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Chronic Pain Syndromes Physiotherapy

There’s an estimated 116,000,000 Americans who have chronic pain every year, and it costs an averae of $600,000,000,000 for medical treatment, lost work time and lost income.

Chronic pain is ongoing pain in one or more parts in the body…with or without any real body tissue damage due to injury or illness, beyond normal tissue healing time.

What’s chronic pain?

Pain’s an unpleasant (from mild to very, very terrible) sensation that is associated to injuries or tissue damage BUT can be present WITHOUT any damage or injuries too. Most of the time, pain is acute and short term, but sometimes it can be long term (chronic).

Acute pains are normal and tends to last for a short time – up to 12 or so weeks, sometimes a little longer.

They’re associated with actual tissue injury and damage, to allow injury healing or prevent injuries. Eg it helps us to quickly drawback our hands when accidentally touching a hot pot or sharp object. In a split-second, the brain tells the body that “it’s dangerous, quickly withdraw” to prevent a worse injury.

We feel these all the time, such as soreness or ache in our back or feet or hand, to tell you something, be it to stop what you’re doing that’s causing the pain, and get it treated by seeing a doctor or physio.

It’s signalling done by our brain to protect us and anticipate, so that we can sort out potential problems, and it’s a good thing.

Chronic pain…is a different ball game entirely.

They’re pain that lasts beyond what’s normal, eg a back injury that should heal after 3-4 months, but it’s already been 6 or 12 months and longer. Unfortunately, we have had a lot of patients in our clinics for chronic pains, and at the rate it’s going, we’d probably continue to serve patients with these long term pains.

Often, patients who have chronic pain thinks that their injury or disease has not healed, and that’s why they still have the body pain, but it’s possible that it’s not the case. You see, chronic pain isn’t your brain warning you of possible injury or danger…but what happens instead is that the pain centers in your brain is firing extra pain stimulation that makes you feel pain EVEN THOUGH there’s no new causes of pain in the body.

To make things worse…ANYONE can develop chronic pain, at any age. Yes, even children.

Brain changes in chronic pain

  • When you are injured or develop a painful disease, the injured or damaged part will send pain information to the brain
  • The brain will then analyze this information to see if the threat is real and if there’s any actions that needs to be done to prevent this harm
  • When this pain is constantly triggered, the brain and nervous system maintains a “high alert” status, which makes it more sensitive to pain stimuli or triggers
  • Cells that picks up these sensation in the nervous system when it’s on high alert, making it easier for the brain to interpret these sensations as dangerous threats and more pain, which in turn causs the brain and nervous system to induce and maintain chronic pain symptoms (kinda like if you’re worried about a possible break-ins, and your mind and body goes into hypervigilance where you cant sleep and you worry and you breathe shallow, and this keeps your anxiety which feeds into fears of potential break-in, and the vicious cycle repeats)
  • Pain becomes “chronic” when the pain centers are activated in the brain and the brain continues to interpret these sensations as danger, EVEN when there’s no new tissue damage.
  • This causes the pain centers in the brain to fire / activate from stimuli such as movement, emotions, brain functions such as thinking / learning, sounds, temperature, pressure etc
  • The brain and nervous system continues to react, causing you to keep being in constant state of pain, which in turn causes more sensitivity to stimuli as mentioned above. We have had patients who gets triggered into pain states just by thinking, reading or remembering pain sensations
  • The pain is very real (really experienced) despite no new injuries or trauma

What does chronic pain feel like?

Everyone’s chronic pain is different, personal and subjective, from

  • type (sharp, electrical, dull, deep etc)
  • duration (how long it lasts)
  • frequency
  • triggers

There can be more than one type(s) at a time with different types of duration, frequency and triggers

Common complaints related to chronic pain include:

  • “Everywhere’s painful” and “everything hurts”
  • Sudden sharp episodes, like knives stabbing deep
  • Seems like “pain has its own mind and personality”
  • It gets worse when ____
    • you think about it
    • someone bumps into you
    • you forget something
    • specific words or rituals trigger it
    • upsetting situations such as stress
  • Feeling the pain even when “just resting” or not doing anything to cause them eg no recent falls, accidents or even moving about
  • Feels out of control, that it’d get worse
  • Anxious, worried, even depressed
  • Symptoms may “travel” from one area to another
  • Tired all the time, the pain makes you tired and fatigued
  • Afraid to do normal things, because afraid of normal movements or activities can trigger the pain (avoidance)

These are some of the common complains we hear from patients with chronic pain…and to add, it’s not that the physical condition is worsening, it’s usually because your brain and nerves are becoming more sensitive to painful triggers and stimuli.

