Persistent Pain

Physio Alive

Persistent Pain

Persistent (or chronic) pain is a burden carried by many of us worldwide. It can have huge effects on every aspect of our lives – our ability to work, travel, run a household, play with our kids and grandkids, play sport, exercise, have sex, drive a car, or even just sit on the couch and watch TV – and with all of that, affect our confidence, joy and quality of life.

Over the past 40 years, our understanding of pain has progressed at a rapid rate and we are still learning. An important reframing is that we now acknowledge pain as a protector rather than a reporter. We can experience pain BEFORE we are injured, so that we can take action to prevent it – try bending your finger back and seeing if it hurts. It wouldn’t be very helpful if it only told us AFTER that we had already damaged our body.

But sometimes pain goes on…and on…and on, long after our injury should have healed, or sometimes it hangs around following something pretty innocent, like bending over to pick up a pen.

An important step is being confident that a health professional you trust (like your GP or physio) has screened you for any serious conditions. This is important and you should feel confident that your concerns have been heard and considered.

If your pain has been going on for a more than a few months, your pain system is going to be over-protective – like an alarm system that, after a break-in, has been set to catch even the tiniest of mice sneaking across the floor. Like almost everything we do, whether buttoning our shirts as a kid, catching a ball, or driving, our pain system gets better at producing pain the more it experiences it. You might even notice other signs that it’s becoming over-protective, such as:

Your pain spreading – like from one side of your back to the other, or different body parts becoming sore

Simple, light touch becoming painful, or your painful body part becoming even more exquisitely painful than it was initially

Tasks that were previously painfree becoming restricted by pain – being able to do less and less without pain

Experiencing muscle spasms

Feeling more sensitive to noises, lights, or smells

What these things tell pain scientists, and up-to-date health professionals, is that your body is actually over-achieving at trying to protect itself. Unfortunately this isn’t as good as it sounds, because it can stop you moving in ways (and doing other activities) that can help to teach the pain system to be less protective and to reduce the pain.

Just as everyone’s pain is unique, the process of retraining our sensitised pain systems can be different, and this is still an evolving space with a lot of research happening. At the moment, interventions for retraining the over-protective pain system might include:

Learning about pain biology – this is one of the most important things!

Learning about our nervous system, how it can become sensitised and how we might wind it down again (identifying things like stress, anxiety, depression, lack of sleep or insomnia, fearful thoughts or beliefs – just to name a few)

Moving in new ways, or in a different place, with different people, or when in a different mindframe

Doing different types of exercise than you normally do

Mirror box therapy

Relaxation or mindfulness techniques

A component of manual therapy such as mobilisations or massage, if appropriate

Visualising movement or watching other people move in ways that are painful for you

Several of our physiotherapists are passionate about this area and are continually upskilling as new research and treatment approaches become available, a necessity when working with persistent pain. If this is something you’re interested in exploring further with us, we would love to help.


Useful resources:

Tame the Beast

Neuro Orthopaedic Institute