Chronic Pain.
What is chronic pain?
Pain that persists beyond the expected healing time for a tissue injury — generally defined as pain lasting more than three months — is classified as chronic pain. It affects approximately one in five Australians and is the leading cause of disability worldwide, producing a burden on quality of life, mental health, work capacity and healthcare utilisation that far exceeds the initial injury or condition that triggered it.
Understanding chronic pain requires a fundamental shift from the traditional model — where pain is understood as a signal of ongoing tissue damage — to the modern neuroscience model, where chronic pain is understood as a product of the nervous system itself. This shift in understanding is not merely academic. It directly changes what the most effective treatments are and why they work.
The neuroscience of chronic pain — why it's not what most people think
The traditional explanation for chronic pain — "your pain is because of your injury or structural problem" — fails to account for several well-established clinical observations: many people with significant structural findings on imaging (disc herniations, arthritis, rotator cuff tears) have no pain at all, while others with minimal structural findings have severe pain; the severity of pain does not reliably correlate with tissue damage severity; and pain frequently persists long after tissues have healed.
The modern neuroscience explanation is more accurate and more useful. Pain is an output of the brain — a protective response produced when the brain determines that the body is under threat and that action is needed. The brain integrates information from the tissues, from previous pain experiences, from the environment, from emotions, from beliefs about pain, and from social context to make this determination. In chronic pain, the nervous system has become sensitised — the alarm system is now set at a lower threshold, producing pain more easily and in response to stimuli that would not normally be threatening. This is called central sensitisation, and it is the underlying mechanism of most chronic pain conditions.
Central sensitisation explains why chronic pain is so often influenced by sleep, stress, mood, beliefs and social context — these are all inputs to the nervous system's threat assessment, and they all influence how much pain is produced. It also explains why treating the structural finding alone (the disc bulge, the arthritic joint) frequently fails to resolve chronic pain — the sensitised nervous system is the problem, and it requires a different treatment target.
What causes chronic pain to develop?
Chronic pain develops when the normal protective pain response that accompanies injury or illness fails to settle as expected. Several factors are consistently associated with the transition from acute to chronic pain: high initial pain intensity, early fear-avoidance behaviour (reducing activity because of fear that it will cause harm), poor sleep, psychological distress, low self-efficacy (limited confidence in one's ability to manage), and inadequate early management that focuses only on passive treatment rather than active rehabilitation.
Past pain experiences, adverse childhood experiences, trauma and psychological factors all influence pain system sensitivity and pain chronification risk — not because the pain is "all in your head" (a phrase that is both unhelpful and inaccurate), but because these experiences shape the nervous system's threat assessment in ways that persist.
Common chronic pain conditions
Chronic pain presents across a wide range of diagnoses. The conditions most frequently seen in physiotherapy practice include:
How can physiotherapy help?
Modern physiotherapy for chronic pain is built on the biopsychosocial model — addressing biological, psychological and social contributors to pain simultaneously rather than targeting structural findings alone. This is not a departure from evidence-based practice — it is the most evidence-based approach available for chronic pain.
Pain neuroscience education (PNE) is the most distinctive and important component of modern chronic pain physiotherapy. PNE involves reconceptualising pain with the patient — helping them understand that chronic pain reflects nervous system sensitivity rather than ongoing tissue damage, and that this understanding itself reduces pain and increases confidence in movement. Multiple systematic reviews and meta-analyses confirm that PNE reduces pain, disability and fear-avoidance behaviour in chronic pain patients.
Graded activity and graded exposure — progressively increasing activity levels within a quota-based framework, rather than a pain-contingent (stop when it hurts) framework — reconditioning the nervous system to tolerate movement and activity without producing disproportionate pain responses. The distinction is important: the goal is restoring confidence in movement, not simply increasing exercise load.
