Chronic Primary Pain: What To Do
Pain persisting beyond three months without an identifiable underlying cause that explains it.
Last revised
NICE guidance shifted substantially in 2021 and now recommends against starting most pain medicines for it, which surprises almost everyone.
Key takeaways
- Definition: pain lasting more than 3 months
- Recommended: exercise, CBT or ACT, and acceptance-based approaches
- Most useful single change: Ask about supervised exercise and psychological therapies.
- Commonest mistake: Expecting a scan to explain the pain; findings correlate poorly.
- See a doctor if any of the signs under "When to get help" below apply to you.
Do
- Ask about supervised exercise and psychological therapies
- Ask for a shared plan focused on function rather than pain scores
- Review long-term pain medicines rather than continuing by default
- Pace activity rather than pushing through and crashing
Do not
- Expecting a scan to explain the pain; findings correlate poorly
- Starting opioids for chronic primary pain
- Complete rest, which worsens function and pain over time
The figures behind the list
Each item above follows from these, published in the guidance named at the foot of the page.
| Measure | Figure |
|---|---|
| Definition | pain lasting more than 3 months |
| Recommended | exercise, CBT or ACT, and acceptance-based approaches |
| Not recommended to start | opioids, paracetamol, NSAIDs, gabapentinoids, benzodiazepines |
| May be considered | certain antidepressants |
| Pain | real regardless of whether a cause is found |
Where to go next
- Chronic Primary Pain at a Glance
- What the Guidance Really Says About Chronic Primary Pain
- Chronic Primary Pain — the reference entry
- Pacing Activity: Sorting the Evidence From the Noise
- Opioids for Long-Term Pain: What Published Guidance Supports
When to get help
See a GP promptly for new or changing pain, pain that wakes you at night, pain with fever, unexplained weight loss, a history of cancer, or new weakness or numbness. Seek emergency care for numbness around the genitals or back passage, bladder or bowel changes, or weakness in both legs.
Where this comes from
How this page was put together
Every figure, recommendation and warning above is taken from the guidance named in Where this comes from. Nothing on this page is inferred, summarised or generalised beyond what those bodies publish: where they give a number, it is their number, and where they are silent, so are we. Pages are rebuilt whenever the underlying record changes. Sign-off by a named clinician, where it has happened, is shown at the top of the page along with the date.
Medical disclaimer
This article is general information, not medical advice. It cannot account for your own history, medication or circumstances. Always speak to a GP, pharmacist or another qualified health professional before making changes that affect your treatment, and never delay seeking medical advice because of something you have read here. In an emergency, call 999.