Understanding persistent pain and how pain management programmes can help
By Andy Duckmanton, BOst (Hons), GOsC registered osteopath.
Patient information | 16 October 2026
Persistent pain can affect almost every part of life: movement, sleep, work, relationships and confidence. Understanding the influences on pain can open up useful ways of helping, including NHS pain management clinics and programmes.
The starting point is that your pain is real. Nothing in this article means that pain is imaginary, “all in your head” or your fault. Anxiety, poor sleep or fear can influence pain without making it any less physical or deserving of care. You do not have to prove that you are positive, resilient or trying hard enough to receive help. [1] [2]
On this page
Why pain feels different for different people
Pain involves the body and its nervous system. Signals from tissues are processed and regulated through nerves, the spinal cord and the brain. Injury, inflammation or nerve disease may contribute, while the sensitivity of the system can also change. Persistent pain can involve several mechanisms together. [2] [3]
This helps explain why pain intensity does not always closely match the amount of tissue damage, and why tests may not fully explain someone’s symptoms. A scan cannot measure the whole experience of pain. Physical causes still require appropriate assessment; considering wider influences should never replace that assessment. [2] [3]
People also differ in sensitivity because of factors including genetics, hormonal influences and previous experiences. The same physical stimulus need not feel the same to two people. Pain threshold means the point at which something becomes painful; pain tolerance concerns how much pain someone feels able to endure. These can vary over time. Neither measures character or willpower, and a calm appearance does not establish that pain is mild. [1] [4] [5]
The meaning of pain can influence what happens next. Someone who believes every painful movement is causing further damage may understandably become watchful and avoid activity. If the condition allows safe movement, continuing to avoid it can make returning to everyday life harder. NICE recognises that fears and beliefs about activity can obstruct recovery from persistent low-back pain. [6]
Compare “my back is permanently damaged” with “my back is painful, but I can gradually rebuild what I do”. These interpretations may lead to different actions. A helpful explanation must fit the assessment and answer the person’s concerns. Simply saying “there is nothing wrong” can leave someone feeling dismissed. [6] [7]
Mental health, sleep and daily life
Mental health and pain affect each other. Anxiety, depression and prolonged stress can affect sleep, concentration, distress and the energy available for rehabilitation. Pain can also worsen mental health through exhaustion, uncertainty, isolation and losing valued activities. A review of low-back-pain research found associations between depressive symptoms, greater disability and poorer recovery. An association does not establish that depression caused an individual’s pain or determine their future. [7] [8]
Psychological support can help someone deal with the burden of a physical health problem. Receiving it does not mean that the pain has been judged imaginary, and persistent pain does not require a mental health diagnosis. If pain continues despite someone’s efforts, they deserve reassessment and support, rather than blame. [2] [7]
Sleep and daily circumstances deserve attention too. Pain may interrupt sleep, and poor sleep can increase sensitivity and fatigue. Experimental research has shown that disrupted sleep can lower pain thresholds. This is one reason that sleep problems belong in a pain assessment. [9]
Other relevant influences include confidence in managing symptoms; previous injuries or distressing treatment experiences; feeling heard and involved in decisions; and support from family, friends or colleagues. Physical demands at work, job insecurity, financial pressures, caring responsibilities and isolation can affect both distress and the practical opportunity to recover. The underlying condition, other illnesses and physical capacity remain important. These influences differ between people and cannot all be changed by individual effort. [3] [7]
Placebo and nocebo effects
Expectations can affect pain relief. Placebo effects are changes arising from expectations, learned associations and the treatment context. They can involve the body’s own pain-regulating mechanisms. They can accompany active medicines and physical treatments as well as dummy treatments; benefit from these mechanisms does not make the original pain unreal. [10]
The reverse is called a nocebo effect: negative expectations can contribute to increased pain or adverse symptoms. Neither response is necessarily conscious or voluntary. A clinician’s explanation and the person’s previous experiences can influence these responses. Honest reassurance, clear information and realistic hope are helpful; necessary risks should still be explained, and promises of a cure should be avoided. [10]
Improvement after treatment is not all a placebo effect. It can include the treatment’s specific effects, natural recovery, changes in activity or other care, and normal symptom fluctuation. People often seek help during a particularly bad spell, which may then settle towards their usual level: this is called regression to the mean. There is no universal percentage of recovery attributable to placebo effects, and pain relief alone does not establish that an underlying condition has been cured. [11]
What NHS pain clinics do
NHS pain clinics offer specialist help when pain is difficult to manage. They commonly see people with pain lasting more than three months that is disrupting life, particularly when initial treatment has not helped enough. This can include persistent back, neck or shoulder pain, nerve pain, fibromyalgia and pain continuing after surgery. [12] [13]
Depending on the service, the team may include a pain specialist doctor, physiotherapist, psychologist, specialist nurse, occupational therapist and pharmacist. Their roles complement each other. The clinic can review the problem, discuss treatment options and agree a plan with the person. [13] [14]
Part of care | What it may involve |
|---|---|
Assessment | Reviewing symptoms, previous treatments and investigations; examination where appropriate; deciding whether another specialist assessment is needed. |
Medicine review | Checking benefit, side effects and whether supervised changes would help. |
Physical rehabilitation | Gradually rebuilding movement, activity and confidence with a plan matched to the person. |
Psychological support | Working with distress, fear, difficult thoughts and the disruption caused by pain. |
Practical support | Planning everyday activities, managing flare-ups and considering useful changes at home or work. |
Selected treatments | Injections, nerve blocks or other specialist procedures when appropriate for the particular condition. Some services offer hands-on treatments or other options. |
Services vary, and nobody needs every treatment. Procedures are appropriate for selected conditions; a referral does not automatically lead to an injection or stronger medication. [12] [13] [15]
What happens in a pain management programme?
