Chronic pain: What is it and why won’t it go away?

What is chronic pain?

Pain is a protective mechanism. A response to a perceived threat which may be associated with injury but does not always occur as a result of tissue damage.

Chronic or persistent pain is essentially pain that lasts for more than 3 months. This pain persists beyond the usual tissue healing times and impacts the signals that get sent to and from the brain that determine a threat.

Chronic pain continues even after the tissue healing has occurred and does not respond to treatment in the same way that an acute injury does. Effective management requires a different approach that takes into consideration lifestyle, psychological, behavioural and genetic factors .

In 2019 the Australian Physiotherapy Association (APA) reported these five facts about chronic pain:

  1. Globally, lower back pain causes more disability than any other condition
  2. Only about 1-5% of lower back pain is caused by serious disease or injury
  3. Chronic pain is Australia’s third most costly health burden and the leading cause of early retirement and work absenteeism, costing the economy more than $73 billion per year
  4. Levels of psychological distress are six times higher for those living with chronic pain, while 40% of sufferers report symptoms of anxiety and/or depression
  5. Physios have unique skills to evaluate the biopsychosocial needs of patients in chronic pain conditions


What causes pain to become chronic?

Let’s use an ankle sprain as an example…

When you roll/ sprain your ankle, nerve fibres (called nociceptors) respond to the increase in pressure by sending signals to the brain. The brain then interprets the signals as a threat and encourages you to get your weight off that foot to protect it. This is a good response and will enable healing.

If the above results in a significant sprained ankle and the person does not rest their ankle, continues to run and the tissues do not heal, the result could be what’s referred to as “persistent nociception” and lead to an increased sensitivity to pain called hyperalgesia . This occurs due to the repetitive stimulation of these nerve fibres which in turn forge a pathway that becomes bigger and allows more stimulus to flow more freely. These people have an exaggerated painful response to less stimulus e.g. just putting weight on their foot.

However, there are also times when that initial painful experience does not ease and becomes persistent pain even though the tissues have been given the opportunity to and have healed.

Additionally, there are other conditions that cause pain where there is actual damage to a nerve such as carpal tunnel, spinal cord injury, ulnar nerve compression, multiple sclerosis and other conditions which cause chronic pain where no specific injury has occurred such as fibromyalgia, chronic fatigue and migraines.

What else contributes to chronic pain?

There are many things that contribute to chronic or persistent pain that can impact ones ability to manage. The amount which each of these may impact an individual pain experience will be different to another person with perhaps a similar injury, but all of these things need to be taken into account to fully understand your pain and develop the ideal management strategies.

Pain can be impacted by:

  • Stress, poor sleep and mood
  • Illness and hormonal changes
  • Our beliefs and past experiences
  • Mood, depression and anxiety


How might physiotherapy help?

There is no one size fits all recipe for chronic pain and it takes a range of different elements to manage. It may be necessary to incorporate a team of practitioners (e.g. GP, rheumatologist, physiotherapist) to enable successful management. Physiotherapists are trained to assess chronic pain conditions and identify factors that may influence both tissue healing and long term management and are able to refer to other professions when indicated.

Physiotherapy management involves a lot of education to help you understand your pain which will in turn help with its management. Specific, individualised and gradually paced exercise programs are vital for most chronic pain sufferers to encourage functional movement and enable a gradual return to your activities and achieving your goals.

Our physiotherapists will complete a thorough assessment asking you many questions about your pain but also about other elements of your life which might be influencing your recovery. From all of this information and a thorough physical assessment the physio can work with you to devise a treatment plan that takes into consideration your individual goals, lifestyle factors and general health.

If you suffer from persistent pain, contact the clinic on 8555 4099 for your physiotherapy assessment.

Written by Caitlin Collenette (Physiotherapist)