Managing Chronic Pain

What is chronic pain?

Pain is a natural part of life and serves as a protective mechanism for our body. It plays a vital role in alerting us when something is wrong and is one of the most crucial signals in survival. Pain helps us to recognise injury or illness and warns us when to stop doing things that could cause harm. Such as touching a hot pot on the stove. Chronic pain, also known as persistent pain, refers to pain that lasts for more than 3 months and is felt on most days of the week. It can be either widespread or confined to a specific area of the body. And may occur intermittently or be present constantly.
When pain becomes chronic, it can be considered more as a “disease” rather than a helpful survival mechanism. This is in contrast to acute (short-term) pain.

How common is chronic pain?

Chronic pain is common. 1 in 5 Australians over the age of 45 is living with chronic pain and it is estimated that 30% of the population worldwide suffers from chronic pain. Chronic pain is the leading cause of disability in Australia.

What causes pain to become chronic?

There is not one exclusive cause of persistent pain. In some cases, it may be initiated by an injury or illness and will persist even after recovery. While in other cases chronic pain may stem from a long-term condition, such as osteoarthritis or cancer. Persistent pain arises from a complex interplay of underlying pathological factors, so no single physiological process can explain all the various mechanisms that lead to symptoms.

The longer that pain is present, the relationship between the tissues and state of injury becomes less predictable. Meaning that pain can persist even after tissues have healed.

What are the different types of pain?

There are three primary types of pain:

• Nociceptive pain is pain caused by damage to tissues in the body.
• Nociplastic pain is caused by the brain misinterpreting signals and perceiving them as dangerous, even when they are not.
• Neuropathic pain occurs due to damage to nerve tissue.

How can I manage my pain?

A biopsychosocial multidisciplinary approach is crucial in the management of chronic pain.

• Persistent pain should not be managed with only pharmacological treatment. Although medication may be utilised where recommended by a doctor as a part of treatment.
• A psychologist or psychiatrist can be a valuable part of a healthcare team in managing chronic pain. As prolonged pain can significantly impact mental health. According to the World Health Organization, people with chronic pain are 3 to 4 times more likely to have anxiety or depression than people without pain.

Treatment with a physiotherapist can be an integral part of managing symptoms. This will be discussed in detail in the following section.

• Prolonged rest is generally not recommended in the management of persistent pain as it leads to secondary stiffness and weakness, often worsening symptoms. When you’re in pain, it’s often more helpful to scale back your activities rather than halting them completely. And aim to return to usual as soon as you are able.
• It is also advisable to continue working, but to limit duties and make modifications with support from your employer with a plan to gradually return to your full capacity. Extended time away from work can have negative effects on physical and psychological health.

Self-management as guided by a healthcare practitioner is also important. As it is not ideal for people to be reliant on constant in-patient treatment for relief. Pacing activity and gradually increasing, is key to self-management.

How can physiotherapy help?

Physiotherapy is central to management of chronic pain as part of a multimodal approach. Treatment is not a ‘one-size fits all’ and will depend on findings in assessment.

In some cases, treatment may be specific to an injured area of the body. Otherwise in cases of more widespread pain, your physio may focus on more of a whole-body approach to treatment.

• There is research behind the use of acupuncture in chronic pain which your physiotherapist may include in treatment. Your physio may also include manual therapy with joint mobilisations and massage for desensitisation of the tissues, increase in blood flow and stimulation of mechanoreceptors.
• A crucial part of your treatment will involve exercise therapy, your physio will guide you on the best type of exercise for you, and how to gradually progress your exercise routine.

Exercise helps dampen the pain response

Professor John Booth is one of Australia’s leading Exercise Physiologist working with the relationship between Chronic pain and exercise. Professor Booth advised that after one or two months of daily regular exercise, positive changes were seen in the body and brain of people with chronic pain. Exercise plays a role in reduction of inflammation and the release of neurotransmitters in the brain which helps to dampen the pain response.

• A TENS (Transcutaneous Electrical Stimulation) machine may also be recommended, whereby electrical currents delivered via electrodes placed on the skin help to modulate nociceptive fibres, leading to a reduction in pain. Your physio can teach you how best to apply and use TENS for the best results.

It may be recommended to do a block of a few physiotherapy sessions relatively close together. And then begin to decrease the frequency of sessions as your pain gets under control, until you are able to mostly self-manage. Your physiotherapist may recommend returning to treatment when you experience ‘flare-ups’ of pain to keep things under control.

CITATIONS

1. Chronic pain: an update on burden, best practices, and new advances Cohen, Steven P et al. The Lancet, Volume 397, Issue 10289, 2082 – 2097
2. Chronic Pain Australia. (n.d.). Chronic Pain Australia. Retrieved February 21, 2025, from https://  chronicpai n australia. org.au
3. International Association for the study of Pain (IASP). Classification of Chronic Pain, Second Edition (Revised). 2011. [ONLINE] Available from http://www.  iasp-pain. org/  PublicationsNews/  Content.aspx?ItemNumber=1673;navItemNumber=677
4. Moseley GL. Reconceptualising pain according to modern pain science. Physical Therapy Reviews. 2007;12 (3):169-78.
5. Exercise & Sports Science Australia. (2021, December 2). Exercise medicine: A critical treatment for Australians living with chronic pain. Exercise & Sports Science Australia. https://www.essa.org.au/Web/Web/Resources/Articles/2021/exercise-  medicine- australians-living-with-chroni c-pain.aspx