One in 5 people contend with a chronic musculoskeletal pain condition on a daily basis.  When pain has been present for over three months and previous solutions aren’t working, the forefront question is what should be key elements in my Physiotherapy consults going forwards?
It is important to firstly gain an understanding of your body and why your pain still lingers after you had expected to be recovered. When pain persists beyond our accepted tissue healing timeframes, it is important to understand why this has occurred and what can be done to resolve the problem. It is also important to feel safe when returning to movements which may induce some fear by this time. It has been demonstrated that long after any localised tissue damage may be present, the brain of a chronic pain sufferer retains ‘protective pain memories’ for movements which were initially painful.  An understanding of the localized tissues, including radiological investigations, in conjunction with education on central nervous system changes may assist in guiding a safe pathway back into movement and chip away at fear induced behavior.
If you’ve had pain for over 6 months, how likely is it that your pain and dysfunction will instantly disappear? The longer a problem is present, the longer it is likely to take to recover. This is where appropriate goal setting is crucial and perhaps your ‘goal posts’ need to be moved back just a little. It is important to also consider what aspects of your life are affected and not just focus on pain elimination when setting these goals. By setting functional goals, like getting back to gym classes, work or playing with the kids, you might just find your pain levels gradually reduce in your pursuit of these activities. It is not uncommon for patients to report still experiencing pain, however they are no longer shackled by it and generally feel better overall due to a return to meaningful daily activities.
Is it working?
Consider what treatment have you tried so far and where that has gotten you. To pursue the same course of action and expect a different result can be a waste of your time and money. If you’ve tried multiple sessions of massage, manipulations and machines, will another session really make the difference or is it time to consider an alternate pathway? Your Physiotherapist may encourage a more active approach to your rehabilitation and prescribe you a gradually progressive exercise program. This will address any reduction in conditioning or functional deficits which may have worked their way into your life as a result of this ongoing pain. The right type and amount of exercise can be just the ‘cure’ you were chasing.
 WHO Fact Sheet February 2018 http://www.who.int/mediacentre/factsheets/musculoskeletal/en/
 Exercise therapy for chronic musculoskeletal pain: Innovation by altering pain memories. Nijs. Et al. 2015