Reading Premier Holistic Chronic Pain Clinic: Conditions: Complex Regional Pain Syndrome, Fibromyalgia, Neuropathic Pain, Phantom Pain, Post Traumatic Pain: Reading & London. and web clinics across the UK by arrangement

Persistent pain is one of the most complex and least well managed health conditions in the UK.

An estimated 28 million adults live with it, and I was one of those.

For many, the journey to finding effective help has been long, frustrating, and expensive. Mostly tests have come back normal and treatments helped partially or not at all, because the pain remains.

I established my specialist practice Modern Pain Resolution in 2012 because my recovery journey from persistent and chronic pain literally changed my life.

Modern Pain Resolution specialises in supporting and treating individuals with persistent pain conditions that sit across five clinically recognised categories as defined by the International Association for the Study of Pain and the WHO ICD-11 framework:

1.  1 Chronic primary pain — including fibromyalgia, complex regional pain syndrome (CRPS), and chronic primary musculoskeletal pain

2.  2 Chronic secondary musculoskeletal pain — pain arising from an identifiable structural or systemic condition

3.  3 Chronic neuropathic pain — including phantom limb pain, chronic nerve compression, and sciatica

4. 4 Chronic post-traumatic pain — including post-surgical pain, failed back surgery syndrome, post-amputation pain, and scar and soft tissue pain

5.  5 Chronic visceral pain — including chronic pelvic pain and the pain component of irritable bowel syndrome

What these conditions share is that pain experience is not determined solely by tissue damage or pathology.

Current neuroscience confirms that the brain and nervous system actively construct the feeling of pain by integrating sensory, cognitive, affective, and contextual inputs in ways that are now well understood at the molecular and systems level, and increasingly recognised in medico-legal contexts.

All treatment provided at Modern Pain Resolution is trauma informed, holistic, integrative and addresses the whole person, whole life, nervous system, and all other systems, thus increasing the likelihood of producing lasting change and well managed pain. (1, 2, 3, 4)

 1 Chronic Primary Pain

Complex Regional Pain Syndrome (CRPS)

Complex Regional Pain Syndrome is a chronic primary pain condition characterised by severe, disproportionate, and persistent pain — typically affecting a limb — following an injury, surgical procedure, or tissue trauma. It manifests through a constellation of sensory, autonomic, motor, and trophic abnormalities that evolve and often worsen over time.

Classified as CRPS Type I, occurring without identifiable nerve injury, and CRPS Type II, associated with a confirmed peripheral nerve lesion, the condition is diagnosed clinically using the Budapest Criteria — the current international diagnostic standard. CRPS involves complex and interacting pathophysiological mechanisms including peripheral and central sensitisation, neurogenic inflammation, sympathetic nervous system dysregulation, maladaptive neuroplasticity, and potential autoimmune processes.

Critically, the pain in CRPS is consistently more severe and longer-lasting than would be predicted by the initiating injury — a defining feature that reflects the central role of nervous system dysregulation rather than ongoing tissue damage. (5, 6, 7)

Effect

CRPS is widely recognised as one of the most painful and functionally disabling chronic pain conditions encountered in clinical practice. Its impact extends far beyond the affected limb — encompassing profound disruption to work, relationships, mobility, sleep, and psychological wellbeing.

The 2025 ASIPP guidelines note that patients experience an average diagnostic delay of nearly four years, during which time the condition frequently progresses and becomes increasingly resistant to standard interventions.

Chronic CRPS — typically defined as symptoms persisting beyond twelve months — is characterised by irreversible neurobiological and structural changes including progressive muscle wasting, joint stiffness, dystonia, and trophic skin alterations. The condition carries a substantial psychological burden, with high rates of anxiety, depression, and post-traumatic stress, which both contribute to and are worsened by the severity of the pain experience.

In medico-legal contexts, CRPS following injury or surgical procedure is one of the most significant and complex persistent pain presentations, requiring specialist assessment and multidisciplinary management. (6, 7, 8)

Management

Effective management of CRPS requires a multidisciplinary approach that addresses the full spectrum of its neurobiological, psychological, and functional dimensions.

