Chronic pain can feel overwhelming, but you’re not alone in this journey. Whether it’s back pain, headaches, arthritis, or another persistent condition, we’re committed to helping you regain control. Our approach combines therapeutic education and guided movement, focusing on what works best for your body. We’ll help you understand your pain, learn techniques to manage it, and rebuild strength and mobility. Pain doesn’t have to define your life. We’re here to support you every step of the way, working together to bring comfort and movement back into your daily routine.
There are two main concepts of chronic pain that are important to distinguish. The first is chronic pain in terms of duration, defined as pain lasting longer than expected, usually more than 3 months.1 The second, and more clinically relevant in the field of physical therapy, is chronic pain as a dysfunction. This refers to pain that persists even after normal tissue healing has occurred and is no longer directly tied to a specific tissue injury or structural issue. This form of chronic pain often involves altered pain processing within the nervous system and becomes the central focus in PT management.
This distinction matters. For example, someone with advanced osteoarthritis in the knee who is waiting on a joint replacement surgery may experience ongoing pain, but that pain is still being driven by a clear mechanical and inflammatory process- this is chronic in time, but not necessarily “chronic pain” in the PT sense. In contrast, chronic pain as we refer to it in therapy often involves the nervous system sensitisation, altered pain processing, and sometimes psychological or emotional contributors.
Chronic pain is a widespread issue, affecting over 50 million adults in the US.1 Of these, approximately 20 million experience “high-impact” chronic pain, which significantly limits major life activities such as working, caring for oneself, or participating in social roles.2 Certain populations are disproportionately affected, including women, older adults, individuals with lower socioeconomic status, and those with a history of trauma.
The impact of chronic pain extends well beyond physical discomfort. It can severely impair mobility and function in daily life, disrupt sleep, deplete energy, and contribute to emotional distress. Mental health is often affected, with higher rates of anxiety and depression seen among those who live with chronic pain.3 Chronic pain also hinders one’s ability to work, maintain relationships, and sustain independence.
This is where PT plays a crucial role. By addressing complex, multifactorial nature of chronic pain- including physical, neurological, and psychosocial components- a PT helps patients reclaim function and improve quality of life. Through targeted education, therapeutic movement, nervous system regulation, and gradual reintroduction to activity, PTs support patients in reducing pain and restoring independence.
Chronic pain can arise from a complex interaction of biological, psychological, and social factors. It is not always the result of prolonged tissue damage but often involves nervous system sensitization and maladaptive responses to pain. Some of the most common causes and contributing factors include:
There are certain factors that increase a person’s vulnerability to developing chronic pain.
Numerous chronic health conditions serve as direct contributors to long-term pain, including:
Chronic pain presents in a multitude of ways, depending on the underlying cause, duration, and body systems involved. In cases where pain persists due to ongoing tissue irritation-such as a rotator cuff repeatedly aggravated by weekly bench pressing- the pain may be considered ”chronic in duration.” This type of chronic pain is often tied to a mechanical or structural issue that is consistently irritated. In these instances, symptoms might include localized soreness, limited range or motion (ROM) or stiffness, as well as discomfort that recurs with certain movements or activities, often improving with rest or modification.
On the other hand, the hallmark symptoms of what PTs more specifically refer to as chronic pain as a dysfunction go beyond typical tissue healing timelines- generally considered 8-12 weeks. In these cases, pain persists despite the absence of active tissue damage and is thought to be driven more by changes in the nervous system, a phenomenon known as central sensitization.6 Individuals with this type of chronic pain often describe widespread discomfort, hypersensitivity to touch or movement, fatigue, poor sleep, anxiety, and heightened pain response to stimuli that otherwise shouldn’t be painful. This type of chronic pain is often less about damaged tissue and more about how the brain and spinal cord process pain signals which can make it more challenging to manage and treat.
If you’re experiencing pain that has lasted longer than three months- especially pain that has affected your ability to function at work, home, or in social settings- it may be time to consult a PT. Unlike acute pain, which typically responds to rest and healing, chronic pain often involves the nervous system rather than ongoing tissue damage. Because of this, diagnostic tests like X-rays, CT scans, and MRIs may offer limited insight and are not typically the first line of assessment. Instead, diagnosis relies heavily on subjective reporting and functional evaluation.1
During your initial evaluation with a PT you will be asked in-depth questions regarding your health history, medications, and the nature of your pain- including its location, duration, and any aggravating or alleviating factors. You might also be asked to complete pain and function questionnaires to assess how the condition is impacting your overall quality of life. These functional tests help the PT to identify areas of dysfunction that might be contributing to your pain experience. A PT will also assess how you move and function in everyday tasks. This movement-focused approach is designed to guide a personalized treatment plan that addresses not only physical symptoms but also the border impact of chronic pain on your daily life.. If a serious condition beyond the scope of a PT is suspected, they might refer you to a physician for further diagnostic testing.
