Understanding How our Pain System Works is a Key Step Towards Reducing Persistent Pain

Understanding How our Pain System Works is a Key Step Towards Reducing Persistent Pain

Pain is a natural and necessary part of the human experience. Although pain is often seen as a negative experience, it is an essential part of our built-in protection system. 

Acute pain is a normal response to injury. When you cut your finger, receptors in your finger send information to your brain that something has changed. If your pain system determines that you need to pay attention to your finger, to ensure that you stay safe, you will experience pain other reactions to prevent movement. The responses of your nervous system serve a protective function to ensure that you take care of your finger to allow the healing process to occur. Without this pain experience, you might continue to use your injured finger too much and delay your recovery. 

The nervous system is so good at protecting us, we often experience quite significant pain even when no or very minor changes in our tissue have occurred. We have all experienced intense pain when we stub our toe. Generally, within a few moments the pain subsides, and we realize nothing has been damaged. This is an example that pain is often experienced as a warning that we almost caused damage. Our pain system acts as a protective barrier to stop us before we have gone too far. 

Chronic pain is pain that persists longer than we would typically expect. It can last for weeks, months, or years, and can have many contributing factors. Persistent pain can significantly affect a person’s quality of life. Pain that doesn’t resolve as expected can be a challenge to manage and it can be partially explained as a sign that our pain system is still trying to protect us. Sometimes it is overprotecting us even though the original injury or condition in our tissues has gone through a natural healing response. Sometimes the protective barrier that our pain system puts up warns us to avoid movements far sooner than it needs to.

A thorough assessment with your health practitioner can determine whether your persistent pain is still signalling that something in your body requires further protection or needs to be examined more carefully. Sometimes this persistent pain is signalling that a body part simply is not tolerating the loads we put on it. For example, if you have arthritis in your knee you may benefit from using a cane and strengthening your muscles to better support the load. Knowing how to best pace your return to activities is important. Gradually increasing your activity is almost always the best idea but at a pace that does not “alarm” your built-in protective system.

Frozen shoulder courtesy of Kamloops Physiotherapy and Sports Injury Centre (Read the caption)

Pain is a complex experience that involves everything about us as humans. This includes the health of our tissues, our strength and endurance, the amount that our pain system is trying to protect us and our thoughts, emotions, fears, worries and past experiences. Information is transmitted from the site of injury to the spinal cord and then to the brain, where it is processed and interpreted. After considering the information from the tissues together with all the other factors, the pain system decides how to respond, all in a split second. The response of the pain system can include physical and emotional reactions such as increased heart rate, sweating, anxiety, muscle guarding and pain.

The emotional component of the pain experience can be present to some degree in all people experiencing pain of any type. A violin player may feel differently about a minor injury to a finger the day before a concert compared to an athlete in a rough sport in the middle of game. The amount of tissue injury could be very similar but how each person reacts to it will be individual. The pain experience is influenced by context. It may be easier to manage pain when doing something we enjoy, in a friendly, safe setting as compared to when we feel threatened or unsupported. As pain persists it affects all aspects of our life. Pain can keep us away from work, sports, hobbies and social interactions. This can affect our mood and energy and lead to fear and worry. These emotions can influence our pain system, increasing and prolonging pain. It is important to address both the physical and emotional aspects of persistent pain. 

There are a variety of approaches to managing persistent pain, including medication, injections and psychological support. It is important for individuals with persistent pain to work with their healthcare provider to develop a personalized treatment plan that addresses their specific needs. Mindfulness, meditation and breathing exercises are other examples of pain management approaches. 

Another approach to managing persistent pain is Physiotherapy.

Patellofemoral pain syndrome courtesy of Kamloops Physiotherapy and Sports Injury Centre (Read the caption)

Discover how physiotherapy can help manage your persistent pain

Physiotherapy is a specialized branch of healthcare that focuses on restoring movement and the management of pain. Physiotherapists provide education, physical treatment techniques and exercises. Physiotherapy is beneficial for individuals suffering from persistent pain, as it can help them to manage their pain more effectively and improve their overall quality of life.

Physiotherapists provide a comprehensive assessment to identify the underlying causes of movement problems and pain. They listen carefully to your story and ask questions about your medical history, lifestyle, and physical abilities. Once the underlying components are identified, a physiotherapist can develop a personalized treatment plan that addresses the specific needs of the individual.