Long term problems

  • joint and body stiffness when they try to be more active
  • deconditioning decreases body stamina, strength and tolerance – the body shrinks when it’s used less. The secondary problem from this is that this increases risk of falls, which triggers more fears and furthers more risks of falls
  • prolonged rest also leads to decreased circulation, leading to cells being deprived of much needed oxygen and nutrients, causing cells to heal slower and more swelling, pain and lowered energy
  • weight gain due to decreased activity or movements, which makes the situation worse due to increased fatigue, more risk of arthritic pains
  • increased reliance and use of medication over time
  • seeking out different doctors and health care professionals in the constant search to find pain relief
  • very difficult to perform sustainably at work, with increased chances of disability
  • social avoidance of family, friends and colleagues

Many patients report feeling bitter, frustrated and even depressed. Some of them reported feeling suicidal too – if you have these thoughts and feelings, speak to your doctor and call the suicide hotline. It’s very important so you can get appropriate help, support and even medication to help.


There are many many different causes of chronic pain such as

  • Tissue injuries and/or trauma
  • Diabetes
  • Fibromyalgia
  • Amputations
  • Reflex sympathetic dystrophy (RSD)
  • Operations
  • Arthritis

Direct issues of chronic pain

The problem with chronic pain is that it’s very subjective: every patient experiences it differently, though the medical professionals call it as chronic pain as a whole.

Other than the chronic pain experience, it can also lead to:

  • decreased activity levels (lots of resting)
  • loss of job and working life
  • loss of social life
  • loss of movement and function and mobility
  • financial difficulties and even bankruptcy
  • depression
  • anxiety
  • libido losses
  • disability

With treatment, the far-reaching negative effects of chronic pain can be reduced.

The American Physical Therapy Association launched a national campaign to raise awareness about the risks of opioids and safer alternatives of physiotherapy for long-term pain management. Physiotherapists work together with chronic pain patients to lessen their pain and equally as important: to restore their activity levels as much as possible. 

How is chronic pain diagnosed?

The doctor will do a series of tests in a thorough evaluation. They will:

  • Ask specific questions about your past and present health
  • Find out your medication use for pain and function
  • Ask about your symptoms: location, intensity, how and when the pain occurs, and other questions, to understand your individual pain experiences.
  • Ask you to fill out pain and function questionnaires, to understand how the pain is affecting your daily life.
  • Perform tests and movements with you to identify problems with posture, flexibility, muscle strength, joint mobility, and movement.
  • There may be special tests help to rule out any serious medical issues such as pressure on your nerve, nerve conduction and tests to find underlying disease.
  • They may send a therapist to observe how you use your body for home, work, social and leisure activities, to customize a rehabilitation program that can help improve your pain, movement and overall quality of life
  • get you to undergo imaging tests such as xrays, CT scans and MRI to see if there’s anything undiagnosed

Physiotherapy treatment

First, we’d need to find out

  • how much you can move
  • how much pain do you experience at baseline and when triggered
  • what are your personal goals, hobbies and activities you want to get back to

These will give us a baseline function and pain now, and set goals where and what we can work towards with you.

Not all chronic pain is the same, and it’s not a pain jail. There is help and recovery – we’ll help you along the way.

Physiotherapy treatments may include:

  • strengthening and flexibility exercises are two powerful foundations that we’ll need to work on that will help you move easier with less pain and less discomfort. These exercises are gradually increased in intensity to improve your to help you move more easily with less discomfort. Your therapist will design a program of graded exercises for you to improve your strength and flexibility without triggering pain
  • manual therapy are specific hands-on techniques used to mobilize joint structures and soft tissues, to help with increasing range of motion, decrease pain
  • postural awareness and body mechanics training to improve mechanical posture and movement. This is to improve efficiency and effectiveness as you rest or move, which will decrease energy used and pain experiences, as well as improve movement and function.
  • regular deep tissue release may help to increase circulation, comfort and muscle health
  • regular workouts such as controlled clinical pilates can help improve your core strength which will also prevent injury and pain as well as improve movement

Where To Next?

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