Persistent pain – the issue isn’t in the tissue

What is pain?

Pain is an unpleasant sensation or emotion associated with actual or potential tissue damage. Everyone will have most likely experienced pain at times in their lives. You therefore will know that pain is never fun. However, it is really important for us to be able to feel pain. It is our alarm system that helps to keep our bodies safe and take action when needed.Man in acute pain playing soccer

‘Acute’ pain

Acute pain is the name we give to pain that is short lived. The pain that we get when we break a bone, injure a muscle, have a sore throat or burn our hand on the kitchen hob. It makes us act and listen to our body and will remind us to do the right things as it heals. There are times when our danger alarm becomes too sensitive and pain will hang around long after our body has healed or even when there was very little injury. This is what we call chronic or persistent pain. Unfortunately, this pain is not helpful and often can make daily life more challenging.



There are a few things to note about pain…

Pain is common within our population with one in five New Zealanders experiencing persistent pain.

Pain is:

  • Personal- one person’s experience of pain will be different to anothers and it is important to respect that.
  • Complex- as mentioned above, sometimes the ‘issue isn’t the tissue’. Pain involves all our body systems- our emotions, stress, sleep, our thoughts, our beliefs and even our immune system. Due to this it can affect many areas of your life which can be overwhelming. Due to the complexity, it can take time to explore the nature of your pain and deciding on the best pain management plan.

The ‘alarm system’

We have used the analogy of our pain receptors as an alarm system. Let’s go into this some more detail. Imagine a house alarm. The alarm goes off to alert us if there is danger – this could be due to a burglary, fire or even in some houses a gas leak. We hear the alarm and act on it – whether it’s switching it off, start to put the fire out or phone the emergency services. On hearing the alarm our brain starts to process things, without us even knowing, to determine how dangerous the situation is and which course of action we take and how quickly we take it. Sometimes, the alarm system can be faulty and go off if there is a big gust of wind or burnt toast. This means our house alarm is too sensitive and is trying to tell us there is danger when there isn’t.Persistent pain, woman in pain

Now, let’s put that scenario to our pain system. Instead of the house alarm, it’s the nervous system and our brain that get activated when we hurt ourselves. If we were to stand on a nail, the skin receptors would send a signal to our brain to alert us. We would then look down and see the nail, our eyes now giving our brain more signals that there is danger. Our brain will also be collating lots of different information to assess the situation and to decide the best course of action.  Do we pull the nail out or call the doctor? Like the house alarm above, our pain centres in the brain can also become sensitive. For some people even walking barefoot on a round stone can trigger the pain response as if there was a nail under the foot.


This is what we call ‘sensitisation’ and is when our alarm system becomes too good at protecting us. Things like clothes touching the skin, doing a simple daily task or even thinking about a certain movement can trigger a sensitive alarm system.

Persistent pain can make you feel you can’t do the same hobbies and activities as you previously would. This can result in you not spending the same time with family and friends. You may be worried about how you are going to get better from this pain and which healthcare professionals can help you with this. All these things can build and build, leaving you feeling sad, frustrated and anxious.


How do we help with persistent pain?

As physiotherapists we have a thorough knowledge of pain, the nervous system and how these express themselves in persistent pain. Physiotherapists can help with the process of resetting the sensitive nervous system and empower those living with pain to make changes. Eliminating pain completely isn’t always possible but it is possible to live well with pain!

Not only will we ask lots of questions about your pain but we will dig a little deeper. We will explore your emotions, thoughts and beliefs of your pain, your sleep and more. Being able to acknowledge these as crucial components of your pain experience is important.



BreatheYou will have heard us encouraging exercise and movement for a myriad of physical and mental health reasons, over and over and over again. And here we go again. Movement! When in pain, you will often protect yourself by avoiding movements that are painful or adapt movements. This can be okay in the short term but when lack of movement becomes a habit this can add to your pain. Same with altered movement patterns, after time this could present itself in a different ache or pain. When you fear doing a movement due to pain this will also set off the alarm system. Over time even thinking about doing that movement can trigger the pain response. We realise that this can be a daunting process when you are in constant pain so we will assist you to pace and set small and realistic goals. Furthermore, finding movement in a form that you enjoy is key!

We can help explain pain.  With with more research emerging there are some great tools and resources that can help us help you. We can help devise a safe and effective approach to dulling down that pesky, unhelpful alarm system when it gets too sensitive. If you are living with persistent pain and want to see one of our physiotherapists, please call 03 443 1711 to book an appointment.

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