Understanding and managing persistent pain

Persistent or chronic pain is pain that continues for more than 3 months despite treatment. Unlike acute pain, which signals injury or illness, persistent pain can persist even after the initial cause has been resolved.

Persistent pain can impact a person’s quality of life. It can affect their physical, emotional, economic and social wellbeing. It takes a comprehensive approach to manage persistent pain, as explained in the 6 pillars of pain management.

The 6 pillars of pain management are:

• activity
• healthy diet
• quality sleep
• good mental health
• avoiding harmful substances
• maintaining good relationships

Managing persistent pain requires a multifaceted approach. By focusing on the 6 pillars of pain management, you can improve your quality of life and gain better control over your pain. It's important to work with healthcare professionals to develop a personalised plan that suits your needs.

Activity

Physical activity is crucial for managing persistent pain. Regular exercise can help reduce pain and improve function and quality of life. Here are some tips to incorporate activity into your routine:

• start slow: begin with low-impact exercises like walking, swimming, or yoga
• consistency is key: aim for regular, moderate exercise rather than sporadic intense workouts
• listen to your body: pay attention to your pain levels and start activities that exacerbate your pain gradually
• seek professional guidance: a physiotherapist can design a tailored exercise programme that suits your needs

Healthy diet

A nutritious diet can play a significant role in pain management by reducing inflammation and promoting health. Consider the following dietary guidelines:

• anti-inflammatory foods: incorporate foods rich in omega-3 fatty acids, such as fish, flaxseeds and walnuts
• fruits and vegetables: aim for a colourful variety to ensure a range of antioxidants and nutrients
• whole grains: choose whole grains over refined grains to help maintain steady energy levels
• stay hydrated: proper hydration is essential for overall health and can help manage pain

Quality sleep

Sleep is a vital component of health and wellbeing, particularly for those dealing with persistent pain. Poor sleep can exacerbate pain, making it harder to manage. To improve sleep quality, you can:

• establish a routine: go to bed and wake up at the same time each day
• create a restful environment: ensure your bedroom is dark, quiet and cool
• limit stimulants: avoid caffeine and electronics before bedtime
• practice relaxation techniques: deep breathing, meditation or gentle stretching can promote better sleep

Good mental health

Mental health is deeply interconnected with chronic pain. Anxiety, depression, and stress can intensify the perception of pain. Strategies to support mental health include:

• therapy: cognitive-behavioural therapy (CBT) can help reframe negative thoughts and develop coping strategies
• mindfulness and meditation: these practices can reduce stress and improve pain tolerance
• support groups: connecting with other peoplecan provide emotional support and practical advice

Avoiding harmful substances

Avoiding harmful substances is crucial for managing persistent pain. Such substances can include tobacco, alcohol, and non-prescribed drugs. These substances can worsen pain and interfere with treatments. Instead, focus on:

• seek support to quit smoking: stopping to smoke can reduce inflammation and improve circulation
• limit alcohol intake: drinking alcohol can interfere with sleep and pain medication
• avoid illicit drugs: use medications as prescribed by your healthcare provider and avoid non-prescribed substances

Maintaining good relationships

Social connections and healthy relationships are essential for emotional wellbeing and pain management. Here are ways to nurture relationships:

• communicate: share your experiences and feelings with friends and family
• stay connected: engage in social activities that you enjoy and can handle
• seek support: don’t hesitate to ask for help when you need it
• join support networks: consider joining chronic pain support groups, both in-person and online

You can find advice and support from external and Public Health Wales resources:

• live well with pain
• pain concern
• the pain toolkit
• versus arthritis 
• Public Health Wales: education programmes for patients
• Public Health Wales: national exercise referral scheme