Chronic Pain — NZ Condition Guide | KiwiMeds

What is Chronic Pain?

Chronic pain is pain that persists for more than 3 months, beyond the normal time for healing. It is one of the most common and disabling health conditions — affecting around 1 in 5 New Zealanders. Chronic pain can occur without any identifiable ongoing tissue damage — the pain system itself becomes sensitised. Chronic pain significantly impacts quality of life, mental health, relationships, and work. It is not imaginary — it is a real condition that deserves proper assessment and treatment.

Types and Causes

Chronic pain can be classified as nociceptive (from ongoing tissue damage — e.g. osteoarthritis, cancer pain), neuropathic (from nerve damage — e.g. diabetic neuropathy, post-herpetic neuralgia), or nociplastic (from altered pain processing without tissue or nerve damage — e.g. fibromyalgia, chronic widespread pain). Common causes include musculoskeletal conditions (back pain, arthritis), nerve damage, previous injury, surgery, or illness. In many cases, multiple mechanisms contribute.

Diagnosis

Diagnosing chronic pain involves a thorough history, physical examination, and sometimes investigations to identify any underlying cause or contributing factors. A biopsychosocial assessment — looking at physical, psychological, and social factors — is important, as all three dimensions contribute to the experience of chronic pain. A pain specialist or multidisciplinary pain service may be involved.

Treatment in New Zealand

Chronic pain management is most effective with a multidisciplinary approach. Key components include: education about pain neuroscience (understanding how pain works can itself reduce pain), exercise and physical therapy (graded activity — one of the most evidence-based treatments), psychological therapies (CBT for pain, acceptance and commitment therapy), and medication when appropriate. Pain medications funded by Pharmac include paracetamol, NSAIDs, gabapentin, pregabalin, amitriptyline, and duloxetine. Opioids have limited evidence for chronic non-cancer pain and significant risks — their use should be carefully reviewed.

NZ-Specific Information

Pain New Zealand (pain.org.nz) provides information and advocates for better pain services. Multidisciplinary pain clinics are available through Te Whatu Ora, though wait times can be long. ACC funds rehabilitation for work-related injuries including chronic pain. The NZ Pain Society provides guidelines for healthcare professionals. The Persistent Pain Programme from the Pain Management Service is available in most regions.

Frequently Asked Questions

Will my pain ever go away? For some people, chronic pain can resolve or reduce significantly with the right treatment. For others, the goal is improving function and quality of life despite some pain. Are opioids a good long-term option for chronic pain? Generally not — opioids lose effectiveness over time, and risks (dependence, overdose, hormone disruption) increase. They are reserved for specific conditions under careful monitoring. Does exercise make chronic pain worse? In the short-term, movement may increase pain initially. But graded exercise is one of the best long-term treatments.

Supplements That May Support Management

⚠️ Important: The supplements listed below have varying levels of clinical evidence. They are not a substitute for prescribed medications and should only be considered as adjunctive support under the guidance of a qualified healthcare professional. Always inform your GP or pharmacist before commencing any supplement, as interactions with prescribed medicines are possible.

• Magnesium — Magnesium modulates NMDA receptor activity, a central mechanism in central sensitisation. Supplementation at 300–600 mg/day may reduce pain severity in conditions involving central sensitisation such as fibromyalgia and migraine.
• Vitamin D — Vitamin D deficiency is prevalent in chronic pain conditions and independently associated with increased pain sensitivity. Supplementation in confirmed deficiency has demonstrated reductions in pain scores across multiple pain conditions.
• Palmitoylethanolamide (PEA) — PEA is an endogenous lipid mediator with anti-inflammatory and analgesic properties via mast cell regulation. Multiple clinical trials support its use for neuropathic and inflammatory pain at 600–1200 mg/day, with a good safety profile.
• Alpha-Lipoic Acid (ALA) — ALA has neuroprotective and antioxidant properties with evidence supporting benefit in neuropathic pain, particularly diabetic neuropathy, at 600 mg/day.
• Omega-3 Fatty Acids — Omega-3 supplementation at ≥2 g/day reduces inflammatory mediators that sensitise pain pathways, with meta-analyses supporting reductions in joint, neck/back, and neuropathic pain.

Relevant Vaccinations

Individuals living with chronic pain may benefit from the following vaccinations. Please discuss your vaccination status with your GP or practice nurse, as eligibility and funding through the New Zealand National Immunisation Schedule may apply.

• Influenza (annual) — Viral illness exacerbates pain sensitisation and fatigue in chronic pain conditions. Annual vaccination reduces acute illness burden.
• Shingles (Shingrix) — Herpes zoster causes severe acute pain and post-herpetic neuralgia — a particularly intractable neuropathic pain condition. Shingrix significantly reduces both zoster incidence and post-herpetic neuralgia. Recommended for adults over 50.
• COVID-19 — Post-COVID pain syndromes including widespread musculoskeletal pain are well-documented. Maintaining vaccination reduces this risk.

Dietary Guidance

Evidence-based dietary modifications play a meaningful role in the management of chronic pain. The following foods are generally recommended as part of a balanced, condition-appropriate diet. A referral to a registered dietitian may be beneficial for personalised nutritional planning.

• Anti-inflammatory Mediterranean dietary pattern — Dietary inflammation is a driver of central sensitisation. The Mediterranean diet has demonstrated improvements in pain outcomes and quality of life.
• Oily fish — Dietary omega-3 reduces prostaglandin and leukotriene production driving pain signalling. Regular consumption 2–3 times/week supports systemic anti-inflammatory activity.
• Turmeric in cooking — Regular culinary use of turmeric provides curcumin’s COX-2 and NF-κB inhibitory effects, complementing dietary anti-inflammatory strategy.
• Fermented foods and fibre — The gut-brain axis influences central pain processing. Gut microbiome diversity modulates neuroinflammation relevant to chronic pain sensitisation.
• Adequate protein for muscle maintenance — Deconditioning and muscle weakness exacerbate chronic pain. Adequate protein (1.2–1.5 g/kg/day) combined with appropriate exercise supports musculoskeletal function.

Related Conditions & Medications

Related medications: Paracetamol, Ibuprofen. Related conditions: Depression, Anxiety.