Physiotherapy helps people with long term (chronic) pain develop the skills they need to manage their condition, increase their activity and improve their quality of life.
What is chronic pain?
Chronic pain is usually defined as pain that persists beyond the normal time that tissues take to heal following an injury. Most soft tissue injuries heal up within weeks, although some can take several months to completely heal.
If a pain continues longer than 3-6 months, it is usually described by pain specialists as “chronic” pain. It is helpful to understand the differences between chronic, persistent pain and acute pain.
Acute pain: short-term pains act as an alarm, telling us that something is wrong. While most minor pains are easily treated and quickly forgotten, others are a sign of something more serious that we shouldn't ignore. For example, the pain of a broken leg is helpful because it makes us rest the leg until it heals.
Chronic pain: persistent pain though often serves no useful purpose. The pain messages linked to long-term conditions such as back pain or arthritis are not helpful, and can be annoying and sometimes devastating.
Over time, the pain may affect how we function, including our ability to work and our sleep patterns. It can also have a negative effect on our family and friends.
The causes of chronic pain are not always clear but in some conditions the pain is thought to be due to the pain signals through the nerve fibres becoming confused. The brain is then unable to understand the signals properly. Chronic pain can affect any part of the body and people of any age, including children.
The nerve network associated with chronic pain is also linked to those parts of the brain concerned with emotions. So, pain can affect our emotions, and our emotions can affect our pain. If we are angry, depressed or anxious, for example, the pain often feels worse. If we are feeling positive and happy, we may experience less pain and will often be better able to cope. Pain then is never "just in the mind" or “just in the body”, but a complex mix affecting our whole being.
The relationship between body and mind is complex, so it is important to seek help for any aspect of your condition that you might be struggling with, physical or mental.
How is chronic pain managed?
If your pain persists and becomes chronic then the emphasis might shift more to managing the condition and minimising its impact on your life, rather than necessarily finding a cure.
Some treatments are available which can reduce the pain intensity. For example, you might be prescribed medication, from simple pain-killers to more complex drugs. Other treatments to help reduce the pain include “hands on” treatments, massage and acupuncture, although the benefits of these treatments tend to wear off after each treatment session.
Another way of managing long-term pain is to find ways to reduce the impact of the pain on overall quality of life. This might include learning relaxation techniques, developing goal-setting skills, and learning ways of improving sleep quality.
You could be referred to a specialist pain clinic or a specific pain management programme. Some pain clinics have teams of expert healthcare professionals including doctors, psychologists and physiotherapists. However, pain clinics are not available in every area.
How can physiotherapy help?
Physiotherapists often see patients with chronic pain on an individual basis. Your physiotherapist will assess you and work with you to agree a treatment plan. A specific manual treatment such as massage or soft tissue mobilisation may be appropriate, or perhaps acupuncture. However, treatment is more likely to include advice about movement, posture and finding ways of achieving your goals.
A physiotherapist can also identify practical ways to help, such as making sure you have the correct equipment or the right shoes. Physiotherapists also see patients at a pain management clinic, working as part a specialist team. This is more likely to be a group session.
It is important to have regular reviews with your physiotherapist and ask to see them if your condition changes.
What will happen when I see a physiotherapist?
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Your physiotherapist will assess your condition and difficulties, give you advice and perhaps offer you a physical treatment (see above). You might need to remove some clothes so that the physiotherapist can see your movement and muscle activity that may be contributing to your pain, so it's a good idea to dress comfortably and wear suitable underwear.
What is a pain management programme?
A pain management programme is a specialist rehabilitation approach for groups of patients run by a healthcare team which includes a physiotherapist and a psychologist, and may include an occupational therapist and a nurse.
People with chronic pain may find that it affects many areas of their lives, including how they think and feel. Pain management programmes teach people how best to cope with pain and how to live a more active life.
Referral to a pain management programme is usually through your local pain clinic.
How can I help myself?
- Everyday activities such as walking, swimming, gardening and dancing can improve wellbeing for people with chronic pain. Exercise can help by:
- increasing levels of chemicals known as endorphins which occur naturally in your body and act as pain killers
- relieving tension and stiffness in your muscles, ligaments and joints
- reducing weight gain, the risk of heart disease, osteoporosis, poor balance and falls
- Relaxation techniques can help to reduce persistent pain and muscle tension, and can help to improve broken sleep. There are many types, including breathing exercises and meditation. There may be local classes available, perhaps through your local pain clinic. Ask your physiotherapist, GP or other healthcare professional for advice.
- Support Groups. Pain can send you into a downward spiral of fatigue, low mood and anxiety. Talk to someone who understands what you are going through. Several organisations have helplines staffed by people living with chronic pain and they can also put you in touch with local support groups (see below). It can help to see a counsellor or psychologist. Your GP can advise you about where you can find help.
- Distraction. Try distracting yourself from the pain with an activity that you enjoy. Many hobbies such as photography, sewing or knitting can be done even when your mobility is restricted.
- Good night’s sleep. Give yourself the best chance of a good night's sleep by going to bed at the same time each evening, getting up at the same time each morning and avoiding taking naps during the day. If sleep problems persist, speak to your physiotherapist, GP or other healthcare professional.
- Friends and family. Keeping in touch with friends and family is good for your health and well-being. If getting out and about is difficult, try shorter visits, perhaps more often. If you can’t get out, phone a friend, invite someone round for a coffee or have a chat with your neighbour. Aim to talk about anything other than your pain
Guidance and evidence for physiotherapy
Links and further information
- British Pain Society
- NHS Choices
- Pain concern (helpline 0300 123 0789)
- Action on Pain (helpline 0845 6031593)
- Versus Arthritis (free helpline 0300 790 0400)
- Backcare (helpline 0845 130 2704)
- Healthtalkonline
- Versus Arthritis (high quality information for people with arthritis)
Produced in association with the Physiotherapy Pain Association.