Understanding Chronic Pain

How Pain Works — and How to Work with It,

Not Against It

“Pain is real, but it is also changeable.”

We are physical therapists working daily with people who experiencing pain. Naturally, most individuals try to fight pain, push through it. This is an old school approach to the pain, unfortunately it doesn’t work all the time for all patients. However, modern Pain Neuroscience Education (PNE) has transformed how we understand and treat pain. Pain is not always a direct indicator of tissue damage. It is a multifactorial experience produced by the nervous system, influenced by biological, psychological, and social factors.



The 3 “Buckets” of Pain

Pain can be broadly categorized into three mechanisms:

1. Tissue-Based Pain (Nociceptive)

• Associated with actual tissue injury
• Example: acute injury (e.g., cut, sprain)
• Protective and short-term

2. Peripheral Sensitization

• Increased sensitivity of local tissues
• Pain may spread or refer to nearby areas
• Common in subacute injuries

3. Central Sensitization (Chronic Pain)

• Heightened sensitivity of the nervous system
• Pain persists beyond tissue healing (>3 months)
• Disproportionate pain response (“everything hurts”)

Why Chronic Pain Feels So Persistent

In chronic pain, the nervous system becomes overprotective and hyper-responsive.

Pain signals may continue even when:

• Tissue healing has occurred
• Imaging findings are minimal or normal
• There is no active injury

This reflects neuroplastic changes in nervous system, not imagined symptoms.

A Modern Approach to Pain

Treatment of chronic pain focuses on:

• Education PNE how the pain works, through the stories and metaphors.
• Graded exposure to movement doesn’t get to the point of extreme pain or excursion, take a rest breaks.
• Nervous system regulation: pain in the brain, which controls pain response.
• Behavioral and cognitive strategies

📖 Recommended reading:

Gordon, A. (2021). The Way Out: A Revolutionary, Scientifically Proven Approach to Healing Chronic Pain.

Clinical Guiding Principle

❌ “No pain, no gain”

✅ “More pain = less gain”

Excessive pain during activity can:

• Increase sensitization
• Delay recovery
• Reinforce fear-avoidance patterns

🎯 Therapeutic target: 0–5/10 pain range 

Motion Is Lotion🏃‍♂️‍➡️

Movement remains essential — but must be:

• Gradual
• Controlled
• Consistent

Motivational interviewing techniques are often used to support long-term behavior change.

Managing Flare-Ups: A Practical Approach

On days when pain increases:

• Reduce activity load (not complete rest)
• Pace activities with rest intervals
• Continue gentle movement
• Practice diaphragmatic breathing or mindfulness
• Engage in positive, enjoyable activities

Small regulation strategies can significantly reduce symptom intensity.

Mind–Body Perspective👀

Pain is influenced by:

• Stress levels
• Emotional state
• Cognitive patterns

Addressing these factors is critical for long-term recovery.

Final Thought💭

Chronic pain recovery is a gradual and adaptive process, requiring:

• Education
• Consistency
• Behavioral change

With the appropriate approach, functional improvement and symptom reduction are achievable.

Clinic Locations

Main Office

11820 Parklawn Drive, Suite 140

Rockville, MD 20852

📞 301-881-2273 📠301-881-3880

📧 info@ProActionPT.com | 🌐 www.ProActionPT.com

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6125 Montrose Road, Rockville, MD 2085

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Rockville, MD 20852

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