What Is Chronic Pain?
Chronic pain, sometimes called persistent or long-term pain, is pain that continues or repeatedly occurs for more than three months. It can develop after an injury, illness, surgery or nerve damage, or sometimes occur without a clear underlying cause. (
Unlike acute pain, which often acts as a warning that something has been injured, chronic pain can continue after the original injury or illness has healed.
Chronic pain can affect almost every part of life. It may make sleeping, working, exercising and completing everyday activities more difficult. Long-term pain can also affect mood and emotional wellbeing.
If your pain feels burning, stabbing, shooting or like an electric shock, read our guide to Nerve Pain: Symptoms, Causes and Treatment Options to understand how neuropathic pain differs from other types of pain.
What Causes Chronic Pain?
There are many possible causes of long-term pain.
Some common examples include:
- Arthritis
- Osteoarthritis
- Rheumatoid arthritis
- Long-term back pain
- Sciatica
- Nerve damage
- Diabetes-related neuropathy
- Fibromyalgia
- Previous injuries
- Chronic headaches or migraine
- Endometriosis
- Some inflammatory conditions
- Pain following surgery
Sometimes chronic pain is associated with a clearly identifiable condition. This is often called chronic secondary pain.
In other cases, there may be no underlying condition that adequately explains the amount of pain or its impact. NICE describes this as chronic primary pain.
Importantly, chronic primary pain is real pain even when scans or tests do not show an obvious physical abnormality.
What Does Chronic Pain Feel Like?
Chronic pain does not feel the same for everyone.
Depending on its cause, it may feel:
- Aching
- Throbbing
- Burning
- Stabbing
- Shooting
- Tingling
- Cramping
- Tight or squeezing
- Electric-shock-like
- Tender or extremely sensitive
Some people experience constant pain, while others experience flare-ups followed by periods when symptoms are less severe.
The location can also vary. Chronic pain may affect the back, neck, joints, muscles, nerves, abdomen, pelvis or multiple parts of the body.
How Does Chronic Pain Affect Daily Life?
Living with persistent pain can affect much more than physical comfort.
People with chronic pain may experience:
- Poor sleep
- Tiredness
- Reduced physical activity
- Difficulty concentrating
- Low mood
- Anxiety
- Reduced ability to work
- Social withdrawal
- Difficulty maintaining normal routines
NHS guidance on chronic primary pain notes that associated symptoms can include fatigue, anxiety, low mood and cognitive difficulties.
This is why effective chronic pain management should focus not only on reducing pain intensity but also on helping people function and maintain quality of life.
What Is the Best Treatment for Chronic Pain?
There is no single treatment that works for everyone.
The best approach depends on the cause of the pain, how long it has been present, its severity and how it affects everyday life.
Treatment can include:
- Physical activity
- Exercise programmes
- Physiotherapy
- Psychological therapies
- Medicines
- Weight management where appropriate
- Self-management strategies
- Specialist pain services
- Treatment of an underlying medical condition
For chronic primary pain, NICE recommends supervised exercise and says cognitive behavioural therapy (CBT) or acceptance and commitment therapy (ACT) can be considered.
Can Exercise Help Chronic Pain?
It may seem counterintuitive to exercise when you are already experiencing pain, but appropriate physical activity can be an important part of chronic pain management.
NICE recommends supervised group exercise for adults with chronic primary pain and encourages people to remain physically active for longer-term health benefits.
Exercise programmes can be adapted according to a person’s abilities and circumstances.
This does not mean pushing through severe pain. A gradual, individualised approach is generally more appropriate.
Can CBT Help Chronic Pain?
Yes.
Cognitive behavioural therapy does not mean that chronic pain is “all in your head.”
Instead, CBT can help people develop practical strategies for dealing with pain, stress, sleep difficulties and the effects of pain on everyday life.
NICE recommends considering CBT or ACT for adults with chronic primary pain.
These approaches may form one part of a broader pain-management plan.
What Pain Medicines Are Used for Chronic Pain?
The appropriate medicine depends heavily on the type of pain.