Current evidence supports an integrated treatment model combining physical rehabilitation, psychological intervention, and where appropriate pharmacological support — with no single modality sufficient alone.

Graded motor imagery — a structured programme of left/right limb discrimination, motor imagery, and mirror therapy — is one of the most robustly evidenced treatment approaches for CRPS, working directly on the maladaptive cortical reorganisation and altered body schema that characterise the condition.

Pain neuroscience education, trauma-informed somatic psychotherapy, and brain-directed behavioural approaches address the central sensitisation, autonomic dysregulation, and psychological comorbidity that sustain CRPS over time.

Early intervention produces better outcomes — but even in longstanding, complex cases, significant improvement in pain, function, and quality of life is achievable with the right therapeutic approach. (7, 8, 9, 10)

Fibromyalgia / Chronic Widespread Pain

Fibromyalgia is a chronic primary pain syndrome characterised by generalised musculoskeletal pain present in at least four of five body regions, accompanied by significant fatigue, sleep disturbance, cognitive dysfunction, and mood dysregulation.

Diagnosed using the American College of Rheumatology 2016 criteria, fibromyalgia affects an estimated 2–4% of the global population and is substantially more prevalent in women than men.

Fibromyalgia sits within the ICD-11 classification of chronic primary pain as a condition of chronic widespread pain — meaning that the pain itself is the disease, not a symptom of an underlying structural or inflammatory pathology. Its pathophysiology involves central sensitisation, dysregulation of the hypothalamic-pituitary-adrenal axis and sympathetic nervous system, neuroinflammation, altered gut microbiota, and mitochondrial dysfunction — a complex, multisystem presentation whose mechanisms are increasingly well characterised by neuroimaging and multi-omics research. (11, 12, 13)

Effect

The impact of fibromyalgia on daily life is pervasive and frequently underestimated — in part because the condition carries no visible pathology and has historically been poorly understood by both the medical profession and the legal system.

Persistent widespread pain, unrefreshing sleep, cognitive difficulties — commonly described as fibro fog — and fatigue combine to substantially impair work capacity, social functioning, relationships, and quality of life.

Psychological comorbidities including anxiety, depression, and catastrophising are common and clinically significant, both as contributors to and consequences of the condition.

The 2025 review in Clinical and Experimental Rheumatology confirms that sexual dysfunction, cognitive impairment, and the impact on family life remain significantly under-recognised dimensions of fibromyalgia’s burden.

In medico-legal contexts, fibromyalgia is an established diagnosis with recognised diagnostic criteria — its legitimacy as a condition in its own right is now unequivocal under ICD-11. (11, 12, 13)

Management

Current evidence is consistent that non-pharmacological strategies are the most effective long-term treatment for fibromyalgia — and that physical activity combined with psychosocial intervention produces the best outcomes.

The Royal College of Physicians fibromyalgia guidelines recommend a personalised, patient-centred approach that integrates physical, psychological, and educational components.

Brain-directed behavioural therapies, pain neuroscience education, somatic approaches addressing nervous system dysregulation, mindfulness, and trauma-informed psychotherapy all have an evidence base in fibromyalgia management — working through the shared mechanism of central sensitisation that connects fibromyalgia to other chronic primary pain conditions.

Pharmacological treatments play a limited and supporting role. The most durable improvements come from approaches that address the nervous system, the psychological landscape, and the person’s relationship with their pain — not those directed at the site of pain alone. (11, 13, 14)

Chronic Primary Musculoskeletal Pain

Chronic primary musculoskeletal pain is defined under ICD-11 as chronic pain arising in muscles, bones, joints, or tendons that persists or recurs for more than three months, is associated with significant emotional distress or functional disability, and cannot be attributed to an identifiable disease or damage process.

