Most patients—and many clinicians—expect acute pain to resolve within a matter of weeks. But what happens when it doesn’t? When a patient continues to report pain three months or more after an injury, surgery, or onset of symptoms, it’s time to change the clinical lens. Pain that lingers past the 12-week mark is no longer considered “acute”—it has transitioned into the chronic or persistent pain category and requires a different management approach.
Understanding the Pain Timeline
Pain is typically classified into three main categories:
Acute pain: lasts less than 3 months; often related to tissue damage or inflammation (e.g., sprains, fractures, post-op pain).
Subacute pain: occurs between 4 to 12 weeks and may be a continuation of acute pain.
Chronic or persistent pain: lasts more than 12 weeks and can occur even after the initial injury has healed.
The key issue? Chronic pain is often not a sign of ongoing tissue damage—it’s a dysfunction of the nervous system itself. This is a critical shift in understanding for both patients and providers.
Red Flags vs. Roadblocks
Persistent pain can be mistaken as an indication of something being “missed.” While it’s essential to screen for red flags (e.g., malignancy, infection, fracture, systemic disease), most long-term pain does not signal an urgent pathology. Instead, it reflects a more complex interaction of biological, psychological, and social factors.
Common roadblocks to recovery include:
Maladaptive pain beliefs (e.g., fear of movement, catastrophizing)
Poor sleep and fatigue
Mood disturbances
Lack of return to meaningful activity
Central sensitisation—where the nervous system becomes hypersensitive
These roadblocks are often invisible but deeply impactful.
Shifting the Management Model
For GPs and allied health professionals, the move from acute to chronic pain management requires a paradigm shift:
From “finding the fix” → to “supporting function”
From “what’s broken?” → to “what’s sensitised?”
From “rest and protect” → to “move and engage”
Key Strategies for Managing Persistent Pain
Early Identification
Recognise the risk of pain persistence early—especially in patients with high pain severity, emotional distress, or prior episodes of chronic pain.
Educate to Reframe: Help patients understand that persistent pain is not necessarily a sign of harm. Use metaphors (e.g., “alarm system stuck on”) to explain central sensitisation in plain language.
Multimodal Approach – Combine:
Pharmacological strategies (e.g., judicious use of analgesics, adjuvants like antidepressants)
Physical reconditioning (graded activity, physio support)
Psychological support (CBT, ACT, mindfulness-based interventions)
Set Realistic Goals
Pain elimination may not be the target. Instead, focus on function, engagement, and quality of life.
Collaborative Care Plans
Develop shared care strategies across disciplines—GP, physio, psych, pain specialist—especially when pain becomes disabling.
The Role of Pain Focussed Clinics
Pain clinics can support more complex cases with access to:
Pain specialists
Multidisciplinary teams
Interventional options (e.g., nerve blocks)
Group education and pain neuroscience programs
Early referral can prevent long-term disability and opioid dependence.
What to Tell Your Patients
Patients often feel disheartened by lingering pain. Key messages to communicate:
“We’re shifting gears from healing to managing sensitisation.”
“Pain can change—even if the tissue has healed.”
“You’re not broken. We’re building a team around you.”
The 3-month mark is a critical pivot point in pain care. Recognising when pain stops being “acute” and reorienting the care strategy early can significantly improve outcomes. Persistent pain is complex—but it is manageable. With the right mindset, multidisciplinary care, and patient partnership, we can move beyond the acute model toward long-term recovery and resilience.
