| What We Treat
Chronic Primary Pain
Pain that persists after tissues have healed is a condition in its own right, not a sign that something has been missed.
Overview
What It Is
Chronic primary pain is pain that has persisted beyond three months and is not explained by ongoing tissue damage or another condition. The pain system itself has become sensitised and now generates pain out of proportion to what is happening in the tissues. It is recognised as a diagnosis in its own right rather than a diagnosis of exclusion.
A Condition in Its Own Right
Pain persisting beyond three months without ongoing tissue damage. Recognised as a diagnosis rather than a failure to find one.
Symptoms
How It Tends to Feel
These are the features that point towards this diagnosis rather than another:
Duration Beyond Three Months
Persisting well past the point at which tissues would have healed.
Disproportionate to Findings
Pain considerably greater than examination or imaging would predict.
Spreading Distribution
Often extending beyond the original site over time.
Sensitivity to Touch and Movement
Ordinary input registering as painful.
Emotional Impact
Distress, frustration and low mood, which are consequences as much as contributors.
Function Loss
Usually greater than the pain alone would explain, driven by avoidance.
Causes & Risk Factors
What Drives It
The usual contributors, in rough order of how often they turn out to matter:
Central Sensitisation
The nervous system’s pain processing becomes amplified and persists after the original trigger resolves.
Prolonged Avoidance
Protecting the area reduces its capacity, which lowers the threshold at which pain occurs.
Poor Sleep
Measurably lowers pain thresholds, and is almost always disrupted.
Distress and Uncertainty
Not knowing what is wrong maintains the system in a protective state.
How We Can Help You
Treatment & Management
Treatment is built around what the assessment finds, but generally follows this shape:
When to Seek Help
Red Flags — Don’t Ignore These
Most presentations are straightforward. These features are the exceptions, and warrant prompt assessment:
⚠ Seek Medical Advice If You Notice
- New night pain that wakes you consistently
- Unexplained weight loss, fever or night sweats
- Progressive weakness, numbness, or bladder or bowel changes
- A history of cancer with new unexplained pain
If any of these apply, contact your GP or seek urgent medical care rather than waiting for a physiotherapy appointment.
Common Questions
Frequently Asked Questions
Does this mean the pain is in my head?
No. The pain is real and generated by real changes in the nervous system. The distinction is between pain caused by tissue damage and pain caused by an over-protective pain system, and the second is no less genuine.
Should I wait until it hurts less to move?
No, and this is the hardest part to accept. Capacity is what raises the pain threshold, and capacity only comes from loading. Waiting reduces it further.
Will more scans help?
Rarely, and repeated imaging often makes things worse by producing incidental findings that increase worry and avoidance.
Not Sure If This Is What You Have?
An assessment will tell you what is actually going on and what to do about it. I see everyone myself, and you will leave with a plan rather than a leaflet.
Book Your Initial AssessmentThis page is for general information only and isn’t a substitute for individual medical advice. If you’re experiencing any of the warning signs above, contact your GP or seek emergency medical care as appropriate.