It represents a paradigm shift in the understanding and classification of musculoskeletal pain — moving away from an exclusively anatomical, tissue-focused model towards recognition that pain in the muscles and joints can be a condition in its own right, driven by nociplastic mechanisms and central nervous system sensitisation rather than structural pathology.

Many patients previously diagnosed with myofascial pain syndrome or non-specific regional pain conditions are now more accurately classified within this category, which has significant implications for treatment direction. (15, 16, 17)

Effect

Chronic primary musculoskeletal pain is one of the most prevalent chronic pain presentations in both clinical and medico-legal practice — and one of the most consistently mismanaged, because its absence of structural pathology has historically led to underdiagnosis, delayed treatment, and inadequate recognition of functional impairment.

The condition produces significant disruption to occupational capacity, physical function, and psychological wellbeing.

Because the pain is not explained by identifiable tissue damage, patients frequently encounter scepticism from healthcare providers and insurers — compounding the psychological burden and reinforcing the central sensitisation that maintains the condition.

The ICD-11 classification explicitly recognises chronic primary musculoskeletal pain as a disease in its own right, providing a robust diagnostic framework for clinical and medico-legal assessment of these presentations. (15, 16, 17)

Management

Management of chronic primary musculoskeletal pain requires a fundamental reorientation away from anatomically directed treatments — injections, surgery, and passive physical therapies targeted at the presumed site of pathology — towards centrally directed strategies that address the nociplastic mechanisms driving the pain.

Pain neuroscience education is a cornerstone of this approach, shifting the patient’s understanding of their pain from a structural model to a nervous system model in ways that demonstrably reduce pain intensity, fear-avoidance, and disability.

Graded motor imagery, somatic psychotherapy, brain-gut behaviour therapy approaches, and trauma-informed interventions that address the psychosocial and neurobiological contributors to central sensitisation are all relevant treatment components.

The paradigm shift in classification demands a parallel paradigm shift in treatment — and the evidence increasingly supports it. (15, 16, 17)

Chronic Secondary Musculoskeletal Pain

Chronic secondary musculoskeletal pain is defined under ICD-11 as persistent or recurrent pain arising as part of a disease process directly affecting bones, joints, muscles, or related soft tissue — persisting for more than three months and producing significant functional impairment or emotional distress. Unlike chronic primary musculoskeletal pain, where no identifiable disease process is present, secondary musculoskeletal pain has an identifiable underlying cause — most commonly persistent local or systemic inflammation from autoimmune or autoinflammatory conditions such as rheumatoid arthritis or ankylosing spondylitis; structural changes affecting joints, tendons, or bones such as symptomatic osteoarthritis; or musculoskeletal complications of neurological conditions such as Parkinson’s disease. Critically, the presence of an identifiable underlying condition does not mean that the pain experience is fully explained by that condition — central sensitisation and psychosocial factors substantially modulate pain severity and functional impairment independently of disease activity, a finding with significant implications for both treatment and medico-legal assessment. (16, 17, 38)

Effect

Chronic secondary musculoskeletal pain produces substantial and frequently progressive disability. The combination of an identifiable disease process, persistent pain, and the central sensitisation that frequently develops over time creates a compounding burden — affecting mobility, sleep, occupational function, relationships, and psychological wellbeing. In conditions such as rheumatoid arthritis, pain frequently persists even when inflammatory markers are controlled and disease activity is suppressed — reflecting the independent contribution of central sensitisation and psychological factors to the pain experience. This dissociation between disease activity and pain severity is well-documented in the IASP literature and has direct implications for management: disease-modifying treatment alone is insufficient where central sensitisation, fear-avoidance, depression, or catastrophising are maintaining the pain experience. In medico-legal contexts, the distinction between pain attributable to active disease and pain maintained by central sensitisation is clinically significant and requires specialist assessment. (16, 17, 38)

