Conflating Primary and Secondary Pain: The Harm It Inflicts on Chronic Pain Patients

Treating all chronic pain the same—whether primary or secondary—is not just misguided; it is dangerous and actively harmful to patients.

The Strategic Erasure of Chronic Secondary Pain

The term "chronic pain" has been deliberately redefined to mean only chronic primary pain, with inaccurate definitions promoted to exclude chronic secondary pain entirely. This erasure has been so effective that many doctors and allied health professionals are unaware that chronic secondary pain even exists.

The consequences of this are devastating. People with painful, progressive, incurable diseases are denied appropriate treatment, pushed into ineffective therapies designed for chronic primary pain, and left to suffer without access to the care they desperately need.

This is not an oversight. It is a calculated redefinition of pain that systematically denies care to those with legitimate, treatable medical conditions.

If you are using incorrect definitions of chronic pain and failing to differentiate between chronic primary pain and chronic secondary pain, you are perpetuating harm. You are part of the problem.

This must change.

The only defintions that should be used are the definitions provided by the International Association for the Study of Pain (IASP).

The Critical Differences Between Chronic Primary and Chronic Secondary Pain

• Chronic Primary Pain occurs without an identifiable underlying pathology. It is also called nociplastic or non-specific pain. Conditions such as fibromyalgia, irritable bowel syndrome (IBS), and complex regional pain syndrome (CRPS) fall into this category. Treatments focus on psychosocial factors—education, psychological interventions, mindfulness, and physiotherapy.

  • According to guidelines, opioids should not be prescribed for chronic primary pain.

• Chronic Secondary Pain has a clear underlying cause—a disease process, injury, or structural pathology. Conditions such as arthritis, cancer, nerve damage, multiple sclerosis, and adhesive arachnoiditis fall into this category.

  • Opioids are often the only effective therapy for moderate-to-severe chronic secondary pain.

These two types of pain are not the same disease state and require entirely different treatments.

Yet, many healthcare professionals and policymakers fail to acknowledge this distinction. As a result, people with chronic secondary pain are denied safe, effective, and medically necessary treatment, including opioids.

The Lies That Have Infiltrated Pain Medicine

When you hear statements like:

• "Opioids don’t work for chronic pain." They mean chronic primary pain.

• "Opioids should not be prescribed for chronic pain." They mean chronic primary pain.

These statements are not just misleading; they are dangerous. Multiple large-scale, well-designed studies have proven that opioids are safe and effective for long-term use in chronic secondary pain. Addiction and overdose are exceedingly rare in this patient population.

Yet, despite this overwhelming evidence, patients living with severe chronic secondary pain are being denied appropriate treatment and treated as if their pain were chronic primary pain.

This is malpractice. This is systemic neglect. This is harm.

What Happens When You Fail to Differentiate Between Primary and Secondary Pain?

1. Wrong Treatments: Patients with chronic secondary pain are pushed into therapies like mindfulness and exercise—treatments that cannot address their disease and cannot relieve their pain.

   • Imagine telling someone with advanced rheumatoid arthritis that mindfulness will heal their joint destruction.

   • Imagine telling a cancer patient to meditate away their pain instead of treating it.

   • This is exactly what is happening to people with chronic secondary pain.

2. Untreated Pain: Without appropriate medication, patients are left in constant agony, unable to work, socialize, or even rest.

   • Some do not survive when their opioid medications are taken away.

   • The pain becomes so overwhelming that suicide becomes their only escape.

3. Stigma and Dismissal: When secondary pain is misclassified as primary pain, patients are told their suffering is due to "a hypersensitive nervous system," "anxiety and fear" or "emotional distress."

   • This is not medicine. This is pseudoscience and victim-blaming.

   • Healthcare professionals who perpetuate these misconceptions are inflicting harm.

The Evidence is Clear

We know that untreated chronic secondary pain leads to worsening disease and disability. Conditions like arthritis, multiple sclerosis, and nerve damage progress without appropriate intervention. Even in fully treated cases, pain often persists due to irreversible damage.

When opioids are used responsibly, they provide life-changing relief. They do not cure disease, but they allow people to function, to work, to engage with life. They make life liveable and functional.

Why This Matters

Failing to separate primary and secondary pain is not just bad medicine—it is harmful, unethical, and deadly.

• It forces patients into ineffective "pain education" programs that cannot relieve their pain.

• It denies them access to medication they need to function.

• It strips them of their dignity and condemns them to a lifetime of needless suffering.

• It erodes trust in healthcare providers who dismiss and neglect their physical disease and suffering.

If we want to provide real help, we must treat pain for what it is:

• A symptom of disease in chronic secondary pain.

• The disease itself in chronic primary pain.

One-size-fits-all policies do not work. They cost people their lives and livelihoods.

The Bottom Line

When you conflate chronic primary pain with chronic secondary pain, you are actively causing harm.

• You are denying people with painful, progressive diseases safe, effective, and appropriate medical care.

• You are reinforcing low-quality, dismissive healthcare that leaves patients to suffer unnecessarily.

• You are failing in your duty as a healthcare provider, researcher, or policymaker.

Pain is not one thing. Stop pretending it is.

Call pain what it is, by the correct name and use the correct definitions from the International Association for the Study of Pain (IASP)

Know the difference between primary and secondary pain.

Know how to treat chronic primary and chronic secondary pain.

That is the only way to provide high-quality, person-centred care. The only way to provide precision medicine, the right treatment for the right patient, at the right time.

This is the goal of Pain Patient Advocacy Australia. We are exposing the lies in pain science, in opioid science. The corruption of data, the misreporting and cherry picking, and the gaslighting and victim blaming of patients that has led to the denial of safe and effective long term opioid therapy and facilitated the ongoing forced tapers of opioid pain medications.

This is how the myths were perpetuated. How people living with painful, progressive, incurable disease were targeted and then abandoned by the health system. How pain was turned into a psychological disease, rather than a physical one.

And all who carry the incorrect definitions of ‘chronic pain’ on their websites, in their marketing materials, in their course ware, are complicit in the harm done to people living with painful progressive incurable disease and traumatic injuries.

And are complicit in the denial of care and the denial of safe, effective pain care to people who are amongst the most vulnerable in our community: those who live with constant, severe pain due to incurable disease and permanent injury. People who live with moderate-to-severe, chronic secondary pain.