Chronic PainUnderstanding and Management

Persistent pain is complex and influenced by tissues, nervous system, sleep, stress and context. The right plan supports progress.

What is persistent pain?

Chronic pain refers to pain lasting beyond normal healing time (usually >3 months). The nervous system can become sensitised, making pain easier to trigger and harder to settle.

Physiotherapy focuses on education, pacing, sleep and stress management, and a gradual activity plan to rebuild confidence and function.

Common features

  • Variable pain that is influenced by sleep, stress and activity
  • Muscle stiffness and reduced confidence in movement
  • Fatigue and difficulty pacing activity

Related symptoms: Fatigue, Muscle stiffness, Reduced range of motion

How can physiotherapy help?

  • Education about pain and flare planning
  • Pacing, sleep and stress strategies
  • Graded activity, mobility and progressive strengthening
  • Goal‑setting and a simple progress diary

Assessment and Diagnosis

Pain History

Detailed assessment of pain onset, triggers, patterns, and impact on daily activities and sleep quality.

Functional Assessment

Evaluation of movement patterns, strength, flexibility, and how pain affects specific activities and work capacity.

Psychosocial Factors

Assessment of stress, anxiety, depression, sleep quality, and social support systems that influence pain experience.

Treatment Phases

1

Education & Understanding

Learning about pain mechanisms, flare management, and the role of activity in recovery.

2

Pacing & Sleep

Developing sustainable activity patterns and improving sleep hygiene to support healing.

3

Graded Activity

Progressive return to movement, exercise, and daily activities with confidence building.

4

Long-term Management

Maintaining progress, preventing setbacks, and building resilience for ongoing health.

Pain Management Strategies

Activity Pacing

  • Break activities into smaller, manageable chunks
  • Use timers to avoid overdoing it
  • Plan rest periods before pain increases

Sleep Optimization

  • Consistent sleep schedule
  • Cool, dark bedroom environment
  • Wind-down routine before bed

Stress Management

  • Breathing exercises and relaxation techniques
  • Mindfulness and meditation practices
  • Identifying and managing stress triggers

Recommended Exercises

Gentle Movement

  • Walking in short, comfortable intervals
  • Gentle stretching and range of motion
  • Tai chi or gentle yoga
  • Swimming or water-based exercises

Progressive Strengthening

  • Bodyweight exercises starting very light
  • Resistance bands for controlled loading
  • Core stability exercises
  • Functional movement patterns

Relaxation & Recovery

  • Deep breathing exercises
  • Progressive muscle relaxation
  • Gentle massage or self-massage
  • Heat or cold therapy as appropriate

Recovery Timeline

Weeks 1-4

Education, pacing strategies, and gentle movement introduction. Focus on understanding pain and building confidence.

Weeks 5-12

Progressive activity increase, sleep optimization, and stress management. Building sustainable routines.

Months 3-6

Strengthening programs, return to work/social activities, and flare management strategies.

Ongoing

Long-term maintenance, prevention strategies, and building resilience for future challenges.

When to Seek Professional Help

  • Pain significantly affecting sleep, work, or daily activities
  • New or worsening symptoms that concern you
  • Difficulty managing stress, anxiety, or depression related to pain
  • Lack of progress with self-management strategies
  • Need for guidance on exercise progression or activity modification

Medical Disclaimer

This information is for educational purposes only and should not replace professional medical advice. Always consult a qualified healthcare provider for diagnosis and treatment.