Management

Effective management of chronic secondary musculoskeletal pain requires integration of disease-directed medical treatment with centrally targeted psychological and rehabilitation approaches — addressing the central sensitisation, fear-avoidance, and psychological comorbidity that sustain pain independently of the underlying condition. Pain neuroscience education addressing the distinction between nociception and pain experience, cognitive behavioural approaches targeting catastrophising and activity avoidance, somatic and trauma-informed psychotherapy addressing nervous system dysregulation, and mindfulness-based pain management are all evidenced components of an integrated programme. The ICD-11 framework explicitly recognises the biopsychosocial nature of chronic secondary musculoskeletal pain — and current evidence is consistent that psychological intervention alongside appropriate medical management produces significantly better outcomes than either alone. (16, 17, 38)

Chronic Post-Traumatic Pain

Chronic Post-Surgical Pain

Chronic post-surgical pain is defined under ICD-11 as pain that develops or increases in intensity following a surgical procedure and persists beyond the expected healing period — formally classified as pain present for more than three months after the surgical intervention, localised to the surgical field or projected along the innervation territory of a nerve in that region. It is a significant and frequently underestimated consequence of surgery, affecting an estimated 10–50% of patients undergoing surgical procedures, with higher rates following thoracotomy, amputation, mastectomy, and joint replacement surgery.

In the UK alone, severe post-surgical pain affects an estimated 140,000 patients per year.

The transition from acute to chronic pain involves complex interactions between peripheral sensitisation, central sensitisation, neurogenic inflammation, nerve injury, and psychosocial factors — with pre-existing psychological distress, sleep disturbance, anxiety, and pain catastrophising identified as significant predictors of chronicity.

Surgery does not reliably resolve pain — and in a substantial proportion of patients, it creates a new and persistent pain condition that requires specialist treatment in its own right. (18, 19, 20)

Effect

Chronic post-surgical pain produces a profound and frequently invisible burden.

The person who expected surgery to resolve their pain instead finds themselves in persistent discomfort that is poorly understood by their surgical team, inadequately managed in primary care, and difficult to explain to employers, insurers, and legal representatives.

Functional impairment — affecting mobility, sleep, work capacity, and daily activity — is common and well-documented.

Psychological comorbidities including anxiety, depression, and post-traumatic features are both risk factors for and consequences of chronic post-surgical pain, and the persistent use of opioids prescribed in the post-operative period constitutes an additional and serious clinical concern.

In medico-legal contexts, chronic post-surgical pain is an established ICD-11 diagnosis with recognised causal criteria — its relationship to the index surgical procedure, the presence of central sensitisation, and the extent of functional impairment are all relevant to assessment of causation, prognosis, and quantum. (18, 19, 20)

Management

Management of chronic post-surgical pain requires a biopsychosocial approach that addresses the central sensitisation, psychological contributors, and functional limitations that sustain pain well beyond the surgical event.

Multimodal treatment combining pain neuroscience education, trauma-informed somatic psychotherapy, cognitive behavioural approaches, and nervous system regulation techniques targets the neurobiological and psychological mechanisms that maintain chronicity.

Where opioid dependence has developed in the post-surgical period, integrated psychological support addressing both the pain and the dependence is essential.

The most effective interventions are those that shift the therapeutic target from the surgical site to the nervous system — reflecting the current evidence base and the ICD-11 recognition that chronic post-surgical pain is a condition of the nervous system, not simply an unresolved wound. (18, 19, 20)

Failed Back Surgery Syndrome

Failed back surgery syndrome — now also referred to in the literature as persistent spinal pain syndrome — is defined by the IASP as lumbar spinal pain of unknown origin that either persists despite surgical intervention or develops after surgical intervention for spinal pain in the same topographical location.

It is one of the most challenging and prevalent presentations in chronic pain practice, affecting an estimated 10–40% of patients undergoing spinal surgery and representing a substantial proportion of those referred to specialist pain services.

Its aetiology is complex and multifactorial — encompassing residual or recurrent disc pathology, epidural fibrosis, adjacent segment degeneration, spinal instability, neuropathic pain components, and critically, the central sensitisation and psychosocial factors that frequently predate and survive the surgical intervention.

