The Leeds Teaching Hospitals NHS Trust

Understanding long-term pain

If you are reading this, then you probably have long-term pain, or are close to someone who does. Our aim is not to ‘educate you on your pain’, as you probably know pain better than most people. You know and feel it, you have the ‘lived experience’ of long-term pain. But what you might know less about is the ‘science behind pain’, the physiology of it.

As clinicians, working with people who live with long-term pain, it is our goal to share with you the most up-to-date scientific knowledge about pain. The consensus in modern science is that long-term pain is real. It is not ‘all in your head’. Moreover, long-term pain is as real as acute pain.

We believe that learning about the biology of pain can be extremely valuable, as it can give hope and direction on how to manage it. In this section you will find an explanation of long-term pain, and a list of carefully selected resources to help you learn more about the physiology of long-term pain.

pain physiology

Pain is a protective mechanism - it occurs when your body’s alarm system wishes to alert the brain to actual or potential tissue damage. This is extremely valuable to us as humans.

Some people cannot experience pain. One rare medical condition called Congenital Insensitivity to Pain with Anhidrosis, or CIPA, results in inability to experience pain. People diagnosed with CIPA often die in childhood, due to injuries or illnesses going unnoticed.

Pain is unpleasant and attention-grabbing by design. When it increases, we cannot think, feel or focus on anything else. However, the pain system sometimes acts oddly. The brain could decide that it is not in our best interest to feel pain, despite tissue damage - think of severely injured soldiers who do not report pain until they leave the battlefield, or surfers who cannot feel the pain of a shark bite, until they reached safety.  
Pain can also sometimes hang around for longer than is helpful, after the damage has healed. Think of phantom limb pain - pain in an area of the body that is no longer there (e.g. following amputation).

Events like this show us that the amount of pain experienced does not necessarily relate to the amount of tissue damage; this is particularly true in pain that persists over 6 months. Long-term (chronic) pain often does not indicate on-going damage, even though it feels like it. In fact, long-term pain is often associated with increased sensitivity of the nervous system. This results in an increased response to painful stimuli (hyperalgesia) and even normally non-painful stimuli becoming painful (allodynia) - both are common in people who experience long-term pain.

Understanding your pain is the first step to better managing it. It often takes time and effort, but it is possible! Please see the resources section of this website to find out more about mechanisms of pain.

Learn more about pain