The writer and runner Haruki Murakami says: “Pain is inevitable. Suffering is optional.” But many of the estimated 28 million people in the UK who live with long-term, chronic pain, would beg to differ. Elderly people with back and knee pain become increasingly housebound, withdrawn and socially isolated. Daily nerve pain, headaches or muscle aches lead to depression, unemployment and fractured relationships. And now a study has questioned the safety of commonly used painkillers – diclofenac and ibuprofen – after finding an increased risk of cardiac arrest among users. So just what are you supposed to do if you are in pain?

What does this new study say?

Cardiologist and study author Professor Gunnar Gislason of the Danish Heart Foundation says his study underlines existing concerns. “We found there was an increase in sudden cardiac deaths among people on prescribed NSAIDs [non-steroidal anti-inflammatory drugs]; an increased risk of 31% associated with ibuprofen use, and 50% with diclofenac.” If you are fit and healthy, the increased risk is unlikely to put you in any danger. But if you are already at high risk, taking NSAIDs is a serious decision that you should discuss with a healthcare professional. Gislason sees it as a major public health issue that needs tackling.

But Dr Alan Fayaz, specialist in pain medicine at University College London, says chronic pain itself can put a strain on the heart, irrespective of NSAID use. Furthermore, people who are prescribed long-term, high-dose NSAIDs are more likely to have other health problems than those that are not, so it can be hard to be certain to what degree the NSAIDs are causing the extra cases of heart attack and stroke. But Fayaz does agree that NSAIDs certainly cause side-effects, including bleeding from the gut and kidney damage, and should be used with caution.

So the drugs don’t work?

The experts agree that treating the underlying cause, staying in work, regular exercise and talking therapies are often more successful and less harmful than drugs. The main drugs used for pain control fall into four classes: NSAIDs (eg ibuprofen, naproxen, diclofenac); opioids (codeine, morphine); antidepressants (amitriptyline); and drugs developed for epilepsy (gabapentin, pregabalin). Fayaz says gabapentin can be effective and he favours capsaicin cream – derived from chilli peppers – that can help in fibromyalgia and osteoarthritis. Gislason suggests low-dose naproxen or a weak opioid such as codeine if paracetamol and physiotherapy aren’t enough. New preparations, such as Targiniq, aim to minimise the side-effects of opioids (constipation, for example) by combining them with drugs that counter the unwanted effects. In the UK, medicinal cannabis can be prescribed for muscle spasms in multiple sclerosis but not for chronic pain.

Is pain ever good?

Losing the ability to feel pain makes the world a dangerous place. A short-term pain response makes us snatch our hand out of the fire or jump back from an electric shock. Usually, once the cause of pain (trauma, infection or inflammation) has healed, the pain goes away. But sometimes pain becomes a chronic problem. This might be because the underlying cause – a painful ulcer, say – hasn’t healed, or the condition recurs (as in migraine) for reasons that no one can fathom. Once pain becomes chronic, it is a devil to treat. Changes in the brain and spinal cord, called central sensitisation, mean you experience more and more pain with less and less provocation. You are more likely to experience chronic pain if you are old, female and live in poor housing. But recovery is possible; two-thirds of those with chronic pain get better over time – although that still leaves an estimated 11% of adults and 8% of children who suffer severe pain.

Can I avoid chronic pain to start with?

If only. But there are some precautions worth taking. Top up vitamin D levels by getting out in the spring sunshine or considering supplements in the winter; low vitamin D may (arguably) contribute to generalised pain. Back pain and repetitive strain injuries that start in the workplace may be preventable with better work practices. The over-70s can have a shingles jab to reduce the risk of chronic nerve pain that can persist after an attack.

Can therapy help?

Pain specialist Professor Anthony Jones, of the University of Manchester, thinks so. “There’s good science and evidence behind talking therapies to help to reverse some of the fine tuning problems in the brain that happen in chronic pain. People with osteoarthritis or fibromyalgia anticipate pain differently; they are in a state of permanently expecting bad things to happen to them, including pain.” The brain can distract itself from experiencing pain, and functional MRI imaging has shown which parts of the brain are activated when this distraction is taking place. Jones says that new, simple and safe therapies that use the power of the brain to take more control of how we feel are being developed in the human pain research group at the University of Manchester.

Which talking therapy should I try?

One size doesn’t fit all; the best talking therapy is the one with a therapist and philosophy that most appeals to you. The main sticking point is availability. NHS provision is very patchy and there may be a long waiting list. Private therapists may lack proper training and supervision and can charge as much as £100/session. Cognitive behavioural therapy and mindfulness can help. And an interesting mindfulness-based therapy called acceptance and commitment therapy (ACT) says we should accept what we cannot change but can commit to action that improves our lives. You may prefer to take control of your own therapy. The online Pain Toolkit is full of self-management tips and tools. There are apps to track and rate pain and monitor medication use and general wellbeing.

How can I distract my brain?

Western acupuncture, Tens machines (which deliver a small electrical current to the skin) and tapping (repeated tapping with your fingertips on specific points on the body) do not have strong scientific evidence, but do no harm. The basic idea is that the brain processes signals from these techniques and “blots out” the pain signals. Currently, the National Institute for Health and Care Excellence (Nice) only recommends acupuncture for chronic tension-type headache and migraine, but many NHS pain clinics offer it as an option for other types of chronic pain including backache. Jones says these techniques may not be better than a placebo, but “placebo analgesia is one of the most powerful ways of ‘tricking’ the brain to take more control of pain and can be long lasting.”

Are there pain specialists I could go to?

Your GP can refer you to a specialist pain clinic if you have persistent, disabling or progressive pain despite treatment. If you have become dependent on alcohol, drugs and strong painkillers (opiates), you will need specialist care to wean yourself off. Pain clinics can offer a wide range of options including physiotherapy, psychological support, medication, pain-relieving injections of local anaesthetic or steroids and acupuncture.

I don’t mind being a guinea pig. Are there any trials I can sign up to?

The ReActiv8 study is a trial recruiting volunteers to see whether a novel device helps chronic low back pain. ReActiv8 is a surgically implanted device that uses mild electrical stimulation to activate the large muscles on either side of the backbone for 30 minutes, twice a day. You control when to start and stop each stimulation session via a handheld wireless remote control. The idea is that over time, your body regains control over the muscles that provide lower back stability, which may help relieve chronic low back pain.