Chronic Pain

Pain is a specifically designed system designed to protect us from actual or perceived danger or body damage. Without it, we would not remove our hand from a hot plate, or recognise quickly that our leg is not supposed to stretch that far. However, what happens when pain becomes a continuous message that appears to no longer be related to actual tissue damage or threat? If all imaging and healing indicate that physically, everything appears all ok?

Chronic pain is described as “pain persisting for more than 3 months or beyond the expected time of tissue healing” [6]. All pain caused by muscle damage and inflammation can progress to chronic pain if not timely managed [7]. Chronic pain appears to cause mixed messages between movement and sensory feedback. Musculoskeletal deconditioning, fear of movement, general life stressors and impaired movements are likely to cause this mismatch and normal sensation will be interpreted as ‘warning signals’ or pain [7]. As pain continues for longer periods, a greater degree of sensory changes and abnormalities occur within the pain system, both in the brain and in the tissues [8]. However, none of these changes can be currently seen by any imaging. Chronic pain can lead to hyper-sensitivity or central sensitisation of the pain interpretation system [7] and these changes are proposed to occur as a consequence of associated learning memory from regular pain signals [9].

Additional symptoms may also present with chronic pain. Pain may appear to spread away from the primary injury site [8]. Stress and emotions can also increase pain [10]. Other chronic pain specific symptoms are sleep disturbance, fatigue and decreased concentration [10].

So what can be done to help? Treatment for chronic pain needs to be a collaboration between yourself and a physiotherapist experienced in treating chronic pain. In some cases, psychology and medical pharmacological intervention may also be required. Avenues Physio-Fitness has many physiotherapists who understand and treat chronic pain and have undertaken post-graduate study in this field. Do not worry, you will not be forced into any movement, or any hands on treatment unless your pain allows. We are passionate about educating you about your pain and how to turn down your hyper-sensitive pain signals with simple, non-threatening techniques. Our therapists work closely with all other people involved in your care and encourage the input and assistance from your friends and whanau on this journey. Please do not hesitate to contact us if you or one of your loved ones is suffering from unnecessary pain. It is time to achieve all of your goals, and get back to all your normal activities- let us help!


  1. Vance, C.G.T., et al., Using TENS for pain control: the state of the evidence. Pain Management, 2014. 4(3): p. 197-209.
  2. Johnson, M.I., et al., Transcutaneous electrical nerve stimulation for acute pain. The Cochrane database of systematic reviews 2015. 6: p. CD006142.
  3. Bertalanffy, A., et al., Transcutaneous electrical nerve stimulation reduces acute low back pain during emergency transport. Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine, 2005. 12(7): p. 607-611.
  4. Tracey, I., Can neuroimaging studies identify pain endophenotypes in humans? Nature Reviews Neurology, 2011. 7(3): p. 173-181.
  5. Saimon, Y., et al., Effect of tens on pain threshold: comparison of brief intense mode tens with DNIC. Physiotherapy, 2015. 101: p. e1314-e1315.
  6. Lewis, G. and D. Rice, Chronic pain: we should not underestimate the contribution of neural plasticity. Critical Reviews in Physical and Rehabilitation Medicine, 2014. 26(1-2): p. 51-86.
  7. Nijs, J. and B. Van Houdenhove, From acute musculoskeletal pain to chronic widespread pain and fibromyalgia: Application of pain neurophysiology in manual therapy practice. Manual Therapy, 2009. 14(1): p. 3-12.
  8. Arendt-Nielsen, L., C. Fernández-de-Las-Peñas, and T. Graven-Nielsen, Basic aspects of musculoskeletal pain: from acute to chronic pain. The Journal of manual & manipulative therapy, 2011. 19(4): p. 186-193.
  9. Zusman, M., Associative memory for movement-evoked chronic back pain and its extinction with musculoskeletal physiotherapy. Physical Therapy Reviews, 2008. 13(1): p. 57-68.
  10. Nijs, J., B. Van Houdenhove, and R.A.B. Oostendorp, Recognition of central sensitization in patients with musculoskeletal pain: Application of pain neurophysiology in manual therapy practice. Manual Therapy, 2010. 15(2): p. 135-141.