Physiotherapy management for persistent pain may include pain science education, advice on activity pacing, self-management techniques like 

muscle release and breathing, manual therapy and exercise. Manual therapy involves hands-on techniques, such as massage and joint mobilization, that are designed to optimize movement in affected areas. Exercises are tailored to the individual’s specific needs and abilities. These exercises work to improve strength, flexibility, posture and control and can help to reduce pain and prevent further aggravation. Physiotherapists may also provide treatments such as acupuncture and dry needling. Acupuncture and dry needling both use fine needles that are inserted into specific points on the body to relax muscles and stimulate your natural built-in pain relief systems. Physiotherapists work together with other health practitioners including kinesiologists, registered massage therapists, occupational therapists, counsellors, and medical doctors to utilize a team approach to manage all aspects of your pain experience. 

Tennis elbow courtesy of Kamloops Physiotherapy and Sports Injury Centre (Read the caption)

Key goals of physiotherapy include providing tools that give individuals some control over the pain they are experiencing and improving function leading to an improved quality of life. Persistent pain can be scary and can impact an individual’s ability to carry out daily activities. Physiotherapy can help you understand how your pain system functions while improving your mobility resulting in decreased pain and increased function. Physiotherapists love to enable individuals to engage in activities that they may have previously found difficult or thought impossible.

Physiotherapy can also help to reduce the need for medication to manage persistent pain. Many individuals feel that pain medication is their only way to manage their symptoms. Pain relieving medication has its role and is managed by your doctor or pharmacist. Some people experience side effects and the amount of pain relief may decrease in the long term. Physiotherapy can provide ways to effectively manage pain, hopefully reducing the need for medication and avoiding side effects.

Physiotherapy can help prevent flare-ups or further injury. Individuals that are deconditioned can be at increased risk for falls, sprains and strains. Physiotherapy can help to improve strength, conditioning and balance reducing the risk of further injury and improving overall health.

In conclusion, physiotherapy has a lot to offer to help you better manage your persistent pain. It involves a range of tools including education, treatment techniques and exercises to improve function. Physiotherapy can be a standalone treatment or as part of a comprehensive treatment plan that includes other medical management, therapies, and psychological support. By working with a physiotherapist, individuals with persistent pain can improve their overall quality of life and reduce their reliance on medication to manage their symptoms.

(Adapted from Moseley, L. et al, Master Sessions , NOI Group 2022)


This appointment is your opportunity to tell us what hurts and discover whether physiotherapy or chiropractic care is a good fit for you! During this session, you will talk with a physiotherapist or chiropractor on a phone call (or online) and create the right care plan specifically for your pain. There is no obligation on this session is to find out whether physiotherapy or chiropractic care can help you getting back to doing the things you love in life.

Frequently Asked Questions

When we discuss that emotions and thoughts can contribute to pain, people will often say “so my pain is all in my head or is just psychological?” The brain is a key component of your pain system and thoughts, emotions and other ‘psychological” factors can contribute to your pain experience. This is not suggesting that pain is made up. All pain is real. Just remember to consider that pain is a very complex experience that is not all about the current state of your tissue and does not automatically signal that there is damage.

When you experience pain it can be associated with changes in muscle tension, circulation, nerve firing, hormone levels, heart rate, and breathing. It can also lead to fatigue, sleep disturbances, and changes in appetite and digestion. Additionally, pain can contribute to changes in thoughts and mood.

About John Howick

Kamloops Physiotherapy And Sports Injury Centre Kamloops Bc Physiotherapy John

John is a graduate of UBC where he obtained his physiotherapy degree in 1989. With over 30 years of private practice experience, John provides the vision and leadership that has allowed Kamloops Physiotherapy and Sports Injury Centre to become the largest private physiotherapy clinic in Kamloops. John balances his management role as owner of Kamloops Physiotherapy with a continued passion for providing optimal patient care to people with complex chronic pain and movement dysfunction.

Are you a current patient of John and want to book online with him or see his availability? Click the Book Now button below to go to our online booking page. 

Medical Disclaimer:

The information presented in this blog post is for educational purposes and should not be interpreted as medical advice. If you are seeking medical advice, treatment or a diagnosis, consult with a medical professional such as one suggested on this website. The Clinic Accelerator Inc. and the author of this page are not liable for the associated risks of using or acting upon the information contained in this article.

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