Chronic pain remains one of the most complex aspects of personal injury cases, often transforming modest injuries into high value claims, which can take years to settle. As courts grapple with fluctuating symptoms and subjective presentations, evidence shows that the clinical approach to chronic pain has transformed significantly. 

The NICE Guidelines NG193 (2021) mark a decisive shift away from approaches centred on invasive surgical interventions and medications, instead prioritising lifestyle-based, self-management-oriented therapies. This evolution reflects the thought that long-term improvement often depends less on medical intervention and more on equipping individuals with the skills to manage their symptoms independently. This is especially the case for patients with non-organic pain, which cannot be fully explained by structural findings alone, and which often stems from a more minor orthopaedic injury which fails to resolve in accordance with the expected prognosis. 

NICE NG193 is built around the biopsychosocial model in recognising the breadth of factors that interact to shape a person’s pain experience outside of solely organic causes, for example, work stress, family dynamics, past-trauma, and lifestyle habits. This approach puts pain education at the forefront, giving pain sufferers practical, sustainable skills to manage their pain independently over time, thus providing them with increased agency and confidence in dealing with their symptoms. This guidance increasingly shapes medicolegal expert evidence, with pain specialists emphasising the biopsychosocial model over purely biomedical explanations. Against this backdrop, lifestyle-based interventions have become central to modern chronic pain management. 

A recent article published in the Journal of Clinical Medicine by Jo Nijs et al recognised that accumulating evidence demonstrates that “lifestyle factors…are linked to the severity of chronic pain through both direct mechanisms (such as neurophysiology) and indirect pathways (such as improvements in mood)”. The article indicates that a key step in implementing a multimodal lifestyle approach is to first identify the relevant lifestyle factors that may be perpetuating the patient’s condition, such as poor diet, obesity, or insomnia. Additionally, it is important for treating clinicians to be alive to the potential barriers for patients making the behavioural change necessary to maintain a healthy lifestyle, such as maladaptive beliefs. These barriers can be addressed by “providing pain neuroscience education with integrated motivational interviewing”. 

The next step is creating a personalised programme of lifestyle interventions. These include treatments related to both physical activity – such as physiotherapy, hydrotherapy, adaptive sports, yoga, and exercise programmes from a personal trainer – as well as psychological interventions, such as CBT and ACT, mindfulness-based stress reduction, and meditation. Additionally, research shows that changes to a patient’s diet, such as anti-inflammatory eating patterns and nutrient dense foods, can help reduce pain intensity. There may also be an argument for other social and lifestyle interventions, such as sleep hygiene programmes, vocational rehabilitation input, pain-tracker mobile applications, and peer support groups for sufferers of chronic pain. 

This shift in the way chronic pain is treated has important implications for the insurers and lawyers handling these cases, especially in relation to quantum. A key advantage of lifestyle-based therapies is their cost effectiveness, especially in high value cases. The costs associated with lifestyle interventions, for example, CBT and ACT courses, physiotherapy, gym memberships, or guidance from a nutritionist, are relatively low. Additionally, as the focus is on educating patients to be able to self-manage their pain, these reduce their future treatment needs. This is in comparison to medical interventions, such as surgeries, which carry a high upfront cost and a risk of complications, or medications, which bring an ongoing long-term expense and the potential for side-effects and dependency. 

Nevertheless, it is clear that lifestyle interventions cannot work alone to treat chronic pain but should be used alongside the necessary medical treatments. Ultimately, a measured approach is warranted, which should be guided by the relevant medicolegal opinion. However, insurers should remain openminded when it comes to understanding and integrating lifestyle interventions into the claimant’s rehabilitation and settlement package, and should consider offering funding for these early into the litigation, aligning with NG193 to demonstrate proactive, evidence-based support.

Jade Davis is a member of Clyde & Co’s chronic pain subject matter group.