For example, neuropathic pain often requires different medicines from inflammatory or musculoskeletal pain.
Possible medicines include:
- Paracetamol in appropriate conditions
- NSAIDs such as ibuprofen or naproxen
- Amitriptyline
- Duloxetine
- Gabapentin
- Pregabalin
- Tramadol in selected circumstances
- Other prescription medicines depending on the underlying condition
For chronic primary pain, NICE specifically recommends not initiating opioids, NSAIDs, paracetamol, benzodiazepines or gabapentinoids as treatments for the chronic primary pain itself because evidence of benefit is limited and these medicines can cause harm. It does allow consideration of certain antidepressants after discussing benefits and harms.
This distinction is important because chronic pain is not one condition.
Why Doesn’t Paracetamol Always Work for Chronic Pain?
Paracetamol may help some forms of pain, but it is not effective for every chronic pain condition.
For example, NHS guidance on peripheral neuropathy notes that ordinary painkillers such as paracetamol and ibuprofen often do not work well for neuropathic pain.
That is because nerve pain is produced by abnormal nerve signalling rather than simply by tissue inflammation or injury.
When pain has a neuropathic component, a doctor may consider medicines designed specifically for nerve pain.
Gabapentin for Chronic Nerve Pain
Gabapentin is commonly used for neuropathic pain.
It is also prescribed for epilepsy and is a prescription medicine.
Gabapentin may cause side effects such as dizziness and drowsiness, which can affect activities such as driving.
If you’re researching gabapentin for nerve pain, see our detailed Gabapentin (Neurontin): Uses, Side Effects and Safety article.
Pregabalin for Chronic Nerve Pain
Pregabalin is another commonly used medicine for neuropathic pain.
It can cause dizziness and sleepiness and may produce dependence in some people.
It should not be stopped suddenly after regular use without medical advice.
Learn more about one of the commonly used medicines for nerve pain in our guide to Pregabalin Side Effects: Common and Serious Reactions.
Tramadol for Chronic Pain
Tramadol is an opioid painkiller used for moderate to severe pain.
However, its role in long-term pain needs careful consideration.
For neuropathic pain, the NHS states that tramadol may be used when other treatments have not worked and generally only for a short period because of dependence and other risks.
For chronic primary pain, NICE recommends against initiating opioids to manage the condition.
This means tramadol should not simply be viewed as a general long-term solution for any chronic pain.
Comparing prescription opioid medicines? Read Tramadol vs Oxycodone: Differences, Strength, Uses, Side Effects and Safety for a closer look at these two medicines.
Codeine for Chronic Pain
Codeine phosphate is an opioid painkiller that can be used for certain types of pain.
However, long-term use can result in tolerance, dependence and addiction.
For chronic primary pain, NICE advises against initiating opioids, including codeine, specifically for the management of the chronic primary pain condition.
If codeine has been prescribed for another medical condition, treatment should be reviewed regularly, particularly when prolonged use is being considered.
Want to understand the differences between two commonly discussed opioid medicines? Read Codeine Phosphate vs Tramadol: Uses, Differences, Side Effects and Safety.
Oxycodone for Chronic Pain
Oxycodone is a stronger prescription opioid used for severe pain in appropriate clinical circumstances.
However, stronger does not automatically mean better for chronic pain.
The CDC recommends that non-opioid and non-drug treatments be maximised for subacute and chronic pain and that opioids should only be considered when the expected benefits for pain and function outweigh the risks.
In other words, the objective of chronic pain treatment should not simply be to keep increasing opioid strength.
If you’re researching oxycodone products, see our guide Roxicodone: Uses, Side Effects, Risks and Important Safety Information.
Roxicodone and Long-Term Pain
Roxicodone is a brand containing oxycodone.
Because it is an opioid, the same major considerations apply: sedation, constipation, tolerance, dependence, misuse and overdose.
A person should never increase the amount taken simply because pain has become worse.
Long-term opioid treatment should involve ongoing clinical review and consideration of whether benefits continue to outweigh risks.
What About Morphine for Chronic Pain?
