Chronic Pain:

What is it and
What can we do.
Elizabeth Inscore, SPT
University of New England
 What is Chronic Pain?
Pain that persists beyond normal time of healing and/or
persisting for 3-6 months or longer
long-lasting, persistent, and of sufficient duration and
intensity to adversely affect a patients well-being,
function, and quality of life.
impairment is greater than anticipated based on the
physical findings or injury and it occurs in the absence of
observed tissue injury or damage.
 Neuropathic vs. Nociceptive vs.
Non-neuropathic a sensitization (CS)
1. Neuropathic: Pain eliciting nervous system changes, may have
irreversible effects if long lasting
2. Nociceptive: Pain stemming from
the physiological response of the
body due to a tissue damaging event.
3. Non- neuropathic central
sensitization: Increased signally in
the central nervous system that
presents as pain hypersensitivity.
 . How do we differentiate?
Step 1: Is this neuropathic pain?
- Is the pain arising from a direct lesion/disease to the nervous system?
Step 2: Does the pain have nociceptive origin?
- Is there a history of body tissue damage?

Step 3: What is the patient experiencing/presenting as now?

1. Hx. of tissue damage +local pain +following healing process
Nociceptive
2. Hx. of lesion to nervous system + medical dx. + pain/sensory
dysfunction neuroanatomical distribution Neuropathic
3. No hx. of lesion to nervous system + potential past tissue damage +
no medical dx. of pain + neuroanatomical illogical distribution CS
 The Psychological Components:
Pain continuum/catastrophizing
Fear of Movement
Perceptions of pain and the consequences
Emotional factors
Social/situational stressors
Motivation
Patient Reported Themes
experiencing chronic LBP:
1. Fear due to the unpredictability and
incontrollable aspect of pain
2. Negative past experiences reinforcing
fear of debilitation/degeneration
3. Societal beliefs about fear of damage,
horror stories
4. The need for diagnostic certainty
5. Repeated failure to control pain results in
regression
 Education:
1. Teaching anatomical foundations
2. Our patients want to know the
why
3. Pain doesnt always mean
damage!
4. Pain is not a result of neurological
changes
5. The body was meant to move
http://www.paininmotion.be/education/tools-for-clinical-
practice
 Interventions:
Metaphors, examples, pictures, models, hand-outs
Avoid utilizing negative/medical language
Suggest stress relieving options
Diaphragmatic breathing
Meditation
Develop strategies/goals that are patient led
Encourage/facilitate exercise and activity
Ergonomics/functional activities
 Cognitive Restructuring:

Used to decrease pain catastrophizing

and fear of movement

Identifying negative thoughts

Constructing realistic alternative responses
Positive self-coping statements
Therapeutic Exercise
Aerobic Conditioning
Range of Motion
Stretching exercises
Progressive resisted strengthening as tolerated

Manual Therapy
Passive range of motion
Grade I/II joint mobilizations
Soft tissue work
 References:
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