Persistent pain

Chronic or Persistent Musculoskeletal Pain


Persistent pain affects the muscles, joints and bones and has lasted for more than 3 months. It is a common problem effecting as many as 3 out of 10 adults in the UK. Persistent pain can affect any part of the body and can be felt in one or more body areas at the same time.

Pain can start following an accident or injury but often onsets gradually, without an obvious cause. Scientific research shows that pain that lasts longer than 3 months is likely to be due to changes in the nervous system rather than as a result of ongoing damage or injury.  Therefore, tests such as x-rays and MRI scans that look at the state of tissue are often negative or inconclusive and therefore are not often needed. This means that pain is a result of a sensitised nervous system, which x-rays and scans are unable to detect.

What should I do?

Evidence shows that if people with persistent pain engage with simple pain management strategies it can improve their function, mental health and quality of life. This active approach is the most effective way of management persistent pain. Things you can do to help your-self include;

  • Learning about the causes of persistent pain
  • Remain active by planning, prioritising and pacing your activities
  • Talk to friends and family about how they can support you to stay active
  • Learning ways to improve your mental health
  • Using meditation and or relaxation techniques
  • Improving your sleep
  • Speak to your employer about ways of adapting your role / work environment


The aim of pain medication is to offer relief and then to enable people to return to previous activity levels. Although medication can be useful, it is often not a cure for persistent pain and a can cause a number of unwanted side effects. Therefore, any medication should be carefully considered to see if it is effective. Sometimes it is helpful to reduce or stop pain medication as the costs (side-effects including causing pain!) outweigh the benefits. See the NHS campaign Pain Killers Don’t Exist for more information about pain killers. People should carefully follow advice from a qualified professional regarding the use of pain medication and always follow the instructions on the packet. Remember you can ask your local pharmacist if you are unsure about the use of medication.

Pain and activity

Although persistent pain rarely indicates serious injury, it often affects people’s ability to work, socialise and exercise. Overdoing or underdoing activity can result in increased pain levels because the nervous system becomes more sensitised. This leads to people avoiding day to day tasks because they fear making their pain worse. This reduction in normal activity can results in worsening physical and mental health and can lead to financial difficulties and other social problems.

Pain and mood

People experiencing persistent pain often report a negative effect on their mental health with feelings of anxiety and depression being common. This is because of the way the nervous system responds to pain. Unfortunately, this can lead to a vicious cycle where pain and mood interact making matters worse. Motivation can be effected and people can become withdrawn and worried.

YouTube Videos developed by TIMS

These videos have been developed by the clinical teams in Tyneside Integrated Musculoskeletal Service (TIMS) to support the management of patients in our service. If you have not been referred to this resource by TIMS you follow the advice at your own risk.

Introduction to pain self-management

You may have been told that there are no medical solutions to “cure” your pain. You may also have been told that you need to find ways to self-manage your pain. But what does this mean? This short video is part of a series of pain management videos with the aim to support you in your self-management journey.

Understanding your pain

Persistent pain is complex. This video explains: what persistent pain is, what is going on inside us when we have persistent pain, why people develop persistent pain in the first place and how it makes us feel and what we can do about persistent pain.

Graded activity / exercise

When living with persistent pain it can be difficult to exercise and remain active. We know that remaining active is important when managing persistent pain. Please watch this video for information and advice about how to move and exercise in a gentle but effective way.

Sleep and Pain

Living with pain can have a big impact on a person’s ability to have a good night’s sleep. Please see this video for some hints and tips to improve your sleep


Planning, prioritising and pacing your activities can allow you to gain more control of your pain. Please see this video for information about pacing and how best to incorporate this into your daily life.


We understand that living with pain can have a big effect on the quality of a person’s life. Please see this video which gives you information about how by setting meaningful goals you can improve the enjoyment of your life.

Managing pain flare-ups

Pain flare-ups are in inevitable part of living with persistent pain. Please see this video for information about planning for and managing flare-ups. We also have a patient information leaflet TIMS – Flare Ups available to download.


We have long been told about how important it is to maintain good posture. It may be news that maintaining good posture is not so important as we have long-believed. Please see this video for evidence-based information about what we know about posture.


Useful links for persistent pain


  • Ehlers Danlos Syndrome 
    • Information and support for people with Ehlers Danlos Syndrome.
  • Hypermobility Syndrome Association
    • The hypermobility syndromes association (HMSA) provides support and information for everyone with a hypermobility syndrome as well as health and social care professionals who support them.
  • What is Joint Hypermobility
    • Developed by Versus Arthritis this booklet reviews the different types of hypermobility and provides information on diagnosis and treatment.
  • Fibromylagia
    • Information on causes, symptoms and treatment from Versus Arthritis.
  • Tempero-mandibular Disorder (TMD) TMD describes a variety of conditions which affect the jaw joints and/or the muscles around the jaw.  This leaflet contains advice and information on coping with TMD.
  • Osteoarthritis Information Booklet
    • Developed by Versus Arthritis this useful booklet provides information about osteoarthritis and how to manage your condition.
  • Escape Pain. An education and exercise programme for people with chronic join pain or osteoarthritis.
    • We are now able provide escape pain delivered virtually via microsoft teams or via face to face groups located across Newcastle and Gateshead. These groups will provide you with the support required to exercise appropriately and provide advise and education for management of your joint. Please complete the referral form for TIMS stating you would like to be considered for an escape pain class.
    • The programme is also available online using the Escape Pain Website, Apple iOS and Google/Android apps. Both tools take you through a six week programme, with two session per week, containing:
      • Exercise videos with simple, easy to follow exercise with clear instructions that were developed so you can do the exercises safely in their homes;
      • Educational videos with engaging animations giving simple advice and information to help you understand how to better manage your condition;
      • Individual progress chart to track your improvement over time.​
  • An Introduction to Mindfulness