Morphine is another opioid used for severe pain in appropriate medical situations.
It can be highly effective for certain types of pain but also carries significant risks, including dependence and respiratory depression.
The CDC recommends that clinicians consider non-opioid treatments first for chronic pain and assess benefits and risks carefully before initiating opioid therapy.
Strong Painkillers for Chronic Pain: Are They the Answer?
A common search question is:
“What is the strongest painkiller for chronic pain?”
The answer is more complicated than simply choosing the strongest opioid.
Chronic pain can result from very different mechanisms. A medicine that works well for severe acute pain may provide limited benefit for a particular chronic pain condition.
NHS pain services also emphasise that medicines are only one part of chronic pain management and that opioids such as morphine, oxycodone and tramadol have an important role in some situations but are not universally effective for chronic pain.
The goal should be better function and quality of life alongside appropriate pain control, not simply achieving the highest possible dose.
Can Chronic Pain Be Treated Without Opioids?
Yes.
The CDC recommends maximising non-opioid and non-pharmacological treatments for chronic pain where appropriate. Options include exercise therapy, physical therapy, psychological approaches, mindfulness, acupuncture and other treatments depending on the specific condition.
Possible non-opioid medicines include:
- NSAIDs for appropriate conditions
- Certain antidepressants
- Gabapentin
- Pregabalin
- Topical treatments
- Other condition-specific medicines
The correct choice depends on the diagnosis.
Chronic Pain and Sleep
Pain and sleep can affect each other.
Chronic pain can make it harder to fall asleep, stay asleep or achieve restorative sleep. Poor sleep can then make coping with pain more difficult.
This can create a cycle:
Pain → poor sleep → fatigue → reduced activity → greater difficulty managing pain
Addressing sleep as part of an overall treatment strategy may therefore be useful.
If persistent pain is affecting your sleep, read our guide Why Am I So Tired but Can’t Sleep? Causes, Symptoms and What to Do for more information about sleep difficulties.
Chronic Pain and Mental Health
Long-term pain can affect emotional wellbeing.
People living with chronic pain may experience anxiety, frustration, low mood or reduced enjoyment of activities.
This does not mean the pain is psychological.
Rather, chronic pain can affect physical, emotional and social wellbeing at the same time. NHS guidance recognises the impact of chronic pain on mood, sleep and quality of life. (nhs.uk)
This is one reason multidisciplinary treatment can be useful.
When Should You See a Doctor About Chronic Pain?
Speak with a healthcare professional if:
- Your pain lasts longer than three months
- Pain is getting progressively worse
- Pain interferes with work or everyday activities
- You develop new numbness or weakness
- You have unexplained weight loss or other concerning symptoms
- Your pain regularly disrupts sleep
- Over-the-counter treatments are no longer helping
- You find yourself relying increasingly on prescription painkillers
The aim should be to identify the underlying cause where possible rather than simply increasing medication.
When Is Chronic Pain an Emergency?
Chronic pain itself does not always represent an emergency, but certain accompanying symptoms require urgent assessment.
For example, back or leg pain accompanied by:
- New loss of bladder control
- Difficulty passing urine
- Loss of bowel control
- Numbness around the genitals or anus
- Severe or worsening weakness in both legs
can indicate serious nerve compression and requires emergency medical attention.
For more information about these warning signs, see our guide What Does Sciatica Actually Feel Like? Symptoms, Causes and Warning Signs.
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Co-codamol
C0-codamol is a combination codeine based painkiller that works for mild to moderate pain. It’s effective for the muscle pain, injuries, and chronic pains to a certain level. Having a combination of codeine and paracetamol, the drug works great for effective relief by offering dual action. Codeine works to reduce the painful sensations and Paracetamol changes the brain’s perception of the pain. In combination both work great for the patient. However, the long term regular use of the drug is prohibited.
Tramadol
Treating lower back pain is effective with Tramadol. It’s used to treat moderate to severe pain offering great support. You can have the medicine to suppress the pain until your lower back pain triggers. Paired with the therapy sessions, physical exercise for back strength and stability, the Tramadol works better. You can get maximum benefit of the medicine over a short time combining the physiotherapy.
