Why am I still feeling pain?

You can continue to experience persistent pain long after the initial injury has healed.
It is not a simple problem. There is no dividing line between skin, muscles, nerves, the spinal cord, the brain and thoughts, beliefs and emotions – it is the nervous system as a whole that produces your pain experience.
The fact that environmental and emotional factors can influence pain does not make it any less real.
See rest of ‘Persistent Pain’ section to learn more about why you still hurt.

Isn’t pain a signal of damage to the body?

Not necessarily – Persistent pain often reflects a problem with the pain system itself rather than damage in a particular part of your body. It’s a bit like a fire alarm that sounds without a fire.

Why haven’t I been given a diagnosis?

Persistent, or chronic, pain is a valid diagnosis. Just because you haven’t been given a specific diagnosis, such as a torn ligament or compressed nerve, doesn’t make your persistent pain any less real.

Will an X-ray or scan tell me what’s causing my pain?

No – Not in the majority of cases and can actually do more harm than good.
Pain is poorly correlated with x-rays and scans and many changes seen are part of the natural ageing process and are not predictive of pain and are not a reason to avoid activity. Many people will have these appearances on imaging, whether they have pain or not. See this link.
Remember that persistent pain is less to do with local tissue damage and more due to an over sensitive pain protective system so an X-ray or scan will not help with guiding further management. You can still be experiencing pain with a ‘normal’ x-ray or scan.
Don’t worry if you’ve already had these types of investigations and have been told you have ‘degeneration’, this finding is not a reason to stop activity or to just accept being in pain. Go to Self Help section for more information.

Why can’t I have stronger medication?

Stronger medication is not necessarily more effective and can result in unpleasant side effects.
You might even become dependent on the medication. People can develop a tolerance to medication they use regularly, meaning they need stronger and larger doses to get the same pain relief.
Also, the drugs that are often used for acute pain are not usually effective for persistent pain.

Should I stop if it hurts?

No – Persistent pain is less to do with an injury to your body and more to do with the brain and nervous system. Pain is like an alarm system that occurs when the brain perceives threat of damage to the body and wants us to act. Therefore, pain can still be felt even after the body tissue has healed and the longer pain persists, the weaker the link between damage and pain.
Hurt is rarely equal to harm with persistent pain so it’s still safe to move even if you are feeling pain but do this in graded way so that you slowly build up a tolerance. This gradual exposure to movement can in fact reduce the threat value to the nervous system and slowly reduce pain as well as build confidence to be more active.

Can stress influence my pain?

Yes, absolutely.
The sensitivity of the nervous system can be turned up or down by many factors so stress can certainly make the system more sensitive and wound up, which in turn can increase pain and muscle tension. This can then lead to more stress due to pain which sets up a vicious cycle that can be difficult to get out of sometimes. See Self Help section for more useful strategies to break this cycle.
Ongoing stress has also been shown to have physical effects on body tissues that can make people more susceptible to injuries or episodes of pain in the first place. This can sometimes explain why you can suddenly feel pain one day when carrying out a movement or activity you’ve down a thousand times before without any problem.
Therefore, it’s really important you develop ways to help manage your stress, if necessary, to help manage your persistent pain better.
Watch this short video to learn the single most important thing you can do for your stress.
If you are feeling stressed, anxious or low in mood and you would like further help and support, visit NHS website – Health in Mind website for more information.

Is it my fault I have this pain?

No – No one asks for a persistent pain problem to develop, and no one deserves the suffering that can come with it.
In the UK it is estimated that one in 5 people experience persistent pain, so there are many people like you living with pain. However, pain does not need to lead to long term suffering if you can learn new ways to understand pain and manage the problem better.
See the Self Help section for further information.

Is the pain all in my head?

Yes and No – We now know that every pain experience we have is produced 100% of the time by the brain. This includes acute pain, such as twisting your ankle or stubbing your toe, when there is a clear injury to local tissue as well as persistent pain where the ongoing pain experienced is less to do with tissue damage. However all pain, including persistent pain, is still felt in the body.
It is common for people with persistent pain to feel like others doubt that their pain is real. Persistent pain may not be visible on a scan or to others around you, but it is a recognised condition that is based in the central nervous system (brain and spinal cord).

When should I accept the pain and give up trying to find a cure?

When you have been appropriately investigated and have been diagnosed with a persistent pain condition, it may be time to look at the ways you can manage this condition.
It is important however, to know that giving up trying to find a cure does not mean giving up on the problem entirely – it simply means that you may have to take a different approach. This will likely mean enhancing your ability to self-manage the pain. See Self Help section for further information.
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