Manual therapy — joint mobilisation and soft tissue techniques — reduces pain through neurophysiological mechanisms including peripheral and central pain inhibition, providing short-term relief that facilitates participation in the active rehabilitation program.
Dry needling addresses myofascial trigger points that are consistent contributors to chronic pain in many presentations. Real time ultrasound assists in retraining the deep stabilising muscles that chronic pain has consistently disrupted. Clinical Pilates provides a structured, supervised exercise environment that builds movement confidence alongside physical capacity.
Sleep management, stress reduction and lifestyle factors are addressed as part of comprehensive chronic pain management — not because they are the "cause" of pain, but because they are significant inputs to the nervous system's threat assessment and their improvement consistently reduces pain.
For patients where exercise physiology is appropriate — particularly those with co-occurring metabolic conditions or significant deconditioning — exercise physiology may also be appropriate.
Patients with chronic pain may be able to be treated through a Medicare GPCCMP (previously CDMP or EPC). For NDIS participants with chronic pain, see our NDIS physiotherapy page.
Our physiotherapists Yulia Khasyanova, and Mauricio Bara have experience in chronic pain management and are members of the Australian Physiotherapy Association. Yulia's certification in the Biopsychosocial Reframed Chronic Pain Treatment Model is directly relevant to complex chronic pain presentations.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
Pain that persists beyond the expected healing time for a tissue injury — generally defined as pain lasting more than three months — is classified as chronic pain. It affects approximately one in five Australians and is the leading cause of disability worldwide, producing a burden on quality of life, mental health, work capacity and healthcare utilisation that far exceeds the initial injury or condition that triggered it.
Understanding chronic pain requires a fundamental shift from the traditional model — where pain is understood as a signal of ongoing tissue damage — to the modern neuroscience model, where chronic pain is understood as a product of the nervous system itself. This shift in understanding is not merely academic. It directly changes what the most effective treatments are and why they work.
The neuroscience of chronic pain — why it's not what most people think
The traditional explanation for chronic pain — "your pain is because of your injury or structural problem" — fails to account for several well-established clinical observations: many people with significant structural findings on imaging (disc herniations, arthritis, rotator cuff tears) have no pain at all, while others with minimal structural findings have severe pain; the severity of pain does not reliably correlate with tissue damage severity; and pain frequently persists long after tissues have healed.
The modern neuroscience explanation is more accurate and more useful. Pain is an output of the brain — a protective response produced when the brain determines that the body is under threat and that action is needed. The brain integrates information from the tissues, from previous pain experiences, from the environment, from emotions, from beliefs about pain, and from social context to make this determination. In chronic pain, the nervous system has become sensitised — the alarm system is now set at a lower threshold, producing pain more easily and in response to stimuli that would not normally be threatening. This is called central sensitisation, and it is the underlying mechanism of most chronic pain conditions.
Central sensitisation explains why chronic pain is so often influenced by sleep, stress, mood, beliefs and social context — these are all inputs to the nervous system's threat assessment, and they all influence how much pain is produced. It also explains why treating the structural finding alone (the disc bulge, the arthritic joint) frequently fails to resolve chronic pain — the sensitised nervous system is the problem, and it requires a different treatment target.
What causes chronic pain to develop?
Chronic pain develops when the normal protective pain response that accompanies injury or illness fails to settle as expected. Several factors are consistently associated with the transition from acute to chronic pain: high initial pain intensity, early fear-avoidance behaviour (reducing activity because of fear that it will cause harm), poor sleep, psychological distress, low self-efficacy (limited confidence in one's ability to manage), and inadequate early management that focuses only on passive treatment rather than active rehabilitation.
Past pain experiences, adverse childhood experiences, trauma and psychological factors all influence pain system sensitivity and pain chronification risk — not because the pain is "all in your head" (a phrase that is both unhelpful and inaccurate), but because these experiences shape the nervous system's threat assessment in ways that persist.