Living with chronic pain can feel isolating and confusing- especially when tests indicate nothing is “wrong” but the pain is very real. The good news is, there are effective, non-invasive ways to treat chronic pain by addressing how your brain and nervous system process pain. Surgery is rarely needed, and in most cases results in failed outcomes.
These approaches are focused on calming the nervous system, improving movement, and rewiring the brain’s perception of pain.
Surgery is rarely effective for chronic pain that isn’t tied to ongoing tissue damage:
While not all chronic pain can be prevented, there are proactive steps you can take to reduce your risk and build resilience against long-term discomfort. Prevention focuses on maintaining a healthy, active lifestyle, managing stress and addressing pain early on. Listening to your body, modifying activity as needed, and staying consistent with self-care routines can go a long way in protecting health long-term. Strategies for prevention include:
Living with chronic pain can be overwhelming, but there are proven strategies to help manage it more effectively. One powerful approach comes from the work of Adriann Louw and the Pain Neuroscience Education model, which emphasizes the idea that pain is not always a sign of injury but rather how the brain processes perceived threats such as pain.9 Understanding this can help reduce fear, increase movement, and break the pain cycle. Programs such as Exercise is Medicine (EIM) also support the use of regular, personalized physical activity as a safe and effective way to manage chronic pain, improve mood, and enhance quality of life.10 Coping strategies such as activity pacing, mindfulness, diaphragmatic breathing, and maintaining a consistent routine can help individuals regain control and reduce the impact of pain on their daily lives.
During a flare up, it’s important to stay calm and avoid catastrophizing. Using techniques such as gentle movement, relaxation techniques, or guided meditation can aid in reducing the influence of the parasympathetic nervous system and thus reduce pain. It is also important to remember that what works for one person might not work for another and it might take some exploration and trial and error to find what coping mechanism works best for you. A personalized treatment plan under the guidance of a licensed PT is crucial. This plan should evolve with your needs and include both physical and psychological components. Seeking professional guidance ensures you’re not alone in navigating the complex \ities of chronic pain. With the right support, you can build resilience, reduce the intensity and frequency of pain, and take meaningful steps towards recovery.
Physical therapy is a highly effective, evidence-based approach to managing chronic pain. Unlike medications that simply act as a band-aide to mask symptoms, PT aims to address the root causes of pain while improving mobility and function. Through targeted exercises, hands-on techniques, and patient education, PTs empower individuals to better understand and manage their pain and related symptoms for long term relief.
At the onset of treatment, a PT performs a comprehensive initial assessment. As mentioned, this includes obtaining an extensive past medical history as well as assessment of physical limitations, movement patterns, strength and ROM, as well as pain behaviors including frequency, duration, and aggravating or alleviating factors. At Confluent Health, this process also includes a biopsychosocial approach that recognizes that chronic pain is not just a physical issue, but often influenced by emotional, psychosocial, and lifestyle factors; this assessment guides the development of personalized treatment plans that are tailored to the patient’s unique goals and needs.
PT for chronic pain may include a variety of techniques and interventions, such as:
The ultimate goals of PT are to reduce pain, enhance function, and improve overall quality of life. Sessions are designed to promote gradual progress and long-term success, not just temporary relief.
Personalization is key- no two individuals experience chronic pain in the same way. That’s why treatment plans are continually adjusted based on patient response and progress towards goals. The partnership between the PT and patient is built on communication, trust and shared decision making.
If you’re living with chronic pain, you don’t have to manage it alone. PT offers evidence-based, non-invasive solutions that can reduce pain, restore function, and improve your quality of life. Take the first step towards healing- schedule a consultation with a licensed PT at Confluent Health and begin a personalized plan to regain control of your health and well-being.
Physical Therapy can help provide Pain Neuroscience Education to help you better understand the source of your pain. Additionally, your PT can provide graded exposure to movement and exercise at a pace that fits you.
Yes, we offer virtual reality treatment using the Oculus Quest headset. Our pain science apps can help you learn about the cause of your pain and strategies to improve it, backed by research.
Chronic pain can persist even after tissues have healed due to changes in how your brain and nervous system process pain, this is known as central sensitization.
No, chronic pain is read and valid. While it may not always be linked to tissue damage, it results from complex interactions between the brain. Nerves, and body.
Yes, many people experience significant relief through a combination of education, movement, lifestyle changes, and support. While it may take time, recovery is possible.
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