The condition is not a single diagnosis but a clinical syndrome — one that demands individualised assessment rather than a return to further surgical intervention. (21, 22, 23)

Effect

Failed back surgery syndrome is associated with severe and often refractory pain, profound functional disability, significant psychological comorbidity, and high rates of healthcare utilisation and opioid dependency.

The impact on work capacity is considerable — many patients are unable to return to employment, and the financial, relational, and psychological consequences of this are compounding.

The experience of having undergone surgery with the expectation of relief, only to be left with equal or greater pain, creates a specific psychological landscape characterised by loss of trust in medical systems, grief, anger, and helplessness — all of which are clinically significant and require direct therapeutic attention.

In medico-legal practice, failed back surgery syndrome is a well-recognised diagnostic entity with established IASP criteria, relevant to personal injury, clinical negligence, and disability assessment. (21, 22, 23)

Management

Management of failed back surgery syndrome requires a multidisciplinary approach with realistic goal-setting — improvement in function and quality of life rather than complete elimination of pain.

Pain neuroscience education addressing the central sensitisation mechanisms that sustain FBSS, cognitive behavioural approaches targeting fear-avoidance and catastrophising, somatic and trauma-informed psychotherapy addressing the nervous system dysregulation and psychological sequelae of failed surgical intervention, and mindfulness-based pain management are all evidenced components of an integrated treatment programme.

Further surgical intervention is rarely indicated and frequently counterproductive.

The evidence increasingly supports psychologically directed, centrally targeted treatment as the most effective approach for this complex and often long-suffering patient group. (21, 22, 23)

Post-Amputation Pain and Phantom Limb Pain

Post-amputation pain encompasses two distinct but frequently co-occurring pain presentations: residual limb pain, localised to the stump, and phantom limb pain — a neuropathic pain experience arising from the cortical representation of the amputated limb that is no longer present.

Phantom limb pain affects an estimated 64–80% of individuals following amputation, with the majority experiencing onset within the first 24 hours.

It is characterised by a spectrum of subjective sensory experiences — burning, cramping, stabbing, or electric sensations perceived in the absent limb — and reflects the maladaptive neuroplastic reorganisation of the somatosensory and motor cortex that follows limb loss.

The mechanisms are now well understood at the neuroscience level — involving cortical remapping, altered body schema, and central sensitisation — and this understanding directly informs the most effective treatment approaches. (24, 25, 26)

Effect

Phantom limb pain and post-amputation pain produce significant and sustained disruption to rehabilitation, prosthetic use, functional recovery, sleep, and psychological wellbeing.

The persistent experience of pain in a limb that no longer exists is profoundly disorienting — and for many amputees, inadequately addressed by standard post-operative pain management, which is primarily pharmacologically directed and fails to target the cortical mechanisms driving the experience.

High rates of anxiety, depression, and post-traumatic stress are associated with both the circumstances of amputation and the ongoing pain experience, compounding functional disability and reducing quality of life.

In medico-legal contexts involving traumatic amputation, industrial injury, or military injury, phantom limb pain and post-amputation pain are recognised clinical sequelae requiring specialist assessment of both their neurobiological and psychological dimensions. (24, 25, 26)

Management

Graded motor imagery is the most robustly evidenced treatment approach for phantom limb pain, working directly on the cortical reorganisation and altered body schema that underpin the pain experience.

The three-phase GMI protocol — left/right limb laterality recognition, explicit motor imagery, and mirror therapy — sequentially activates cortical motor networks in ways that progressively reduce the maladaptive remapping driving the pain.

A 2025 randomised clinical trial of a home-based GMI protocol demonstrated significant reductions in phantom limb pain with effects sustained at twelve weeks post-intervention.

