What is... Chronic Pain?

A clear guide for clinicians, legal professionals, and curious minds.

Pain is something we’ve all experienced. But for millions of people, pain doesn’t go away when it should. Instead, it lingers, sometimes for months, years, or even a lifetime. That’s what we call chronic pain.

But what exactly is chronic pain? How is it different from acute pain? And how does it feature in clinical negligence and personal injury cases?

In this article, we’ll explore what chronic pain is, how it's diagnosed and treated, and what legal professionals need to understand when these complex symptoms become part of a claim.

So What is Chronic Pain?

Chronic pain is typically defined as pain that persists beyond the expected period of healing - usually longer than 12 weeks.

It may stem from an identifiable cause (e.g. surgery, trauma, arthritis), or it may exist without a clear underlying pathology. In either case, the impact on the person’s daily life can be significant and disabling.

Chronic vs. Acute Pain

• Acute pain: short-term, usually with a clear cause (e.g. injury, infection), and resolves with treatment or healing.

• Chronic pain: long-term, may persist even after tissues have healed, and often becomes a condition in its own right.

  
  

What Causes Chronic Pain?

There isn’t a single cause, but several mechanisms can be at play:

1. Nociceptive Pain

Due to ongoing activation of pain receptors by tissue damage or inflammation (e.g. osteoarthritis, post-surgical pain).

2. Neuropathic Pain

Caused by nerve damage or dysfunction (e.g. diabetic neuropathy, post-herpetic neuralgia, spinal cord injury).

3. Central Sensitisation

The nervous system becomes over-reactive—processing normal signals as pain. Seen in conditions like fibromyalgia or chronic widespread pain.

In many cases, chronic pain is multifactorial, influenced by biological, psychological, and social factors, often referred to as the biopsychosocial model of pain.

Examples of Chronic Pain Conditions

• Fibromyalgia

• Complex Regional Pain Syndrome (CRPS)

• Chronic lower back or neck pain

• Phantom limb pain

• Trigeminal neuralgia

• Chronic pelvic pain

• Failed back surgery syndrome

• Post-traumatic pain syndromes

• Somatic symptom disorder (pain with no clear physical origin)

These conditions may have no visible signs on imaging or scans - but that doesn’t make the pain any less real.

Diagnosing Chronic Pain

Diagnosis often involves excluding other causes, supported by detailed pain history, functional assessments, pain diaries or questionnaires and consideration of psychological factors such as depression.

There is no single test for chronic pain, which can sometimes lead to misunderstanding, scepticism, or delayed diagnosis.

How Is It Managed?

Management is rarely about “curing” the pain. Instead, it focuses on reducing intensity, improving function, and enhancing quality of life.

Treatments include:

• Medications

• Physical therapy and graded exercise

• Psychological interventions

  
  

Successful management often involves education, reassurance, and a shift from a “fix-it” model to a long-term support model.

Chronic Pain in Legal Contexts

Chronic pain plays a central role in many personal injury and clinical negligence claims, especially when pain develops after an accident, pain persists beyond expected recovery, the pain is disproportionate to objective findings, or affects quality of life more than expected, or llegations of delayed diagnosis, surgical error, or mismanagement are involved.

Common Legal Issues:

• Causation: Did the injury cause the pain? Or would it have developed anyway?

• Credibility: Is the pain consistent, medically plausible, and supported by history and documentation?

• Prognosis: Will the pain improve, remain stable, or worsen?

• Capacity and impact: Can the person work, care for themselves, or engage in normal life activities?

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Expert witnesses (often pain specialists, rheumatologists, psychologists) are crucial in helping courts understand the reality and implications of chronic pain.

Final Thoughts

Chronic pain is real, complex, and often misunderstood. It challenges our assumptions about what pain should look like and demands a more nuanced, compassionate, and informed response.

For clinicians, it's a call to listen and validate.

For lawyers, it's a challenge to understand the invisible.

For patients, it's a journey of resilience and adaptation.

If you're handling a claim involving chronic pain, or if you're a clinician supporting someone through it, getting the right medical and legal insight matters more than ever.