A pain management programme provides structured rehabilitation. A clinic appointment and a pain management programme, usually shortened to PMP, are related but different. The clinic provides specialist assessment and treatment planning. A PMP is a course that some people are offered to develop practical skills through education, supported activity and repeated practice. [12] [16]
Programmes are often delivered in groups over several sessions. They may include individually adapted exercise, pacing activity, relaxation or mindfulness, understanding pain, managing its emotional effects, sleep strategies and planning for setbacks. Participants work towards goals that matter to them, such as walking to the shops, returning to a hobby or spending more time with family. [16] [17]
Psychological approaches may include cognitive behavioural therapy (CBT), which explores how thoughts, feelings and actions interact, or acceptance and commitment therapy (ACT), which helps people make room for difficult experiences while taking steps towards what matters to them. In this context, acceptance means finding ways to live meaningfully with the situation as it is now. It does not mean giving up on improvement or agreeing that the pain is acceptable. [15] [17]
The aim is to build manageable habits and useful skills. Pacing can help someone find a sustainable level of activity and adjust it, while rehabilitation can support gradual progress. The team should help adapt the plan when symptoms or circumstances make it difficult. Learning alongside others can also provide support and reduce the sense of facing pain alone. [16] [17]
For practical examples of pacing and planning difficult days with back pain, see our back pain flare-up guide.
Assessment helps establish which programme or form of support is suitable. Format and intensity vary. Some services offer individual alternatives for people who cannot attend a group. Concerns about groups, access or mental health can be discussed with the team rather than assuming that they rule someone out. [18]
Benefits and the research evidence
The benefit is a coordinated plan that addresses several obstacles together. Imagine someone whose back pain has disrupted sleep, reduced walking and made them frightened of a flare-up. A plan might combine a medicine review, help with sleep, gradual walking practice and a clear approach to difficult days. Each element supports a different part of their situation. This is an illustrative example; the right combination depends on assessment.
Useful gains might include doing more, feeling more confident, experiencing less distress and having better ways to handle setbacks. Skills can remain useful after appointments end. The central purpose of a PMP is to improve daily functioning and quality of life, including when pain continues. Pain relief is welcome, but it is not the only worthwhile outcome. [12] [17]
There is research supporting this approach, with realistic limits. A Cochrane review published in the BMJ included 41 trials involving 6,858 people with chronic low-back pain. Multidisciplinary rehabilitation improved pain and disability compared with usual care, although the average long-term improvements were small. Individual results vary, and no programme can promise complete pain relief. [19]
Related research also supports individual care that addresses pain-related beliefs, behaviour and movement. In the RESTORE trial, cognitive functional therapy improved disability more than usual care for chronic disabling low-back pain, with benefits maintained at one year. This was a specific physiotherapy approach, so it should not be treated as proof that every NHS group programme produces the same results. [20]
Finding NHS support
A referral is an opportunity to receive additional support. If pain has persisted for several months, is restricting life and remains difficult to manage, a GP can advise about the local pain service. It can help to explain what pain prevents you doing, what has already been tried and what you most want to regain. [12] [16]
For a broader comparison of available support, read Choosing the right help for muscle and joint pain.
In East Sussex, the usual starting point is the GP and East Sussex MSK service. As of 16 October 2026, the partnership states that a new community pain service will begin operating on 2 November 2026. People already receiving care or waiting for support do not need a new referral because of this change. [21] [22]
Pain management recognises that a person’s experience deserves attention even when symptoms cannot be completely explained or removed. A helpful plan works with the person’s priorities and circumstances. Continuing pain should never be treated as evidence that someone is imagining it, has caused it through their attitude, or has failed to try hard enough. [1] [7]
Related patient guides
Sources and further reading
Select a numbered citation or source title to open the original. Local service information is dated 16 October 2026.
1. International Association for the Study of Pain. Revised definition of pain and explanatory notes
2. British Pain Society. Understanding and Managing Long-term Pain — patient booklet
3. International Association for the Study of Pain. Low Back Pain — mechanisms and the wider influences on recovery
4. International Association for the Study of Pain. Genetic Biomarkers of Pain States
5. International Association for the Study of Pain. Overview of Sex and Gender Differences in Human Pain
7. NICE. NG193 — Chronic pain in over 16s
8. Journal of General Internal Medicine. Association Between Depressive Symptoms or Depression and Health Outcomes for Low Back Pain — systematic review and meta-analysis
10. International Association for the Study of Pain. Placebo and Nocebo Effects — treatment expectations and the patient–physician interaction
12. NHS. How to get NHS help for your pain
13. Surrey and Sussex Healthcare NHS Trust. Pain management — assessment and treatment options
14. NHS England. Adult Specialised Pain Service Specification
15. NHS Education for Scotland. The Matrix — multidisciplinary pain management programmes for chronic pain
16. British Pain Society. Pain Management Programmes — participant information
17. British Pain Society. Guidelines for Pain Management Programmes for Adults, 2021
18. The Walton Centre NHS Foundation Trust. Pain Management Programme — options and assessment
20. The Lancet. Kent and colleagues, 2023 — RESTORE randomised trial of cognitive functional therapy
21. East Sussex MSK Community Partnership. About Pain Management — referral information
22. East Sussex MSK Community Partnership. The new community pain service — frequently asked questions
This general information supports, and does not replace, an individual assessment.