Trauma-informed somatic psychotherapy, pain neuroscience education, and psychological approaches addressing the grief, adjustment, and post-traumatic features associated with limb loss are integral components of a comprehensive management programme — recognising that phantom limb pain is simultaneously a neuroscience phenomenon and a profoundly human experience. (24, 25, 26)

Post-Trauma Persistent Pain and Scar and Soft Tissue Pain

Post-traumatic persistent pain encompasses chronic pain developing or increasing in intensity following tissue injury — including accidents, burns, crush injuries, and soft tissue trauma — and persisting beyond the expected healing period of three months.

Scar and soft tissue pain, which may arise from post-surgical scarring, burn injuries, or traumatic wounds, involves a complex interplay of peripheral sensitisation at the scar site, neurogenic inflammation, and central sensitisation that maintains pain independently of ongoing tissue damage.

Both presentations are formally classified under chronic post-surgical and post-traumatic pain in ICD-11. The development of persistent pain following trauma is not inevitable — it is significantly predicted by psychosocial factors including pre-existing anxiety, depression, adverse childhood experiences, and the psychological impact of the traumatic event itself — making trauma-informed assessment and treatment essential from the outset. (18, 27, 28)

Effect

Post-traumatic persistent pain and scar pain carry a substantial burden that extends well beyond the physical.

The circumstances of the original trauma — accident, assault, workplace injury, medical procedure — frequently involve psychological trauma that is inseparable from the physical pain experience, and that the nervous system encodes in ways that sustain and amplify the pain long after the tissue has healed.

Hyperalgesia and allodynia at and around the scar site, referred pain, and the psychological impact of visible scarring combine to affect body image, self-confidence, relationships, and occupational function.

In medico-legal practice, post-traumatic persistent pain and scar pain following accident or injury are among the most frequently assessed presentations — and the ICD-11 classification provides a robust diagnostic framework for establishing causation, chronicity, and the nature and extent of functional impairment. (18, 27, 28)

Management

Effective management of post-traumatic persistent pain and scar pain requires direct engagement with both the peripheral sensitisation at the injury site and the central sensitisation and psychological trauma that sustain the broader pain experience.

Trauma-informed somatic psychotherapy is particularly relevant here — addressing the nervous system encoding of the traumatic event, the body’s held response to threat and injury, and the psychological sequelae that maintain central sensitisation.

Pain neuroscience education, desensitisation approaches to hyperalgesia and allodynia, mindfulness-based pain management, and cognitive behavioural techniques targeting catastrophising and fear-avoidance are all evidenced components of an integrated treatment programme.

The aim is not only reduction of pain but restoration of a settled, functional relationship with the body and its history. (18, 27, 28)

Chronic Neuropathic Pain

Chronic Nerve Compression

Chronic nerve compression — encompassing conditions such as carpal tunnel syndrome, thoracic outlet syndrome, cubital tunnel syndrome, and chronic spinal nerve compression — is classified under chronic neuropathic pain in ICD-11, arising from sustained mechanical pressure on peripheral nerves that produces neuroinflammation, altered nerve conduction, and central sensitisation. The IASP defines neuropathic pain as pain arising as a direct consequence of a lesion or disease affecting the somatosensory system. Chronic nerve compression produces characteristic features including sharp, shooting, or burning pain, tingling, numbness, and dysaesthesia in the distribution of the affected nerve. Critically, the presence of structural nerve compression does not reliably predict pain severity or chronicity — central sensitisation and psychosocial factors significantly modulate the pain experience independently of the degree of compression, and surgical decompression does not reliably resolve pain in all patients. (29, 30, 31)

Effect

Chronic nerve compression produces significant functional impairment — affecting grip strength, upper limb function, sleep, occupational capacity, and quality of life. The characteristic sensory symptoms, particularly in the hands and arms, are frequently disabling in occupations requiring manual dexterity. Where surgical decompression has been undertaken without full resolution of symptoms, the resulting persistent neuropathic pain represents a significant clinical and medico-legal challenge — requiring specialist assessment of the central sensitisation and psychosocial factors maintaining the pain beyond the structural lesion. (29, 30, 31)

