When pain persists, the plan should gradually rebuild capacity.

Pain that persists or recurs for more than 3 months, causes significant distress or functional limitation, and is not better explained solely by another condition. It is real and may coexist with other diagnoses.

• Persistent pain or episodic flare-ups
• Restriction in daily activity, work or sport
• Sleep, energy, mood or concentration may be affected

Long-term pain in muscles, bones or joints where functional impact is not fully explained by structural findings. Assessment includes load, sensitivity, sleep and wider health context.

• Pain in one or several body regions
• Increased sensitivity and reduced load tolerance
• Symptom fluctuation without a clear new injury

A chronic widespread pain syndrome often accompanied by fatigue, unrefreshing sleep and cognitive difficulty. Diagnosis is clinical and requires consideration of other important explanations.

• Widespread pain and increased sensitivity
• Fatigue and unrefreshing sleep
• Stiffness, “fibro-fog”, headache or other fluctuating symptoms

Features suggesting altered pain processing when tissue or nerve damage does not fully explain the presentation. This describes a clinical mechanism, not a label based on pain intensity alone.

• Widespread pain or pain that changes location
• Sensitivity to touch, pressure or multiple stimuli
• Symptoms influenced by sleep, fatigue, stress and load

Low-back pain lasting more than 3 months without a single specific cause that explains the complete presentation. Physical, health and psychosocial factors may all influence function.

• Low-back pain and stiffness
• Difficulty with sitting, bending, lifting or walking
• Symptoms fluctuating with activity, sleep or periods of stress

Long-term neck pain without one lesion that necessarily explains the symptoms. Posture, work, activity and individual sensitivity are assessed together.

• Neck and shoulder pain or stiffness
• Restriction or lack of confidence when turning the head
• Headache or fatigue during prolonged work

Neuropathic pain caused by irritation or injury of a nerve root that may continue after the original cause has been treated. Neurological examination distinguishes it from referred pain.

• Burning, electric or shooting pain into an arm or leg
• Numbness, tingling or altered sensation
• Weakness, reflex change or functional restriction

Back or neck pain, with or without limb symptoms, that persists or recurs after spinal surgery. Causes may be multiple and require medical coordination.

• Persistent or recurrent pain after surgery
• Nerve symptoms in an arm or leg
• Reduced tolerance for walking, sitting, work or loading

Disorders of the jaw joint and chewing muscles that may produce persistent pain in the jaw, face or temple region.

• Pain in the jaw, cheek, ear region or temples
• Clicking, locking or restricted mouth opening
• Pain with chewing and tension in chewing muscles

A joint condition involving cartilage, bone and surrounding tissues. Imaging findings and pain severity do not always correspond.

• Load- and activity-related pain
• Usually brief stiffness after rest
• Restricted movement, weakness and functional difficulty

Long-term pain that may involve the rotator cuff, glenohumeral joint, nervous system or combined factors. Imaging alone does not identify the symptom source.

• Pain when lifting or using the arm
• Night pain or pain when lying on the shoulder
• Weakness and restriction in work, dressing or sport

A tendon capacity and load-related condition that may persist for months, affecting the Achilles, patellar, gluteal, rotator-cuff or other tendons.

• Localised pain during tendon loading
• Stiffness after rest or at the start of activity
• Reduced strength and tolerance for repeated activity

Long-term pain that may arise from the hip joint, gluteal tendons, abdominal wall, pelvis or referred sources. Location alone is not a diagnosis.

• Groin, lateral-hip, buttock or pelvic pain
• Difficulty walking, using stairs, sitting or side-lying
• Restricted movement and reduced load tolerance

Pain continuing after an injury, a period of overload or without one clear cause. Meniscal, patellofemoral, osteoarthritic and pain-sensitivity presentations are differentiated clinically.

• Pain with walking, stairs, sit-to-stand or running
• Swelling or stiffness that may fluctuate
• Weakness and reduced confidence in the affected knee

Regional pain associated with muscles and surrounding tissues, often with tenderness and reduced tolerance. Tender points alone should not be treated as proof of cause.

