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The Beyond Pain Foundation

Conditions we support

Conditions guide

Chronic widespread pain

Chronic widespread pain is pain in many parts of the body that lasts for months. Often no single cause is found, and doctors may call it chronic primary pain. The pain is real, and there are ways to manage it. This guide explains what it is, how it is assessed, what the NHS recommends, and your rights at work.

UK adults living with chronic pain
Over 4 in 10
UK adults with chronic widespread pain
About 1 in 7
People in England with chronic primary pain
1 to 6 in 100
Pain is called chronic after
3 months

This guide is general information, not medical advice. Medicines and treatments must be prescribed or recommended for you by a doctor or pharmacist. We do not give doses here.

What chronic widespread pain is

Chronic pain is pain that lasts, or keeps coming back, for more than 3 months. Chronic widespread pain is when that pain affects many areas of the body. It is usually felt on both sides of the body, above and below the waist, and along the spine, neck or chest.

Sometimes the pain is caused by another condition, such as arthritis. But often no clear cause is found, or the pain is much more than any injury or illness would explain. NICE calls this chronic primary pain. It is a condition in its own right, not a sign that nothing is wrong.

In chronic primary pain, the nervous system becomes more sensitive and keeps sending pain signals. Stress, poor sleep, past injuries and life events can all play a part. The pain is real even when scans and blood tests are normal.

Fibromyalgia is one type of chronic primary pain. Read our fibromyalgia guide if you have been given that diagnosis.

Primary and secondary pain

NICE's chronic pain guideline (NG193) splits chronic pain into two groups. You can have both at the same time.

Chronic primary pain

Pain with no clear underlying cause, or pain that is out of proportion to any injury or illness. It often comes with distress and makes daily life harder.

Chronic secondary pain

Pain caused by another condition, such as arthritis, endometriosis or nerve damage. Treatment focuses on that condition.

Widespread pain

Pain in many areas at once. It may be primary, secondary, or a mix. Fibromyalgia is a common form.

Other primary pain

NICE also includes some long-term headaches, pelvic pain, stomach pain and back pain with no clear cause.

With other conditions

Widespread pain often comes with tiredness, poor sleep, low mood, anxiety or irritable bowel syndrome.

Mild to severe

Some people manage work and family life with small changes. For others, the pain limits them a lot. It can change over time.

Symptoms and flares

As well as pain in many places, you may have stiffness, tiredness, sleep that doesn't feel refreshing, trouble concentrating, and being more sensitive to touch, cold or pressure. Pain can ache, burn, throb or stab, and it may move around.

Pain often goes up and down. A flare is a time when it gets much worse. Flares can be set off by stress, poor sleep, illness, changes in routine, or doing more (or less) than usual.

  1. Day to day

    Baseline

    Your usual level of pain. Knowing your baseline helps you plan and spot changes.

  2. Hours to a day or two

    Early warning

    More aches, worse sleep or more tiredness. A good time to ease off and use your flare plan.

  3. Days to weeks

    Flare

    Pain is much worse and normal tasks may be very hard. Keep moving gently if you can.

  4. Days to weeks

    Settling

    Pain eases back towards your baseline. Build back up slowly to avoid another flare.

These timings vary a lot from person to person. They are a rough guide, not a rule.

Have a flare plan

NICE says your care plan should cover what to do in a flare. Write down what helps you, such as heat, rest breaks, gentle stretching or relaxation, and who to contact. It is easier to follow a plan made on a good day.

When to get urgent help

Chronic pain on its own is not an emergency. But new or different symptoms should never just be put down to your usual pain.

Call 999 or go to A&E if you have

  • chest pain, or pain spreading to your arm, jaw or back
  • sudden weakness or numbness on one side, or trouble speaking
  • sudden, very bad breathlessness
  • loss of bladder or bowel control with back pain
  • thoughts of ending your life and feel you may act on them

Call NHS 111 if

  • you have a new, severe pain that is not like your usual pain
  • you have a high temperature with severe pain
  • you are in a mental health crisis. In England, call 111 and choose the mental health option (option 2)
  • you need help and your GP is closed

See your GP if

  • you have had pain in many places for 3 months or more
  • you have swollen joints, a rash, weight loss, night sweats or fevers
  • your pain is getting worse or changing
  • you feel low or anxious most days

Living with pain can be very hard. If you are struggling, you can talk to Samaritans any time, day or night, free on 116 123.

Diagnosis and referral

There is no single test. Your GP will ask where the pain is, how long you have had it and how it affects your work, sleep, mood and family life. They will examine you.

Blood tests or scans may be used to look for other causes, such as inflammatory arthritis, thyroid problems or low vitamin D. If a cause is found, that condition is treated. If not, or if the pain is more than the cause would explain, you may be told you have chronic primary pain.

NICE says your doctor should agree a care and support plan with you. It should cover what matters most to you, your goals, and the benefits and risks of each option. Your GP may refer you to a rheumatologist if another condition is suspected, or to a pain clinic if treatment isn't helping.

Treatments and medicines

No single treatment works for everyone. The aim is to help you do more and live better, not only to lower the pain. NICE's chronic pain guideline (NG193) sets out what the NHS should offer for chronic primary pain.

Exercise programmes

GP, physiotherapist or local NHS service

NICE recommends a supervised group exercise programme, adapted to your needs and abilities. No one type of exercise is best. Start gently and build up slowly. Staying active afterwards keeps the benefits going.

Talking therapies

NHS Talking Therapies (self-referral in England) or GP

Acceptance and commitment therapy (ACT) and cognitive behavioural therapy (CBT) can help you cope and do more of what matters to you. They do not mean the pain is "in your head". A course usually runs over several sessions.

