Chronic Pain: Understanding Causes, Assessment and Support
Chronic pain usually means pain that persists or recurs for more than three months. It can follow an injury or recognised illness, but sometimes the cause is less clear. That does not make the pain imaginary. A good assessment takes both the possible medical explanation and the impact on sleep, function, work and everyday life seriously. [1]
New or changing symptoms need their own assessment
Do not assume a new, severe or rapidly worsening symptom is simply part of a long-standing pain condition. Contact your GP or NHS 111 if urgent clinical assessment is needed. For back pain accompanied by new loss of sensation around the genitals or anus, new bladder or bowel problems, symptoms affecting both legs, or pain after a serious accident, follow the NHS advice to seek immediate emergency care through 999 or A&E. [3] A routine functional-medicine appointment is not the right place for emergency assessment.
Chronic primary pain and chronic secondary pain: what is the difference?
NICE distinguishes chronic secondary pain, in which an underlying condition adequately accounts for the pain or its impact, from chronic primary pain, where no condition adequately explains it or the effect of pain is disproportionate to the observable disease or injury. These descriptions can overlap, and a person’s diagnosis may need reconsideration if symptoms change. [1]
| Pain description | What it means for assessment |
|---|---|
| Chronic secondary pain | Investigate and manage the relevant underlying condition, with its condition-specific guidance |
| Chronic primary pain | Consider the full experience of pain and its effects; do not equate the absence of a single diagnostic test with the absence of a real problem |
| Both types together | Decisions may need to draw on both a general pain assessment and disease-specific care |
This is a framework for talking with a clinician, not a tool to diagnose which category applies to you.
What does a useful chronic-pain assessment look at?
The history matters: where pain occurs, when it started, how it changes, prior diagnoses, injuries, medicines, tests and treatments, and what has or has not helped. It should also consider sleep, mood, physical function, work, relationships and the individual’s priorities. These influences are clinically relevant without implying that a person’s pain is simply psychological. NICE recommends a person-centred approach, shared decisions and sensitivity when results do not reveal a clear explanation. [1]
An examination, tests or specialist opinion may be appropriate in some situations. Repeating broad panels or scans simply because pain continues is not always helpful; any proposed investigation should have a clear question and an explanation of what its result could change.
What if my scans or blood tests are normal?
Normal results can be reassuring about the particular question a test investigates, but they do not automatically settle every possible cause or invalidate a person’s pain. The clinician should explain what has been considered, what remains uncertain and what changes would justify reassessment. [1]
For a wider view of unresolved or overlapping concerns, read the existing persistent-symptom assessment page. That page is not a substitute for a review of new, severe or rapidly changing symptoms.
What support may be useful?
Appropriate care depends on the type of pain, established diagnosis, treatments already in place and personal goals. Some people need a targeted condition-specific treatment. Others may benefit from properly guided activity, rehabilitation, discussion of sleep and daily routines, or psychological approaches that help with the burden of persistent pain. NICE’s recommendations for managing chronic primary pain should not be applied indiscriminately to every form of chronic secondary pain. [1]
When pain is hard to manage, a GP may consider referral to a specialist pain service or a pain-management programme. These services can support function and day-to-day coping, even where complete pain relief is not possible. This is a description of relevant NHS care pathways, not a claim that Dr Stavy operates a pain clinic or offers specialist procedures. [2]
Where do arthritis and fibromyalgia fit?
The website already has a guide to arthritis and joint pain and a separate fibromyalgia guide. Those pages explain more specific questions. Chronic pain is broader: a person may need to understand whether an established diagnosis explains the problem, whether there are overlapping issues and which clinician or service should lead ongoing care.
Neither an alternative therapy nor a laboratory panel should be presented as a proven universal cure for chronic pain. Continue existing prescribed medicines as directed; changes to pain medication should be planned with the responsible prescriber, particularly if longer-term use or withdrawal needs careful management.
What should I bring to a consultation?
A short timeline and list of current diagnoses, treatments, medicines and supplements can make the discussion more useful. Relevant reports, a description of how pain affects ordinary activities, and a few priorities for the next steps are often more valuable than trying to bring every result from the past decade. Ask what the next action will address, who will coordinate it and when symptoms should be reviewed again.
To enquire about the suitability of a general medical review, use contact Dr Stavy. This does not establish a separate specialist pain treatment or imply that a private consultation replaces your GP, physiotherapist or existing pain service.
Frequently asked questions
Does chronic pain always mean there is an untreated injury?
No. Persistent pain may relate to an underlying condition, may be classified as chronic primary pain, or may involve both. A clinician should consider the individual presentation rather than assume one explanation fits everyone. [1]
Can chronic pain be real even when tests are normal?
Yes. A test only addresses the question it was designed to investigate. NICE recommends a sensitive approach to normal results and a review of symptoms and function. [1]
When should my diagnosis or treatment plan be reassessed?
If the presentation changes, if a new symptom appears or if the present plan is not meeting important goals, discuss reassessment with the clinician responsible for your care. Severe or urgent symptoms require a faster route. [1, 3]
Does Dr Stavy offer specialist pain procedures?
No such offering is established by this page. The article provides general information; confirm the practice’s actual medical-consultation scope before booking.
Further information and references
- NICE NG193. Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain. Published 7 April 2021. See Context and recommendations 1.1.1–1.1.23; section 1.2 applies specifically to chronic primary pain. https://www.nice.org.uk/guidance/ng193/chapter/recommendations. Accessible text: https://www.ncbi.nlm.nih.gov/books/NBK569960/.
- NHS. How to get NHS help for your pain. Sections “Contact a GP”, “Pain clinics”, “Pain-management programmes”. https://www.nhs.uk/live-well/pain/how-to-get-nhs-help-for-your-pain/.
- NHS. Back pain. Sections “Urgent advice” and “Immediate action required”. Last reviewed 5 March 2026. https://www.nhs.uk/conditions/back-pain/.