Primary vs Secondary Persistent Pain: What’s the Difference and Why It Matters

If you live with persistent pain, chances are you’ve been given labels that felt confusing, dismissive, or even frightening. Terms like primary pain, secondary pain, central sensitisation, or “your scans look normal” can leave people wondering what’s actually going on, or worse, questioning whether their pain is being taken seriously.

This article is here to clear that up. To explain clearly, calmly, and in line with modern pain science: what primary persistent pain and secondary persistent pain actually mean, and why this distinction can be empowering rather than threatening.

What is secondary persistent pain?

Secondary persistent pain refers to pain that persists in association with an identifiable disease process or ongoing tissue condition.

That does not mean that tissue damage or the disease process alone fully explains the pain experience, but it does mean there is a recognised important biological contributor.

Common examples

• Rheumatoid arthritis and inflammatory conditions

• Endometriosis

• Cancer-related pain

• Neuropathic pain linked to nerve injury or disease
  

In secondary persistent pain, effective treatment involves addressing the condition causing the pain. In certain inflammatory conditions for example, DMARDs (disease modifying anti-rheumatic drugs) may be prescribed which actually have an impact on the condition itself, as opposed to just the pain it causes (hence, disease modifying).

What is primary persistent pain?

Primary persistent pain is pain that persists without a clear, ongoing tissue injury or disease process that adequately explains the pain.

That does not mean that tissues are completely irrelevant in these cases, people with persistent pain often move less so they may get weaker for example, but it does mean there is no detectable tissue damage or disease that explains the ongoing pain.

Common examples

• Fibromyalgia

• Chronic widespread pain

• Non-specific low back pain

• Chronic migraine

• Irritable bowel syndrome

Why this distinction matters for recovery

Education and treatment that is helpful for people with primary persistent pain may not be so for primary secondary pain, and visa versa.

Teaching someone with primary persistent pain that "pain doesn't always equal damage" may be helpful in allowing them to understand their tissues are healthy despite the pain they feel in those areas.

Teaching someone with secondary persistent pain that "pain doesn't always equal damage" is likely to be unhelpful and potentially irritating if their pain is mainly caused by their neuropathy (damaged nerves), for example.

Final Points

Both types of pain are real. Both types can be very severe or relatively mild. Both types require holistic, individualised treatment.

If you have persistent pain (longer than three months) and you're unsure which type you have, consult a healthcare professional. Getting a thorough holistic assessment is the first step on the path to effective treatment.