Persistent pain is defined as ongoing or lasting for more than 3 to 6 months, or pain that extends beyond the expected time period of normal soft tissue healing. It should be highlighted that persistent pain is common, with approximately 20% of people experiencing it in some form or another. Any injury has the potential to result in persistent pain, however most do not and the acute pain settles after the soft tissue injury has healed. So, why then do some people suffer persistent symptoms? The pain experience is a complex process, involving the area where the tissue damage occurred, in addition to the central nervous system which processes the pain. This includes the spinal cord and the brain. In order to understand why the pain may be persisting your physiotherapist will usually take a holistic approach, discussing your physical and psychological wellbeing in addition to other lifestyle factors.
Many people don't realise that physiotherapy can assist with persistent pain conditions. Clinicians at Auckland Physiotherapy hold post-graduate qualifications and are trained to manage complex pain conditions. Pain conditions that we can help treat include persistent pain, Fibromyalgia, complex regional pain syndrome (CRPS), phantom limb pain, headaches, and nerve damage.
Treatment is often multi-faceted and dependent on what we have highlighted together as relevant factors in your case. Your physiotherapist will thoroughly assess your condition to ensure an accurate diagnosis and treatment plan. We will set goals through shared decision making. Treatment may consist of pain education, use of pacing and an activity diary, pain modulating exercises, manual therapy, tailored exercise programmes, graded exposure techniques, mirror box therapy, Pilates, acupuncture, and trigger point therapy. Read below for specific disorders. For our blog on persistent pain see here.
Complex regional pain syndrome (CRPS) (formerly reflex sympathetic dystrophy) is a chronic systemic disease characterized by severe pain, swelling, and changes in the skin. It may initially affect an arm or leg and spread further up or down the limb; 35% of people report symptoms throughout their whole body. CRPS can occur after fracture, periods of immobilisation, nerve damage, and/or major traumatic injuries.
Recent research has shown that a graded motor imagery or 'mirror box therapy' can help reduce your pain and improve your function. All clinicians at Auckland Physiotherapy are trained in this and can guide you through this process. Research supports the use of graded motor imagery to reduce pain in CRPS. Follow this link if you would like to read more about graded motor imagery.
Fibromyalgia is characterised by chronic widespread pain and a heightened and painful response to pressure. Other symptoms include fatigue, sleep disturbances, and joint stiffness. The primary symptom of fibromyalgia, namely widespread pain, appears to result from neuro-chemical imbalances including activation of inflammatory pathways in the brain which results in abnormalities in pain processing. The exact cause of Fibromyalgia is unknown.
After a thorough assessment your physiotherapist will prescribe, and then take you through a tailored treatment programme to assist you with your symptoms. This may consist of stretches, strengthening exercises, Pilates, and other pain modulating treatments such as soft tissue release, acupuncture, and manual therapy. Recent research strongly supports aerobic and strengthening exercises as the most effective ways of reducing pain and improving global wellbeing of patients with Fibromyalgia see here .
