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By Marianna Bernal, Physiotherapist


Pain is said to be chronic if it persists for more than three months. Many people are new to the notion of chronic pain because they are taught that pain goes away when tissues heal after an injury or illness. However, this is not the case for 1 in 5 Australians, as pain may not lessen after the healing process.

Chronic pain is complex because it involves the central and peripheral nervous systems, made up of the brain and spinal cord and may not be easy to treat, especially with analgesia alone. Persistent pain affects the individual as well as their family, friends and wider community.

Pain can become chronic due to changes to the nerves or nervous system which keeps firing and signaling pain. These changes can be unrelated to the original diagnosis or injury. Pain levels can be intense and unrelenting as well as lead to various degrees of disability if not managed well.

Pain is the body’s way to let you know when you are sick or injured as it leads people to take action. Pain has been crucial in humans’ ability to evolve and survive. This type of pain is acute pain (nociceptive pain) and is a reaction to noxious or painful stimulus. Acute pain is generally simple to treat and tends to fade away as the healing process takes place.

Chronic pain may not be warning you of damage occurring in the body as there is no longer a direct link between pain and harm being caused by the (preceding) injury.


It is widely accepted in the medical/ health professions that management should be holistic, involving all aspects of the client’s life. A Biopsychosocial model of assessment and management is now used and basically means that three aspects should be considered to provide good health care:

  1. a) Bio – biological: the physical body should be assessed for changes or injury,
  2. b) Psycho – psychological: the aspects of anxiety and stress should be addressed,
  3. c) Social – aspects of the social situation and home/ work environment should be considered.

These three aspects will have a bearing upon your pain experience although is not possible to determine how much of each is contributing to the chronicity of pain.


The most important person in managing your pain is you. It has been shown in clinical studies that the more you understand about the mechanisms of pain; the better you can control it. You know more about your pain than any health professional, you live with it every day; although you will need some guidance from trained health professionals.

A holistic approach usually involves a team of health professionals (doctor, physiotherapist, psychologist, social worker, etc). They will assess you and advise you on the best course of action, including education and graded physical activity.

The most common areas of pain management are:

  • Medication
  • Physical activity
  • Psychology


Movement gives the nervous system and the brain a lot of feedback about the body and the environment around us; it helps to normalise the nervous system.

Physical activity has many positive effects on our bodies: helps to keep heart and lungs healthy, improve muscle and joint function and stimulates you mentally.Chemicals released during exercise will also help to reduce your sensitivity to pain.

In the early stages, people often want change to happen quickly, however; this can result in pain flare-ups. A more gradual systematic approach is required with small increments of activity. It may be that the limitation to exercise is your major concern.

Therefore, seeing a Physiotherapist to improve your tolerance to exercise as well as decrease pain severity may be a way to start. Our fully qualified Physiotherapists can assist you on grading and pacing your physical activity to recondition your muscles and joints and assist you with persistent pain through many exercise modalities:

  • Clinical Pilates
  • Exercise Based Rehabilitation
  • Hands on Physiotherapy
  • Hydrotherapy

It therefore takes time, practise and patience for people to learn and effectively implement new strategies. Learning to deal effectively with flare-ups of pain is an important part of the management.

Some of the most common chronic pain conditions are listed below:

  • Back pain
  • Ankle and foot pain
  • Chemotherapy-induced pain
  • Cluster headaches
  • Complex regional syndrome
  • Fibromyalgia
  • Frozen shoulder
  • Headaches
  • Joint pain
  • Neuropathic pain
  • Osteoporosis
  • Radicular pain
  • Sciatica
  • Shingles
  • Trigeminal neuralgia
  • Tennis elbow


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