Intended for healthcare professionals

Practice Practice Pointer

Chronic pain: definitions and diagnosis

BMJ 2023; 381 doi: https://doi.org/10.1136/bmj-2023-076036 (Published 27 June 2023) Cite this as: BMJ 2023;381:e076036
  1. Youngjoo Kang, foundation year 1 doctor1,
  2. Louise Trewern, lead lived experience trainer2,
  3. John Jackman, GP, rheumatology associate specialist3,
  4. David McCartney, director of graduate entry medicine5,
  5. Anushka Soni, honorary consultant rheumatologist6
  1. 1Royal Berkshire NHS Foundation Trust, Reading, UK
  2. 2Live Well With Pain Team, UK
  3. 3Oxford University Hospitals NHS Foundation Trust, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, UK
  4. 5Medical Sciences Division, University of Oxford, Oxford
  5. 6Nuffield Department of Clinical Neurosciences/Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford
  6. *Joint senior authors
  1. Correspondence to Anushka Soni anushka.soni{at}ndorms.ox.ac.uk

What you need to know

  • Acknowledging chronic pain as a diagnosis in its own right can help clinicians and patients move on from a mindset of searching for a diagnosis to discussing long term management strategies

  • Consider non-pain features such as poor sleep, low mood, and reduced physical activity: these can be both a cause and a consequence of chronic primary pain

  • Consultations where patients feel believed, listened to, and validated can enable a therapeutic relationship that forms the basis for subsequent management strategies, including supported self-management.

Pain related diseases are the leading cause of disability and disease burden worldwide.12 Chronic pain affects between a third and half of the population globally,345 and high impact chronic pain—defined as pain experienced on most days or every day in the previous three months that causes restriction in at least one activity—has been found to affect 4.8% of the US adult population.6 Furthermore, chronic pain is a common reason for accessing healthcare, with 22-50% of GP consultations being related to pain.7 Patients often report a delay in diagnosis,8 with a longer and more difficult journey to diagnosis being associated with reduced satisfaction with subsequent treatment.9

A lack of diagnostic biomarkers and universally effective treatment options for chronic pain often result in frustration for both patients and clinicians.710 Consultations can sometimes focus on how to treat pain, without first naming the diagnosis of chronic pain. Creating space in the consultation for this can help patients to feel heard, reduce frustration, and refocus on supported self-management strategies rather than the clinician striving to fix the problem. This article offers an approach to identifying and discussing chronic pain with patients, drawing on formal guidance from the UK,11121314 patient voices, and our clinical experience.

What is chronic pain?

According to the …

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