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The complexity of persistent pain

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Niall Halliday

Physiotherapist (MSc Pain Science), Chairperson of Chartered Physiotherapists in Pain Management group, Irish Society of Chartered Physiotherapists 

A focus on the importance of understanding your pain, with its impact on your life; and the role of the physiotherapist in implementing coping strategies to help manage your pain.


Everyone has an understanding of pain, which is usually based on our own experiences, the experiences of those close to us, as well as ideas and information we get from wider society. When it comes to pain we often have a clear expectation of how much an injury or impact should hurt, where we should feel it and long it should last.

However, for many people this expectation is not met and pain does not behave they way we expect.

The cost of persistent pain on Irish society

There are a rare few people who are born insensitive to pain which, unfortunately, can lead to an accumulation of injuries and problems that in some cases can reduce life expectancy.

For a much larger group of people pain can become a constant feature in their lives, arriving without warning, affecting many areas of their body and lasting for a long time. This type of pain is called persistent pain and in Ireland a 2008 study found that over 20% of the population have had persistent pain for over 10 years.

Persistent pain has a huge impact on peoples’ lives affecting their mood, work, family relationships and finances. It is also a very costly problem for the health service with the the same 2008 study estimating the total cost of persistent pain at €4.7bn per year, which at the time was 2.55% of GDP.

Learning how to manage your condition

We now know that pain is multimodal with a number of factors affecting our experience. The complexity of persistent pain as a condition can seem like the greatest hurdle in both assessing people looking for help with their pain, and working with them to improve their symptoms.

However, our understanding of how the body works in relation to how we experience pain is developing all the time. This new understanding is placing neuroscience education for people in pain as a core part of recovery. Allied to this are developments in exercise physiology and prescription in persistent pain. Along with management strategies for mood and sleep, these strategies offer a solid platform upon which to base recovery. Physiotherapists also play an important role in helping people with persistent pain.

A multi-disciplinary approach to treating your pain

The best framework to understanding and manage persistent pain is the bio-psychosocial framework. By understanding this very complex condition from a biological, psychological and social perspective we have the best chance of planning a successful recovery.

Acknowledging this complexity is very important because, in my opinion, there are usually no quick fixes for persistent pain; there are slower paced solutions, which involve planning and teamwork between the physiotherapist and the person in pain.

Implementing pain management strategies with your physiotherapist

The role of a physiotherapist is to listen to the person in front of them and identify the factors affecting the person in pain. Using their knowledge of pain biology, exercise, goal setting and problem solving a physiotherapist can help the person in pain understand their condition and develop a recovery plan.

It is important for a physiotherapist to explain the significance of the many tests and scans people may have had, ensuring that the management plan in place is the right one. Developing fitness, education and management strategies take time for people in all walks of life and it is no different for those suffering with persistent pain. A strong relationship between the person in pain and the physiotherapist is key to a positive outcome.

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