Antidepressants

Prescription, for adults 18 and over

NICE says doctors can consider amitriptyline, citalopram, duloxetine, fluoxetine, paroxetine or sertraline. These can help pain, sleep, distress and quality of life even if you are not depressed. They should be reviewed with your doctor.

Acupuncture

Sometimes on the NHS, often private

NICE says a single short course can be considered, given by a trained practitioner. Studies show benefit in the short term, up to about 3 months.

Medicines NICE says not to start

For chronic primary pain, NICE advises doctors not to start paracetamol, anti-inflammatories such as ibuprofen, opioids such as codeine or tramadol, gabapentin or pregabalin, or benzodiazepines. It also advises against starting antipsychotics, ketamine, local anaesthetics and steroid trigger point injections. There is little evidence they help this kind of pain, and some can cause harm or dependence over time.

If you already take one of these and it helps, NICE says your doctor should review it with you and agree a plan, not just stop it. Don't stop any medicine suddenly without advice.

NICE also advises against TENS machines, ultrasound, interferential therapy and biofeedback for chronic primary pain, as the evidence does not show they help. This advice is about chronic primary pain only. If you have chronic secondary pain, different treatments may be right for you.

Specialist options

  1. Rheumatology

    If another cause is suspected

    A rheumatologist can check for conditions such as inflammatory arthritis, lupus or polymyalgia, and confirm whether the pain is primary or secondary.

  2. Pain clinic

    If first treatments haven't helped

    NHS pain clinics have doctors, nurses, physiotherapists and psychologists. They can review your medicines and help you manage pain day to day. Your GP needs to refer you.

  3. Pain management programme

    Usually group sessions over several weeks

    These courses cover pacing, gentle exercise, relaxation, sleep and coping with emotions. NICE could not find enough evidence to recommend for or against them for chronic primary pain, but many NHS pain services still offer them.

Self-help and living well

Day to day

  • Pace yourself: break tasks into smaller chunks with rests between
  • Keep gently active, even on bad days, at a level that suits you
  • Set small, realistic goals and build up slowly
  • Plan your week so busy days are followed by quieter ones

Sleep and mind

  • Keep regular times for going to bed and getting up
  • Cut down caffeine and screens in the evening
  • Try relaxation, breathing or mindfulness
  • Stay in touch with people and do things you enjoy

Learning how pain works can also help. Flippin' Pain explains the science of pain in plain language, and Pain Concern has free guides on managing activity, sleep and emotions.

Getting the best care

Before and during appointments

  • Keep a simple diary for a few weeks: pain, sleep, mood and what you did that day
  • Mark where it hurts on a body outline and take it with you
  • Write down your top 3 questions before you go
  • Explain what you can't do any more, not just how much it hurts
  • Ask: "Is this primary or secondary pain, and what else have you ruled out?"
  • Ask for a written care and support plan, including what to do in a flare
  • Ask about NHS exercise programmes, Talking Therapies and pain clinic referral

If you don't feel listened to, you can see another GP at your practice, or ask for a second opinion. You don't have to prove your pain is real. It is.

Chronic pain and work

Chronic pain can count as a disability under the Equality Act 2010 (the Disability Discrimination Act in Northern Ireland). This applies if it has more than a minor effect on your daily life and has lasted, or is likely to last, at least 12 months. You don't need a specific diagnosis, and conditions that come and go can count.

If so, your employer must make reasonable adjustments. These might include:

  • Flexible start and finish times
  • Working from home some or all of the time
  • Regular short breaks to move or stretch
  • A phased return after time off
  • Swapping heavy or repetitive tasks
  • Parking close to the entrance
  • Time off for appointments
  • Changes to duties during a flare

Ergonomic equipment can make a big difference. Examples include an adjustable ergonomic chair, a sit-stand desk, a supportive cushion, a monitor arm, an ergonomic keyboard and mouse, and voice recognition software to cut down on typing.

Access to Work is a government grant that can pay for equipment, support workers and travel to work. For advice on your rights, contact Acas or Citizens Advice.

Benefits

If you can't work because of your pain, you may get Statutory Sick Pay from your employer for up to 28 weeks. You may also be able to get Personal Independence Payment (PIP), or Adult Disability Payment in Scotland, whether or not you work. Depending on your situation, Universal Credit or Employment and Support Allowance may help. Turn2us and Citizens Advice can help you check what you can claim.

How The Beyond Pain Foundation can help

If NHS waits are too long, or the help you need isn't available to you on the NHS, we may be able to fund:

  • A private consultation with a rheumatologist or pain specialist
  • Physiotherapy or a supervised exercise programme to help you build up activity safely
  • A course of acupuncture, as NICE suggests can be considered
  • A pain management programme or course
  • Workplace or home equipment, such as an ergonomic chair, sit-stand desk or supportive seating

We fund treatment and equipment, not everyday living costs such as rent or bills. Treatment must be from a registered or qualified practitioner. Prices vary, so always get a written quote to include with your application.

Apply for funding Check the requirements

Support and sources

Pain Concern

Charity and helpline

Helpline 0300 123 0789. Leave a message and they usually call back the next working day. Free leaflets, a podcast and a self-management tool.

painconcern.org.uk

Flippin' Pain

Pain education

Plain-language videos, podcasts and worksheets on how persistent pain works and what helps.

flippinpain.co.uk

Pain UK

Alliance of pain charities

Brings together more than 50 UK pain charities. Useful for finding a charity or support group for your condition.

painuk.org
Sources for this guide

Last reviewed: October 2026.