Pregabalin
When you are suffering from lower back pain due to nerve damage and it makes the recovery slower. Pregabalin long with proper care, rest, and strength management, you can have better recovery and stability in pain. Though long term use of the drug is not recommended, you can have it on an interval basis.
Are These Painkillers Safe?
The opioid or codeine based painkillers are effective but sedative at the same time. There can be some serious and common side effects of painkillers. Still, using them in moderation helps you to make the most out of these medicines. Just makes sure to consider the following conditions:
- Always use these medicines according to given guidelines or prescription
- Avoid overdose or extended use of these medicines
- If you need to take the painkillers for more than 4-weeks, consult your doctor for dose adjustment
- Never increase dose on your own
- Take the medicine with plain water followed by a light meal
- Avoid taking alcohol or other sedative drugs like antidepressants or sleeping pills with these painkillers
- Be careful of the painkiller interactions and never combine the drugs
If you feel any side effects like breathing difficulty, hallucinations, itching, change in heart rate, consult your doctor or reach out to medical emergency
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Frequently Asked Questions About Chronic Pain
What is considered chronic pain?
Pain that persists or repeatedly occurs for more than three months is generally considered chronic pain.
What is the best medicine for chronic pain?
There is no single best medicine. Treatment depends on the underlying condition and type of pain. Neuropathic pain, arthritis, inflammatory pain and muscular pain may require different approaches.
What is the strongest painkiller for chronic pain?
There is no universally best or strongest treatment. Strong opioids such as oxycodone or morphine can be appropriate in certain situations, but opioids are not routinely recommended for chronic primary pain and carry significant risks.
Does tramadol help chronic pain?
Tramadol may help certain types of pain, but long-term use requires careful medical review because of dependence and other risks. It may be used for selected neuropathic pain for short periods.
Can gabapentin help chronic pain?
Gabapentin is used for neuropathic pain and may be appropriate when pain is caused by nerve damage. (nhs.uk)
Can pregabalin help chronic pain?
Pregabalin is commonly used for neuropathic pain. Whether it is appropriate depends on the underlying cause and individual circumstances.
Can codeine be taken long term for chronic pain?
Long-term codeine use can lead to dependence and other harms. Whether treatment should continue depends on the original indication and ongoing benefits and risks.
Does chronic pain ever go away?
Some chronic pain conditions improve substantially or resolve when the underlying cause is treated. Others may persist and require long-term management.
Can exercise make chronic pain worse?
Starting too quickly or doing an unsuitable activity can aggravate symptoms. However, appropriate, gradual physical activity is an important part of chronic primary pain management and is recommended by NICE.
Why don’t normal painkillers work for nerve pain?
Neuropathic pain is produced by abnormal nerve activity, and ordinary painkillers such as paracetamol and ibuprofen may not work well for it. Specific neuropathic pain medicines may therefore be considered. (nhs.uk)
Final Thoughts
Chronic pain can affect the body, sleep, work, relationships and emotional wellbeing. Treating it effectively usually involves more than finding a stronger painkiller.
The first step is understanding what type of pain you have and what may be causing it. Depending on the condition, treatment may include exercise, physiotherapy, psychological therapies, targeted medicines or specialist pain management.
Medicines such as gabapentin, pregabalin, tramadol, codeine and oxycodone all have different roles and risks. They should not be treated as interchangeable, and stronger opioids are not automatically better for long-term pain. NICE recommends against initiating opioids for chronic primary pain, while U.S. CDC guidance recommends maximising non-opioid and non-pharmacological approaches for chronic pain and carefully weighing benefits against risks before considering opioids.
The most effective long-term approach is one that addresses the underlying condition where possible, improves physical function and quality of life, and uses medicines appropriately and safely.
Medical disclaimer: This article is for general educational purposes and does not replace an assessment or treatment plan from a doctor, pharmacist or other qualified healthcare professional. Prescription medicines, particularly opioids and medicines that can cause dependence or sedation, should only be used under appropriate medical supervision.
