A holistic approach to Chronic pain

Physiotherapy has always been devoted to understanding patients’ pain and how to alleviate, manage and prevent it. So, what’s changed?

As the landscape of pain management advances, it is increasingly clear that a multidimensional approach to pain is not just beneficial but necessary.

One of the best ways to manage pain is through a biopsychosocial (BPS) approach. This broader approach means looking at the whole person and using a combination of different strategies to manage pain effectively. We might need to use a mix of medications, exercise, lifestyle modification, diet, relaxation and stress management techniques.

This approach also means you may need help from different health professionals. It’s important to find professionals who take the time to understand you and your unique needs, as not all healthcare providers are familiar with managing chronic pain.

Physiotherapy plays a central role in treating chronic pain as part of a holistic approach to pain management. Your Physio will assist you with coping strategies, both physical and psychological. Your treatment will consist of education and understanding partnered with exercises for strength, range, coordination and balance. Your Physio may liaise with your ‘team’ and direct you to other health practitioners who can help you better understand your condition and improve your everyday activities. Your team may include your local GP, a pain specialist, psychologist and an exercise physiologist.

What exactly is Chronic Pain?

Chronic pain is defined as pain that has persisted for more than three months. It can be anywhere in the body and can start from a serious injury or something quite insignificant. There does not need to be any evidence to prove it exists. It won’t necessarily show up on any imaging or blood tests.

Pain originates in the brain as a protective mechanism, but persistent pain does not always indicate ongoing harm or damage. The brain interprets signals from the body and environment to determine whether we feel pain. The nervous system, or “pain system,” includes many nerves and brain cells.

Chronic pain often results from a hypersensitive pain system rather than tissue damage. This hypersensitivity can be influenced by thoughts and feelings, such as fear or anger. Chronic pain can lead to reduced activity, deconditioning, and increased fear of movement. The goal in managing chronic pain is to shift focus from the initial injury to modifying the brain’s interpretation of danger and calming the pain system.

There are numerous chronic pain conditions including Rheumatoid Arthritis, SLE, Fibromyalgia and Polymyalgia Rheumatica and Chronic Lower Back Pain amongst many others.

Our understanding of the causes and treatment of pain has advanced. Modern approaches to treating low back pain focus on physical activity and encouraging people with low back pain to self-manage their pain and activity. One of the challenges of helping patients is in overcoming a traditionalist approach that relied on dispensing pain medication. 

“The brain is responsible for what we feel but doesn’t get it right all the time” – Kal Fried

What does Self-management look-like?

• Setting personalized and achievable goals
• Creating a pain management plan that incorporates team-based care
• Developing your skills and ability to self-manage chronic pain
• Reviewing and adjusting your pain management plan regularly.



If you would like to learn more about Chronic pain here are some good resources to get you started:

• Learn more and become a painchanger at https://chronicpainaustralia.org.au/painchanger/
• Understanding Pain with Mr Brainman- a simple video that helps you understand what current research says about chronic pain – that it’s not a joint or muscle problem, rather a ‘re-wiring’ of the brain perception of itself.
• Rethinking persistent pain – Professor Lorimer Moseley explains how pain works and explains new approaches to reduce your pain.
• Book: Why does it still hurt? – Science journalist Paul Biegler discusses how the power of knowledge can overcome chronic pain.
• The following article and podcast will give you a taste of his book where Biegler talks about his own chronic pain journey and very clearly explains the concept of central sensitisation, where the body creates its own understanding of what is painful.