Chronic Pain Syndrome (Adjunct)
Also known as: Chronic pain syndrome, Chronic primary pain, Chronic secondary pain, Persistent pain, Chronic non-cancer pain, Nociplastic pain, Central sensitisation, Mixed-mechanism chronic pain
Chronic pain is pain that persists or recurs for longer than three months. It may be chronic primary pain, where pain itself is the principal clinical problem, or chronic secondary pain associated with an identifiable underlying condition, and nociceptive, neuropathic and nociplastic mechanisms often coexist. Chronic pain syndrome commonly involves functional impairment, sleep disturbance, fatigue, emotional distress, reduced social participation and altered pain processing. Assessment should identify pain mechanisms, contributing medical conditions, red flags, medicine risks, psychological and social factors, functional goals and the person's understanding of their condition. Management is multidisciplinary and may include education, supported physical activity, psychological therapies, condition-specific treatment, sleep management, medicines where indicated and coordinated rehabilitation. In Chinese medicine, chronic pain overlaps with Bì Zhèng (痹证), Tòng Zhèng (痛证), Yāo Tòng (腰痛), Xié Tòng (胁痛), Tóu Tòng (头痛) and Wèi Wǎn Tòng (胃脘痛), with mechanisms including Qi stagnation, Blood stasis, Cold-Damp obstruction, Damp-Heat obstruction, Phlegm with Blood stasis, Qi and Blood deficiency, and Liver and Kidney deficiency. Pattern differentiation must be integrated with the diagnosed pain mechanism, affected tissues, neurological findings, medicine use and psychosocial context. Acupuncture is adjunctive only and must not replace investigation of new pathology, disease-modifying treatment, rehabilitation, psychological support or medically supervised medicine management.
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Lifestyle & Diet
- •Keep moving with graded, paced activity rather than boom-and-bust cycles; small consistent doses beat occasional big efforts.
- •Set specific functional goals (walking distance, sitting tolerance, return to work tasks) instead of chasing a pain score of zero.
- •Protect sleep with a consistent schedule, a wind-down routine and treatment of sleep apnoea or insomnia where present.
- •Use pain education and self-management strategies to understand pain as a nervous-system output, not only tissue damage.
- •Consider psychological support such as CBT or acceptance and commitment therapy where distress, avoidance or catastrophising is prominent.
- •Keep a current medicines list and review analgesic use, side effects and effectiveness with the prescriber.
- •Maintain social connection, meaningful activity and work participation where possible.
- •Manage weight, smoking, alcohol and metabolic health, all of which affect pain and recovery.
- •Use warmth for Cold-Damp type pain and gentle movement for stiffness, checking skin and sensation before applying heat.
- •Track flare-ups and triggers to build a written flare-up plan with the treating team.
- •Attend regular medical review, and report any new or changed pain rather than assuming it is the same problem.
Cautions & Contraindications
- •Do not treat pain of unknown or newly changed cause — exclude fracture, infection, malignancy, inflammatory disease and neurological compromise first.[,]
- •Never advise unsupervised cessation, reduction or dose change of analgesics, opioids, anticonvulsants, antidepressants or disease-modifying medicines; medicine changes belong with the prescribing clinician.[,]
- •Use conservative depth and angle over the thorax, supraclavicular fossa and upper back to avoid pneumothorax, and avoid deep needling over vital structures.[]
- •Avoid strong needling, cupping and gua sha in patients with bleeding disorders, thrombocytopenia or unstable anticoagulation, and in fragile, atrophic or steroid-thinned skin.[]
- •Do not needle through infected, inflamed, ulcerated or irradiated skin, or into lymphoedematous limbs after axillary or inguinal node clearance.[]
- •Avoid moxibustion, heat lamps and strong heat where sensation is impaired (neuropathy, diabetes, spinal cord injury) or where circulation is compromised — burn risk.[]
- •Use caution with electroacupuncture in patients with cardiac implantable electronic devices, and avoid current across the chest or through the device field.[]
- •In pregnancy, avoid points traditionally contraindicated and coordinate care with the maternity team.[]
- •Reduce needle number, retention time and stimulation intensity in central sensitisation, fibromyalgia-type presentations and frail patients, because over-treatment commonly provokes flare-ups.[,]
- •Exclude restricted herbs including Ephedra (Má Huáng) and Aconite (Fù Zǐ, Chuān Wū, Cǎo Wū) from any herbal reference used in Australia.[]
- •Do not offer acupuncture as a substitute for psychological therapy, rehabilitation or pain-service referral where these are indicated.[,]
When to reassess or seek care again
- •Initial visit: confirm the medical diagnosis, pain mechanism (nociceptive, neuropathic, nociplastic or mixed) and any outstanding investigations.
- •Initial visit: screen all red flags, record baseline pain scores, sleep, mood, function and participation, and document medicines including opioids and sedatives.
- •Initial visit: agree specific functional goals and a treatment trial length rather than open-ended symptomatic care.
- •Every visit: re-screen for new or changed pain, neurological change and medicine-related harm before treating.
- •Every visit: record response, post-treatment flare-ups and tolerance, and adjust needle number, retention and stimulation accordingly.
- •After 4 to 6 sessions: review measurable change in function, sleep and pain interference; if there is no meaningful change, revise the plan rather than repeating it.
- •Ongoing: coordinate with the GP, pain service, physiotherapist and psychologist, and refer where distress, dependence or declining function emerge.
- •Ongoing: review at least every 3 months for goal progress, medicine changes, comorbidity and the continuing appropriateness of maintenance treatment.
- •Brief Pain Inventory (BPI) — pain severity and interference
- •PEG Pain Screening Tool — three-item pain, enjoyment and general activity screen
- •Pain Disability Index (PDI) — disability across seven life domains
- •Patient-Specific Functional Scale (PSFS) — patient-nominated functional goals
- •Oswestry Disability Index (ODI) — where low back pain predominates
- •Neck Disability Index (NDI) — where neck pain predominates
- •Pain Catastrophizing Scale (PCS) — rumination, magnification and helplessness
- •PROMIS Pain Interference — standardised interference scoring
- •A validated sleep and mood measure, since both track with pain outcomes
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Sources & Further Reading
Clinical guidance, red flags and safety notes on this page draw on the following current sources alongside the classical references above.
- National Institute for Health and Care Excellence
- National Institute for Health and Care Excellence
- Healthdirect Australia
- International Association for the Study of Pain
- Australian Government Department of Health and Aged Care
- Australian Health Practitioner Regulation Agency and Chinese Medicine Board of Australia
- Therapeutic Goods Administration
- Therapeutic Guidelines (Australia)
- Centers for Disease Control and Prevention
- Australian Health Practitioner Regulation Agency
- International Association for the Study of Pain
Educational reference for licensed practitioners. Not a substitute for individual clinical assessment. Refer to conventional care for any red-flag or undiagnosed presentation.