Chronic Pain: A GP-Led Approach to Management
Chronic pain — pain lasting more than 3 months — affects around one in five Australian adults. Back pain, osteoarthritis, headaches, and musculoskeletal conditions are the most common causes. Understanding what chronic pain is, and what modern management looks like, helps you have a more productive conversation with your GP.
Acute vs Chronic Pain
- Acute pain — short-term; a warning signal from tissue damage. Resolves with healing.
- Chronic pain — persists beyond expected healing time or occurs without ongoing tissue damage. The nervous system itself becomes more sensitive — pain signals amplify even when there’s no longer an acute injury.
This shift in understanding matters: for chronic pain, treating the “cause” (an MRI finding, for example) often doesn’t resolve the pain. The pain has become the condition.
Common Types of Chronic Pain
- Chronic back pain — most common; often has no identifiable structural cause on imaging
- Osteoarthritis — knees, hips, hands
- Neuropathic pain — nerve-related; e.g., after shingles, diabetes, sciatica
- Migraine and chronic headaches
- Fibromyalgia — widespread musculoskeletal pain with fatigue and sleep disturbance
- Complex regional pain syndrome
- Post-surgical pain
- Pelvic pain — including endometriosis
Modern Evidence-Based Management
Chronic pain is best managed through a combination of approaches — no single treatment works well on its own.
Movement and exercise
Counter-intuitively, appropriate exercise is one of the most effective treatments for most chronic pain. Start low, go slow; graded activity reduces pain sensitivity over time. Your GP can refer to an exercise physiologist or physiotherapist.
Pain education
Understanding how chronic pain works (the neurobiology of pain) reduces it. This isn’t motivational — it’s neuroscience. Resources like Explain Pain and online programs can be more effective than many medications.
Psychology and pain
CBT and ACT (Acceptance and Commitment Therapy) have strong evidence for chronic pain. This isn’t “it’s all in your head” — it’s recognising the role of the nervous system and developing practical coping skills. Accessible through a Mental Health Treatment Plan with your GP.
Sleep, mood, and stress
Pain, poor sleep, low mood, and stress form a vicious cycle. Improving any one helps the others.
Allied health
- Physiotherapy — movement, manual therapy, exercise prescription
- Exercise physiology — individualised exercise programs for pain conditions
- Occupational therapy — activity pacing, workplace modifications
- Psychology — pain-focused CBT/ACT
- Dietitian — anti-inflammatory approaches; weight management
A GP Management Plan and Team Care Arrangement gives you Medicare rebates on up to 5 allied health visits per year. See our chronic disease plan guide.
Medications
Simple analgesics
- Paracetamol — first line; modest effect in chronic pain but safe.
- NSAIDs (ibuprofen, naproxen, celecoxib) — effective for inflammatory pain; risks with long-term use (stomach, kidney, cardiovascular).
Adjuvant medications
- Antidepressants — duloxetine, amitriptyline, nortriptyline. Helpful for neuropathic pain and fibromyalgia even without depression.
- Anticonvulsants — gabapentin, pregabalin. Effective for nerve pain.
- Topical treatments — capsaicin, lidocaine, NSAID gels.
Opioids — modern position
The evidence for long-term opioid use in chronic non-cancer pain has changed dramatically. High doses don’t typically reduce pain more than moderate doses. Long-term use is associated with tolerance (needing more for less effect), dependence, hyperalgesia (pain worsening from the medication itself), and significant side effects.
Current guidance:
- Opioids aren’t first-line for most chronic pain conditions
- When used, start low, time-limited trial, clear goals
- If they’re not helping after a reasonable trial, taper off
- Combining opioids with benzodiazepines or alcohol significantly increases overdose risk
- If you’re on long-term opioids and want to reduce them, your GP can help — tapering slowly is safe and often improves pain
Medical cannabis
Available on prescription in Australia for chronic pain in some circumstances. Evidence for benefit is mixed; your GP (or a specialist) can discuss whether it’s suitable for you.
Procedures
- Joint injections — corticosteroid or hyaluronic acid for arthritic joints
- Nerve blocks — diagnostic and sometimes therapeutic
- Radiofrequency ablation — for specific back pain conditions
- Spinal cord stimulators — for selected severe neuropathic pain
Referred by your GP to pain specialists, interventional radiologists, or orthopaedic surgeons.
Pain Management Clinics
Multidisciplinary pain clinics combine doctors, psychologists, physiotherapists, and occupational therapists in structured programs. The most effective intervention for severe, complex chronic pain. Your GP can refer you — wait times for public clinics vary; private options are faster but have gap fees.
Frequently Asked Questions
Why did my GP stop prescribing my strong painkillers?
National prescribing guidelines have tightened based on evidence of harm from long-term opioid use. Your GP is following safety-focused practice, not being unhelpful. Safer alternatives exist.
Will an MRI find the cause of my pain?
For chronic back pain, MRI findings often don’t correlate with pain — many pain-free people have “abnormal” findings. Imaging is most useful when specific red flags suggest a serious cause.
Does chronic pain mean I have to accept being in pain forever?
No. Many people achieve significant reduction in pain and improvement in function with modern multimodal treatment — even after years of symptoms.
Can I work while managing chronic pain?
Often yes — pacing strategies, workplace modifications, and graduated return to activity can make this possible. Your GP can provide a plan.
Book a Chronic Pain Review
Modern pain management works. If you’ve been living with pain for months and want a fresh approach, book a long appointment with your GP. Find your nearest Family Doctor clinic.