Management

Management of chronic nerve compression pain addresses both the peripheral sensitisation at the compression site and the central mechanisms that sustain pain independently of structure. Pain neuroscience education, cognitive behavioural approaches targeting fear-avoidance, somatic and trauma-informed psychotherapy, and graded motor imagery are all relevant treatment components — particularly where surgery has failed to resolve symptoms or where central sensitisation is a dominant feature. (29, 30, 31)

Sciatica / Chronic Radiculopathy

Sciatica — formally classified as painful radiculopathy — is a form of chronic neuropathic pain arising from compression, inflammation, or injury to a spinal nerve root, most commonly in the lumbar spine. It is characterised by pain radiating along the distribution of the affected nerve — typically from the lower back through the buttock and into the leg — accompanied by numbness, tingling, and weakness. Classified under chronic neuropathic pain in ICD-11, sciatica involves both peripheral sensitisation at the nerve root and, in chronic presentations, central sensitisation that sustains pain independently of the original structural compression. Importantly, the degree of disc herniation or foraminal stenosis on imaging does not reliably correlate with pain severity — a well-established finding in the neuroscience literature that has significant implications for both treatment direction and medico-legal assessment. (3, 29, 30)

Effect

Chronic sciatica produces significant and frequently underestimated disability — affecting mobility, sleep, occupational function, and psychological wellbeing. The characteristic radiating pain, particularly when severe or bilateral, can be completely disabling. High rates of anxiety, depression, and pain catastrophising are associated with chronic sciatica and are both risk factors for chronicity and barriers to recovery. In medico-legal practice, chronic radiculopathy following workplace injury, road traffic accident, or failed spinal surgery is one of the most frequently assessed persistent pain presentations — requiring careful differentiation between structural and central sensitisation contributions to the clinical picture. (3, 29, 30)

Management

Management of chronic sciatica requires a shift away from exclusively structurally directed interventions — repeated imaging, injections, and surgery — towards centrally directed treatment addressing the nervous system mechanisms sustaining the pain. Pain neuroscience education is particularly powerful in sciatica, where the gap between imaging findings and pain experience is often wide and deeply confusing to patients. Cognitive behavioural approaches, graded activity, somatic psychotherapy, and mindfulness-based pain management have an established evidence base — and are recommended alongside appropriate medical management in current NICE guidance. (3, 29, 30)

Phantom Limb Pain — already written in the post-traumatic section above and can be cross-referenced here as it sits across both neuropathic and post-traumatic categories.

Chronic Visceral Pain

Chronic Pelvic Pain

Chronic pelvic pain is defined by the International Continence Society as persistent, recurrent, or continuous pain in the pelvic or abdominal region lasting six months or more, associated with gynaecological, urological, gastrointestinal, or musculoskeletal symptoms, and significantly affecting quality of life and functional capacity. Under ICD-11 it is classified as chronic primary visceral pain where no identifiable structural or inflammatory cause is found — reflecting the central role of visceral hypersensitivity and central sensitisation in its pathophysiology. Chronic pelvic pain is characterised by its diffuse, poorly localised quality, its tendency to refer to distant sites through viscerosomatic convergence, and the cross-sensitisation between adjacent pelvic organs — whereby pain in one structure sensitises neighbouring organs through shared neural pathways. Peripheral sensitisation, spinal cord central sensitisation, and dysregulation of descending inhibitory pathways from the brain all contribute to the maintenance of pelvic pain independently of ongoing tissue pathology. Early life experience, psychological stress, trauma, and adverse childhood experiences are robustly evidenced contributors to the development and chronicity of visceral pain — through epigenetic modulation of gene expression and stress-induced remodelling of central pain circuits. (32, 33, 34, 35)