Common chronic pain conditions
Chronic pain presents across a wide range of diagnoses. The conditions most frequently seen in physiotherapy practice include:
- Chronic lower back pain — the leading cause of disability globally. Central sensitisation is a significant component in many persistent back pain presentations, and pain neuroscience education combined with progressive active rehabilitation produces the best outcomes.
- Fibromyalgia — widespread musculoskeletal pain, fatigue, sleep disturbance and cognitive difficulties from generalised central sensitisation. Physiotherapy addressing pain neuroscience, graded exercise and sleep is central to management.
- Complex Regional Pain Syndrome (CRPS) — severe, disproportionate pain in a limb following injury, with autonomic and trophic changes. Graded motor imagery and desensitisation are the most evidence-based physiotherapy interventions.
- Chronic headaches — both cervicogenic and tension-type headaches have a significant central sensitisation component in chronic presentations.
- Chronic neck pain and post-whiplash pain — persistent pain following motor vehicle accidents frequently involves central sensitisation alongside structural contributors.
- Osteoarthritis — the pain of osteoarthritis is modulated significantly by central sensitisation, which is why exercise and psychologically-informed physiotherapy produce disproportionately large pain reductions compared to the modest structural changes involved.
- Chronic pelvic pain — a complex pain condition with musculoskeletal, neural and psychosocial contributors requiring a multidisciplinary approach.
- Myofascial pain syndrome — widespread trigger point pain from myofascial sensitisation. Dry needling and active exercise are the primary interventions.
- ME/CFS and chronic fatigue — conditions where pain, fatigue and central sensitisation are intertwined, requiring specific pacing-based management.
How can physiotherapy help?
Modern physiotherapy for chronic pain is built on the biopsychosocial model — addressing biological, psychological and social contributors to pain simultaneously rather than targeting structural findings alone. This is not a departure from evidence-based practice — it is the most evidence-based approach available for chronic pain.
Pain neuroscience education (PNE) is the most distinctive and important component of modern chronic pain physiotherapy. PNE involves reconceptualising pain with the patient — helping them understand that chronic pain reflects nervous system sensitivity rather than ongoing tissue damage, and that this understanding itself reduces pain and increases confidence in movement. Multiple systematic reviews and meta-analyses confirm that PNE reduces pain, disability and fear-avoidance behaviour in chronic pain patients.
Graded activity and graded exposure — progressively increasing activity levels within a quota-based framework, rather than a pain-contingent (stop when it hurts) framework — reconditioning the nervous system to tolerate movement and activity without producing disproportionate pain responses. The distinction is important: the goal is restoring confidence in movement, not simply increasing exercise load.
Manual therapy — joint mobilisation and soft tissue techniques — reduces pain through neurophysiological mechanisms including peripheral and central pain inhibition, providing short-term relief that facilitates participation in the active rehabilitation program.
Dry needling addresses myofascial trigger points that are consistent contributors to chronic pain in many presentations. Real time ultrasound assists in retraining the deep stabilising muscles that chronic pain has consistently disrupted. Clinical Pilates provides a structured, supervised exercise environment that builds movement confidence alongside physical capacity.
Sleep management, stress reduction and lifestyle factors are addressed as part of comprehensive chronic pain management — not because they are the "cause" of pain, but because they are significant inputs to the nervous system's threat assessment and their improvement consistently reduces pain.
For patients where exercise physiology is appropriate — particularly those with co-occurring metabolic conditions or significant deconditioning — exercise physiology may also be appropriate.
Patients with chronic pain may be able to be treated through a Medicare GPCCMP (previously CDMP or EPC). For NDIS participants with chronic pain, see our NDIS physiotherapy page.
Our physiotherapists Yulia Khasyanova, and Mauricio Bara have experience in chronic pain management and are members of the Australian Physiotherapy Association. Yulia's certification in the Biopsychosocial Reframed Chronic Pain Treatment Model is directly relevant to complex chronic pain presentations.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