• Local or referred pain from a muscular region
• Pressure sensitivity and stiffness
• Pain with prolonged use or repeated loading

Pain caused by a lesion or disease of the peripheral somatosensory nervous system. Causes may be metabolic, traumatic, infectious, toxic or mechanical.

• Burning, tingling, electric or shooting pain
• Numbness or reduced sensation
• Pain from light touch and sometimes weakness

Persistent compression or irritation of a peripheral nerve, such as carpal, cubital or tarsal tunnel syndrome. Symptoms often follow the nerve territory.

• Numbness, tingling or burning in a defined distribution
• Night symptoms or symptoms in particular positions
• Weakness of grip, foot or involved muscles

Neuropathic pain that persists in the affected area after shingles, even once the rash and blisters have healed.

• Burning or shooting pain in a band of skin
• Marked sensitivity to touch or clothing
• Numbness, itching or altered sensation

Persistent regional pain disproportionate to an injury or operation, with sensory, vasomotor, sudomotor and motor changes. Early multidisciplinary recognition and care are important.

• Burning pain and marked sensitivity
• Temperature, colour, sweating or swelling changes
• Stiffness, weakness and restricted limb use

Pain perceived in the amputated part of a limb. It differs from residual-limb pain and may coexist with prosthetic or wound problems.

• Burning, squeezing, cramping or electric pain in the missing limb
• Fluctuating episodes or continuous pain
• Sleep disturbance and difficulty using a prosthesis

Pain that develops or increases after surgery and persists beyond expected healing, after infection, mechanical complications and other causes have been considered.

• Pain near the operated area or in a nerve distribution
• Scar sensitivity, numbness or burning
• Functional restriction persisting beyond the expected recovery phase

Pain continuing after a fracture, dislocation, sprain, accident or soft-tissue injury after the acute phase. It may include nociceptive and neuropathic components.

• Persistent pain in the injured region
• Stiffness, weakness or reduced load tolerance
• Fear of movement or difficulty returning to activity

Pain and restriction may continue after bone union because of stiffness, weakness, sensitivity or complications. Non-union and fixation failure should be excluded when suspected.

• Pain with loading or at end range
• Stiffness and weakness after immobilisation
• Swelling or function that is not progressing as expected

A scar may remain sensitive because of small-nerve irritation, adhesion or heightened sensory response. The wound should be healed and free of infection signs.

• Pain or burning over or around the scar
• Sensitivity to touch, clothing or pressure
• Pulling and restriction with tissue movement

Autoimmune disease such as rheumatoid or psoriatic arthritis may cause chronic pain, joint inflammation and progressive damage. Rheumatology assessment and management are required.

• Swelling, warmth and pain in several joints
• Prolonged morning stiffness
• Fatigue, reduced energy or systemic flares

An inflammatory condition mainly affecting the sacroiliac joints and spine. Inflammatory back pain should not be treated as mechanical pain without medical assessment.

• Back or buttock pain improving with movement
• Prolonged morning stiffness and night pain
• Younger onset, alternating buttock pain or other inflammatory features

A vertebral compression fracture, sometimes after minor or no clear trauma in weakened bone. New pain or postural change requires medical assessment.

• New focal back pain
• Pain with standing, walking or position change
• Loss of height or increasing kyphosis

Bone, disc or joint infection may present as persistent pain and requires urgent medical assessment, laboratory tests and imaging when indicated.

• Severe progressive pain, often also at rest
• Fever, chills or systemic illness
• A hot swollen joint or risk factors for infection

Pain from a primary or metastatic tumour may resemble musculoskeletal pain. Suspicion requires medical assessment and is not managed with physiotherapy alone.

• Progressive, constant or unusual pain for the person
• Unexplained weight loss, fatigue or a history of cancer
• Night pain accompanied by other systemic features

Neurological compression that may cause permanent deficit and requires emergency assessment. Existing chronic pain does not exclude a new acute change.

• New bladder or bowel disturbance
• Saddle numbness or progressive limb weakness
• New gait difficulty, loss of balance or change in hand coordination