Effect

Chronic pelvic pain produces pervasive and frequently invisible disability. Its impact on sexual function, intimate relationships, reproductive health, occupational capacity, sleep, and psychological wellbeing is profound — and is compounded by the diagnostic delays, repeated investigations, and clinical scepticism that characterise many patients’ journeys prior to specialist referral. The condition disproportionately affects women, and the intersection of gender, stigma, and the absence of visible pathology means that chronic pelvic pain is among the most under-diagnosed and under-treated persistent pain presentations in the UK. High rates of anxiety, depression, post-traumatic stress, and a history of sexual or physical abuse are well-documented in this population — both as aetiological factors and as consequences of living with unmanaged, poorly understood pain. The European Association of Urology 2025 guidelines explicitly address the psychological dimensions of chronic pelvic pain as a core component of assessment and management. (32, 33, 35)

Management

Current evidence and the EAU 2025 chronic pelvic pain guidelines are consistent that management directed exclusively at the pelvic organs — repeated laparoscopy, hysterectomy, and interventional procedures — is insufficient and frequently counterproductive where central sensitisation is the dominant mechanism. Treatment must address the neurological, psychological, and psychosocial dimensions of the pain alongside any identifiable peripheral pathology. Trauma-informed somatic psychotherapy is particularly relevant in chronic pelvic pain, given the high prevalence of trauma history and the intimate relationship between pelvic pain, embodied experience, and the nervous system’s encoding of threat and safety. Pain neuroscience education, mindfulness-based pain management, cognitive behavioural approaches, and pelvic floor physiotherapy integrated with psychological support form the evidence base for effective management — with the aim of reducing central sensitisation, improving function, and restoring a settled relationship with the body. (32, 33, 35)

Irritable Bowel Syndrome — Pain Component

The pain component of irritable bowel syndrome represents one of the most prevalent and well-studied forms of chronic visceral pain, affecting an estimated 4–5% of the global population. Recurrent abdominal pain associated with altered bowel habit — the defining feature of IBS under the Rome V diagnostic criteria — is now well understood to arise from visceral hypersensitivity, central sensitisation, gut–brain axis dysregulation, altered gut microbiota, and psychosocial factors that mutually amplify one another. IBS pain is characterised by allodynia — pain in response to stimuli that would not normally be painful — and hyperalgesia — an amplified pain response to normally painful stimuli — both reflecting altered central pain processing rather than structural gut pathology. The molecular mechanisms involve TRPV1 receptor sensitisation, altered cytokine signalling, intestinal hyperpermeability, and epigenetic modulation of pain-relevant gene expression. Cross-sensitisation between the gut and other pelvic structures means that IBS frequently co-occurs with chronic pelvic pain, bladder pain syndrome, and fibromyalgia — reflecting shared central sensitisation mechanisms across visceral and somatic pain systems. (32, 36, 37)

Effect

The pain component of IBS produces significant and often under-recognised functional impairment. Persistent abdominal pain, unpredictable in onset and frequently severe, generates anticipatory anxiety that itself amplifies gut sensitivity through the brain–gut axis — creating a self-reinforcing cycle of pain, fear, and central sensitisation. The impact on daily life is pervasive — affecting food choices, social participation, occupational function, relationships, and psychological wellbeing. Rome V global epidemiological data from more than 54,000 participants confirms that individuals with gut–brain interaction disorders and concurrent psychological distress have 4.45 times higher odds of developing the condition than those without — and substantially worse quality of life, greater healthcare utilisation, and greater functional impairment. (36, 37, 39)

Management

Management of IBS pain is most effective when it addresses the full biopsychosocial picture — gut sensitisation, nervous system dysregulation, psychological history, and life context — rather than gastrointestinal symptoms in isolation. Gut-directed hypnotherapy has one of the strongest evidence bases of any psychological treatment for IBS, with sustained improvement in pain, bowel symptoms, and quality of life demonstrated across multiple trials. Cognitive behavioural therapy, mindfulness, and trauma-informed somatic psychotherapy address the central sensitisation and nervous system dysregulation that maintain visceral pain — and are recommended by both NICE and the Rome Foundation as core treatment options. For a full account of the gut–brain axis treatment approach to IBS and DGBI, see the Mind Gut Connection Clinic page. (36, 37, 39)