What is chronic pain, and how does it work?

I have experienced chronic pain for 20 plus years.  It started very slowly and gradually, with an almost imperceptible increase in pain and pain sites until it reached a point about 15 years ago where I couldn't ignore it any longer or brush it off, as I had before, to overexerting myself.  It took a further 10 years for me to get a diagnosis of fibromyalgia.

Research into pain pathways was quite mature then. It only takes a look along the medicine shelves in supermarkets where usually around a third of the space is dedicated to pain medication, to understand the motivation from Pharma to fund further research and trials.

In the meantime, chronic, or nociplastic pain were neglected as a distinct problem and today we still have medics whose education taught them to treat it like any other pain - if it doesn't respond to analgesics, then it's not really there (aka, imagined - in their heads) so CBT must be the solution.

I have kept myself updated, albeit on the fringes, of pain research over the last 15 years and the collective understanding of pain in general has grown massively and been turned upside down in that time.

Over the last few years in particular, research has focused more directly on chronic or nociplastic pain which in itself is a great relief.  I am particularly encouraged by the interest in the involvement of the immune system and the fascia (search Robert Schleip, one of the most prolific researchers in this area) and eagerly await that interest translating into
greater understanding and better treatments.