What Is Chronic Pain?
Chronic or persistent pain is defined as pain that persists for longer than 3 months. It can persist even after the initial injury or cause has healed, or it may arise without any obvious injury at all. It can be confusing, disheartening, and even invisible to others, but your experience is real, and it matters.
It’s a complex condition in its own right. Chronic pain is characterised by changes in the nervous system that can amplify and perpetuate pain signals. For individuals living with it, chronic pain can significantly impact daily life, movement, emotional well-being, and performance capacity.
Many are used to pushing through discomfort, but when pain becomes persistent and unpredictable, it can affect confidence, training load, mental health, and even identity.
Common chronic pain conditions include long-term joint pain, tendon irritation, lower back pain, persistent neck tension, and complex regional pain syndrome. Conditions such as fibromyalgia or hypermobility spectrum disorders (like hEDS) can also present with widespread chronic pain that doesn’t always correlate with visible injury on scans.
The Science Behind Chronic Pain
One of the reasons chronic pain is difficult to manage is that it involves more than just physical tissues. In chronic cases, the nervous system becomes sensitised, meaning it reacts to normal or minor stimuli as if they were dangerous. This is known as central sensitisation, and it’s a key mechanism in many chronic pain presentations. Over time, this can lead to a cycle where the brain and body become hypervigilant to pain, muscle guarding increases, and movement becomes more restricted, not due to injury, but due to fear or subconscious protective pattern.
Understanding the Symptoms of Chronic Pain
Chronic pain presents differently for everyone, but there are some common patterns. You might notice low back pain, neck pain, or joint pain that lingers long after expected healing times. For some, pain flares up after activity, often linked with fatigue or overuse.
Hypermobility-related pain is also common, especially in those with conditions like hEDS. Others may experience pain associated with autoimmune or systemic conditions like rheumatoid arthritis, fibromyalgia, or chronic fatigue syndrome (CFS). Nerve pain can feel sharp, burning, or electric, and many report increased sensitivity to touch, sound, or stress.
You may feel stuck in a loop, resting too much during flare-ups and struggling to return to activity. Many people with chronic pain feel confused or invalidated by previous healthcare experiences, especially when scans or tests show “nothing wrong.” You may also feel emotionally drained from trying multiple treatments without lasting results, or feel unsure of how to move forward when every attempt at exercise or rehab seems to make things worse.
Medical Treatment Options
Other medical interventions might include referrals to pain clinics, cognitive behavioural therapy (CBT), injections, or specialist support for underlying conditions such as fibromyalgia, rheumatoid arthritis, or complex regional pain syndrome. However, the most consistent recommendation across clinical guidelines is the importance of supported self-management strategies, gradual reactivation, and addressing pain from both physical and psychological perspectives.
According to the NICE (National Institute for Health and Care Excellence) guidelines for managing chronic primary pain (2021), medications like opioids, paracetamol, and NSAIDs are not recommended due to the risk of harm and lack of evidence for effectiveness in chronic pain. Instead, NICE emphasises the value of a multidisciplinary, person-centred approach, including physiotherapy, psychological therapies, exercise, and education.
An Evidence-based Treatment Approach to Physiotherapy
Managing chronic pain requires a holistic, education-based biopsychosocial approach. Physiotherapy for chronic pain is not about “fixing” a single muscle or joint. It’s about restoring trust in your body.
Understanding how pain works can reduce fear, shift limiting beliefs, and help you feel safer to move again. A physiotherapist will work with you to explore safe ways to return to activity, teach you how to pace effectively, and provide tools to reduce nervous system sensitivity. This might involve breathwork, movement therapy, sleep hygiene, and gradual exposure to activities you’ve avoided.
Physiotherapy Rehabilitation Goals
Pain rehabilitation will be highly personalised. It may include nervous system regulation techniques, such as yoga therapy, strengthening exercises, gentle mobility work, and strategies for pacing and planning your week.
For many people, education and movement, rather than passive treatments, create the biggest improvements over time. The goal isn’t necessarily zero pain, but to increase what you can do despite it and reduce the control pain has over your life.
This isn’t a quick fix, but it is a hopeful, value-driven path forward.
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