recovery and is the single best thing you can do for your health. Being physically active throughout your recovery can:

  • Prevent a recurrence of the problem.
  • Maintain your current levels of fitness - even if you have to modify what you normally do, any activity is better than none.
  • Keep your other muscles and joints strong and flexible.

It's recommended you stay at or return to work as quickly as possible during your recovery. You don't need to be pain or symptom-free to return to work.

The following Videos will take you through general exercises to help you manage your pain. The videos are best viewed in order:

  1. Introduction to exercises
  2. Exercise 1 (Wall Slides)
  3. Exercise 2 (Wall Pushups)
  4. Exercise 3 (Lateral Rotation)

When should I ask for advice?

These symptoms are common and in most cases should settle within 6 weeks without seeing a healthcare professional.

Some shoulder pains may last much longer. If your shoulder problem persists, and shows no sign of improvement, it would be recommended to seek advise from a physiotherapist or doctor.

If your shoulder pain is of result of an injury it may benefit from seeking medical attention sooner.

Patients whose GP's are in Durham, the Dales or Easington, can refer themselves to our Integrated MSK Service by downloading our self-referral form.

Other useful support and advice

General joint & inflammatory condition related pain

There are several types of inflammatory conditions that could lead to joint pain. Early diagnosis and treatment will help your symptoms and help limit any damage to your joints.

General joint pain may be due to inflammation or normal degeneration in joints leading to pain, swelling and stiffness in a joint or joints.

There are also some genetic conditions and soft tissue conditions, for example Ehlers-Danlos Syndrome, that can lead to general muscle and joint pain.

The word Arthritis is often used to describe these conditions. Arthritis isn't a single condition and there are several different types.

People who have inflammatory arthritis often describe symptoms including: early morning stiffness for more than 30 minutes, improvement with activity and joint swelling or warmth.

Those of us with symptoms due to degeneration of joints (Osteoarthritis) will often describe: general stiffness, worsening of pain with activity and weight bearing.

We know that general joint pains can make life difficult by causing pain and making it harder to get about. We also know it is hard to predict how this will effect your life as the symptoms of arthritis can vary from week to week, and even from day to day.

Many conditions that lead to general joint pain are long-term conditions. Although there's no cure for arthritis, treatments have improved greatly in recent years and, for many types of arthritis, particularly inflammatory arthritis, there's a clear benefit in starting treatment at an early stage.

Whatever condition you have, remaining physically active will help you stay mobile, will help you maintain your quality of life and will be good for your general health.

There are many conditions that cause general joint pain. Quite often they present with similar symptoms, but there are also important differences between them.  It is therefore important to know what condition you have, to help you understand and manage your condition.

The VersusArthritis website is an excellent source of information regarding your condition and getting the support you need to help you live a fulfilling life. 

The consultant led Rheumatology service within County Durham and Darlington NHS Foundation Trust also has dedicated clinical nurse specialists, additional specialist nursing support and therapies all of which provide comprehensive care throughout the patient's journey.

Persistent pain

Persistent pain, also called chronic pain, is pain that carries on for longer than 12 weeks despite medication or treatment. 

Most people get back to normal after pain following an injury or operation. Persistent pain can also affect people living with other conditions including diabetes, arthritis, fibromyalgia, IBS and back pain. Sometimes the pain carries on for longer or comes on without any history of an injury or operation.

What is pain?

The brain and the nerves inside the spine (the spinal nerves) make up the central nervous system. The spinal nerves carry messages from the body to the brain to tell it what's going on. The brain acts like a control centre working out from these messages if it needs to do anything.

Pain starts s an unpleasant signal in the body.  A signal that, like the warning sign on a computer or a car's dashboard, is designed to make you aware of possible risk. It is there to:

  • Make you aware of a possible risk so that you can explain this risk and react to it appropriately.

