The old-fashioned treatment for persistent pain, also known as chronic pain, was bed rest for weeks or months on end. We now know this is the worst possible approach. Exercise and continuing to work are key to recovery.

Forget resting if you have a painful condition like back pain.

Lying in bed for long periods may actually make the pain last longer because inactivity makes you stiffen up, your muscles and bones get weaker, you don't sleep well, you become lonely and depressed, and the pain feels worse.

You'll also find that it becomes harder and harder to get going again.

A better approach to reducing pain is a combination of:

• exercise
• staying at work
• physical therapy
• painkillers

Exercise

Choose an exercise that won't put too much strain on yourself.

Good options include:

• walking
• swimming
• using an exercise bike
• dancing, yoga or pilates
• most daily activities and hobbies

Activity and stretching needs to become part of your lifestyle so you routinely do exercise a little and often.

Try to be active every day instead of only on the good days when you're not in so much pain. This may reduce the number of bad days you have and help you feel more in control.

But try to avoid overdoing it on good days and paying for this by having more bad days.

Try these flexibility exercises and sitting exercises you can do at home.

Read the beginner's guide to swimming and beginner's guide to dancing.

Go to work despite the pain

It's important to try to stay in work even though you're in pain. Research shows that people become less active and more depressed when they don't work.

Being at work will distract you from the pain, and in most cases, won't make your pain worse.

Talk to your supervisor or boss about the parts of your job that may be difficult to begin with, but stress that you want to be at work.

If you have to stay off work for a while, try to get back as soon as possible.

If you have been off work for 4 to 6 weeks, plan with your doctor, therapist or employer how and when you can return.

You could go back to work gradually. For instance, you might start with 1 day a week and gradually increase the time you spend at work.

You could also agree changes to your job or pattern of work if it helps – a health and safety rep or occupational health department may be useful here.

Physical therapy

Pain experts often recommend a short course of physical therapy. 

This helps you to move better, relieves your pain, and makes daily tasks and activities like walking, going up stairs or getting in and out of bed easier.

Physical therapy for persistent pain can involve manipulation, stretching exercises and pain-relief exercises.

Physical therapy is usually delivered by a physiotherapist, chiropractor or osteopath, or in some cases, an occupational therapist.

Physiotherapists can give you advice on the right type of exercise and activity. Occupational therapists can support you with environmental changes that can help you remain in work and function better at home.

If you have physical therapy, you should begin to feel the benefits after a few sessions.

Your GP may be able to refer you for physical therapy on the NHS, although physical therapy is only available privately in some areas. 

In others, there's direct access to NHS physiotherapy without the need for a GP referral.

Find physiotherapy services in your area.

Your GP can also refer you for exercise referral classes, and some centres have specific classes for lower back pain.

Painkillers for long-term pain

It's safe to use over-the-counter painkillers to reduce your pain so you can be more active.

But it's important to use painkillers carefully, as they have side effects. Paracetamol is the simplest and safest painkiller.

You could also try anti-inflammatory tablets like ibuprofen as long as you don't have a condition (such as a stomach ulcer) that prevents you using them.

It's important to take painkillers at the recommended dose and to take them regularly every 4 to 6 hours, preferably to overcome a flare-up of your pain or help get you through an impending activity.

Don't wait until your pain is severe before you start taking painkillers, as they won't work as well.

If a 2-week course of over-the-counter painkillers does not work, ask for help from your GP or pharmacist.

Read more about choosing a painkiller.

Online help for pain

There's a lot of online information if you're living with pain.

General pain websites

• Action on Pain
• Pain Concern

Self-help tips

The Pain Toolkit is a collection of helpful tips and strategies for persistent pain, put together by someone with long-term pain:

• The Pain Toolkit

Meditation for pain

This 20-minute guided meditation course from Meditainment is free, easy to follow and proven to help people cope with chronic pain. 

It's part of the Pathway through Pain online course, which is provided by the NHS in some areas for people with persistent pain.

Ask your GP or pain specialist how to access the course.