Persistent pain: build a plan around the life you want back

Tell the story beyond the pain number

Pain lasting or recurring for more than three months is commonly described as chronic pain. It may be linked to an identifiable condition, involve a more complex pain process, or include both. These distinctions should help organize care; they should not make your experience feel less real.

Describe the activities pain has changed: sleeping, caring for family, working, walking the dog, or seeing friends. Explain what you have already tried, what helped a little, and what caused problems. A clear account of your life is useful clinical information, even when an imaging report cannot explain every symptom.

Sources: NICE NG193: Assessment of chronic pain

Ask for a working explanation you understand

A working explanation should connect what the clinician has found with what you feel, while leaving room for uncertainty. Ask what has been reasonably excluded, what still needs evaluation, and which changes would prompt another look at the diagnosis.

It can help to say, "I understand we may not have one simple answer. What are the main contributors you think we can address?" That invites a practical conversation without asking anyone to pretend certainty. If an explanation does not make sense to you, ask the clinician to try different words or draw it.

Choose goals that make progress visible

A pain score is one measure, but it cannot describe a whole day. Pick one or two activities that would make life meaningfully easier. You might want to prepare a meal with fewer pauses or manage a short outing without losing the rest of the day.

Then discuss how to measure change, what effort the plan requires, and when you will review it. Keep goals adjustable. A step that is manageable for one person may be too demanding for another because of work, fatigue, caregiving, cost, or another illness. Those limits belong in the plan.

Give every part of the plan a purpose

Ask what each recommendation is meant to change. A medication review, a movement program, a procedure, or support for coping with pain should each have a reason. If several options are discussed, ask which one comes first and how the result will influence the next choice.

Clarify the burden as well as the possible benefit: appointments, transport, out-of-pocket costs, home practice, unwanted effects, and time away from work. Ask what would lead you and the clinician to continue, adapt, or stop an option. Avoid leaving with several disconnected suggestions and no way to judge them.

Make coordination concrete

Ask who oversees the whole plan and which clinician manages medicines, rehabilitation, procedures, and new symptoms. Keep one current treatment list that you can bring to each visit. If recommendations conflict, ask the teams to resolve the conflict rather than trying to decide between them yourself.

Agree on the next contact and how to get help between appointments. A flare deserves instructions that are specific enough to use: whom to contact, what information to send, and what changes require urgent assessment. The plan should be understandable to a partner or caregiver if you want them involved.

Sources: AAPM&R: About Physical Medicine and Rehabilitation

Start a conversation with our pain specialists

At Commons Clinic, Dr. Evish Kamrava offers chronic and acute functional recovery consultation as part of physical medicine, rehabilitation, and interventional care. Dr. Michael Port practices diagnostic and interventional pain management. Their different backgrounds can help you frame the kind of assessment you are seeking.

Before a consultation, write a short timeline and your two most important goals. Bring previous treatment records rather than relying on memory. Read patient accounts for clues about communication and follow-through, then use the visit to decide whether you understand the proposed plan and feel comfortable asking the difficult questions.

Compare a combination of options with one treatment

CDC patient guidance describes several nonopioid approaches, including physical therapy, psychological treatments directed at coping and function, and selected medicines or interventions. The suitable combination depends on the pain condition and your circumstances. Ask which part of the plan addresses movement, which addresses sleep or coping, and which aims to reduce a particular symptom. Tell us if travel, cost, side effects, or previous experiences make an option difficult. A realistic plan should explain what each component contributes and how you will judge its value.

Sources: Nonopioid Therapies

Include the people who help you function

Johns Hopkins describes chronic pain rehabilitation as a team effort that may involve rehabilitation clinicians, therapists, nurses, and behavioral health professionals. Their roles differ, so more appointments alone do not guarantee coordination. Ask who brings the recommendations together and how changes will reach the rest of your team. If you want a partner or caregiver involved, explain what help you need and what information you want shared. Make the next review about meaningful activities as well as pain intensity, so progress reflects your life.

Sources: Chronic Pain

Sources & further reading

• NICE NG193: Assessment of chronic pain
• AAPM&R: About Physical Medicine and Rehabilitation
• Nonopioid TherapiesCenters for Disease Control and Prevention · Updated April 25, 2024
• Chronic PainJohns Hopkins Medicine

We use these medical sources to help explain your options and prepare you for a conversation with our team. Our guides feature our own clinicians; patient reviews describe individual experiences.

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