When your brain receives this message, it will make your body respond by:

  • Creating muscle tension and protective chemicals to try and protect you from further damage
  • Creating chemical that will make you stress, encouraging you to find out what is wrong
  • And chemicals to allow you to respond to this risk, either by getting help, or by moving away

How is Persistent pain different?

Persistent pain is when this 'warning signal' carries on even though the initial cause or risk has healed or disappeared. It is triggered when the nerves carrying unpleasant information become irritated and continue to react even though the initial cause has healed.

Sometimes the pain system stays switched on, perhaps after surgery or changes in posture. The threat chemicals continue to download, making the system fire again - this is known as the vicious cycle of pain. Your pain system may then start to see normal signals as possible risks, making it react, for example during activity, inactivity, changes in weather, or even unpredictable triggers.

Pain management is about helping the body produce chemicals to make a threatened system feel safer.

Who gets persistent pain?

It can affect all ages and all parts of the body. It isn't possible to tell in advance whose pain will become chronic. But we know that people are more likely to develop chronic pain during or after times of stress or unhappiness. People can also experience chronic pain even after usual medical tests don't provide an answer.

What can I do for myself?

Little and often is the key. Gradually and regularly retraining the body that gentle movement holds no nasty surprises can help produce safer chemicals.

There are lots you can do to help yourself and have a better life even with persistent pain. Simple changes can often make a big difference to the amount of disability and suffering you can experience. This is called pain management.

To help manage your pain, you might consider:

  • Planning your day - Make a plan of things to do and places to be to help you keep on top of your pain.
  • Pacing yourself - Don't push through the pain, stop before it gets worse then go back to whatever you were doing later.
  • Learning to relax - Relaxing can be hard when you have pain but finding something which relaxes you will reduce the stress of pain.
  • Taking regular enjoyable exercise - Even a small amount will make you feel better and ease your pain. It will also keep your muscles and joints strong.
  • Taking pain medicine - Pain medicines work better alongside a plan. Patients often say their pain medicines don't seem to work very well.
  • Talking to others - Tell your friends and family about chronic pain and why you need to do things differently at the moment.
  • Enjoyment - Doing things you enjoy boosts your own natural painkillers. Think about what you enjoyed before the pain and introduce it back into your routine.

Remember: we are all different and what helps for one person may not help another. Choose what works for you and pace yourself.

Activity and exercise

Being active and taking exercise is a good prescription for managing pain. Knowing where to start can be daunting for some people with persistent pain as they often find it hard to do things on some days more than others. Don't be put off by the word 'exercise' - any type of movement is exercise.

To begin with your muscles might hurt so it's important that you choose a level of exercise that suits you. Learning how to 'pace' your activity and exercise can help. Most of all it should be enjoyable.

Dealing with stress and depression

When the body feels under threat it produces stress hormones that make us feel anxious and tense. The body sees pain as a threat and when it's persistent or chronic, it can make us feel unwell.

Relaxation

Finding a way to relax can help to reduce pain. Anything which makes you feel good, you enjoy or gives you pleasure is a form of relaxation.

Hobbies and activities may have taken a backseat due to your pain, but it's worth thinking about how to get back to doing things you enjoy. Anything that helps you to focus on things other than your pain is a good form of self-management.

Depression

Dealing with persistent pain can have a detrimental effect on your mental health.  Effective pain management tackles all aspects of your life affected by chronic pain - including your mental wellbeing, be it to help you understand what is going and also strategies helping you deal with this.

You may want to consider the Talking changes team for further advice and assistance with this.

Pain medication

Pain medication can help to reduce your pain and keep you moving. In some cases they won't be effective at treating your pain and can cause side effects.

If you're already taking medication or have other health problems, it's important to check with your pharmacist before taking any non-prescription pain medication.

Pharmacists are a great source of information about chronic pain and medication.

When should I see my doctor?

If you're still in pain after 12 weeks, speak to your GP if you haven't already done so. Your GP will be able to tell you the best plan for managing your pain.

Other useful support and resources