Chronic pain is any pain that lasts for longer than 6 weeks and does not follow normal tissue healing trends. It is still a relatively misunderstood condition, with types, causes and symptoms currently being researched further.
Getting a proper diagnosis from registered, experienced professionals is vital for correct treatment. The symptoms of someone living with chronic pain are uniquely personal, and each person must be examined individually, and a tailor-made treatment plan must be developed.
What is Pain?
The International Association for the Study of Pain (IASP) defines pain as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage”.
During an injury, nerves send alarm signals to the brain via the spinal cord, and the brain sends signals back to the nerves. This process is part of our unique survival mechanisms, helping us to create an appropriate response to get us out of danger (run away from the dangerous wild animal, or the burglar breaking into our house, for example).
In the case of illness (such as a body ache when we have the flu), tissue hasn’t been damaged (this is where the “resembling tissue damage” or “associated with tissue damage” part of the definition comes in) -but the pain alarm still goes off to tell us we must get help from the “tribe” or find a remedy. Our bodies are still trying to alert us to something not being right - that we need to act fast to protect or help ourselves.
However, our body’s pain system is incredibly sensitive. In the way that a house alarm might go off when someone tries to open a door or window, our pain system can activate even before any real damage occurs. Imagine a house alarm triggered not just by someone trying to enter but by someone simply glancing through the window. That’s how sensitive our body’s alarm system can be.
Acute Pain vs. Chronic Pain
Acute pain usually has a sudden start and short (normally up to 6 weeks) duration, signaling an injury, or a health issue. It’s that vital protective function, prompting you to address the underlying cause. It can usually be readily identified and treated, and settles down as the injury heals or the illness passes. It is useful, and typically people aren’t worried about this kind of pain.
Unlike acute pain, chronic pain is defined as pain lasting longer than three months. Although tissues have healed, or the illness has passed, the pain may persist, often without a clear cause. This type of pain doesn’t respond to treatments as you’d expect. Painkillers, ice, or heat therapy may bring little to no relief, and in some cases, they can even make the pain feel worse. Chronic pain arises when the body’s alarm system becomes “stuck,” becoming hypersensitive to harmless stimuli.
The alarm becomes overly sensitive—it can go off from minor triggers, like a gentle breeze or someone walking by, long after the actual threat or injury has passed. When this happens, pain loses its original purpose, it is no longer useful and starts to cause ongoing distress.
This type of pain can lead to significant physical disability, emotional distress, worry, fear and confusion, as it can feel impossible to understand why the pain remains despite healing.
Types of Chronic Pain
Nociceptive pain
Nociceptive pain is caused by damage to or potential damage to body tissues and structures. It can feel like aching, stabbing, or throbbing pain, and is usually caused by an external injury (spraining your ankle) or a condition such as osteoarthritis (where joints become inflamed).
Nociceptive pain arises from signals sent by specialized receptors called nociceptors, which are responsible for detecting potential harm in body tissues. This type of pain is often linked to inflammation, pressure, stretching, or injury in the skin, muscles, joints, and ligaments, but not in the nervous system itself. It acts as a warning signal, alerting you to impending physical damage or potential injury.
Neuropathic Pain
Neuropathic pain, on the other hand, results from injuries or diseases affecting the nervous system, which includes nerves in the arms and legs, the spinal cord, and the brain. This type of pain can manifest as tingling, burning, or shooting sensations and is often more complex to treat because it involves changes in nerve function.
An example of a condition with neuropathic pain is diabetic neuropathy, which is nerve damage that can occur in disc herniation, which causes pressure, bruising and chemical irritation of a nerve. It is pain or numbness usually felt in hands, feet, legs or arms, but can also include shooting pains at night, and muscle weakness.
There are four types of Diabetic Neuropathy:
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Peripheral neuropathy: The most common type, affecting feet and legs
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Focal neuropathy: Affects single nerves, usually in the torso, head or leg
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Autonomic neuropathy: Affects the nerves that control internal organs
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Proximal neuropathy: A rare and disabling type of nerve damage in the thigh, buttock, or hip
Nociplastic Pain
Nociplastic pain is a term used to describe pain resulting from changes in how the nervous system processes danger signals. This type of pain reflects a heightened sensitivity of the danger system, meaning that even normal sensations can be perceived as dangerous and cause pain. Nociplastic pain can result from both functional and structural changes in the nervous system, indicating that the body’s alarm system has become overly sensitive.
It's important to note that nociplastic pain is not indicative of "pain being all in your head." Instead, it highlights how the brain and spinal cord change how they interpret danger signals in a manner that can amplify the experience of pain, and how the severity of pain might be influenced by many factors that might seem unrelated.
Mixed Pain
Mixed pain is a combination of various pain types occuring in the same part of the body. Mixed pain can be chronic or acute, and can include nociceptive, neuropathic, nociplastic pain. Mixed pain is frequently found in conditions such as arthritis pain, lower back pain, postsurgical pain, and cancer pain.
Common Causes of Chronic Pain
What are the main causes of chronic pain?
Chronic pain may begin after an injury, illness, surgery, or significantly stressful life event. If tissue damage was present, the area may have healed but the pain remains. An ongoing cause of pain such as arthritis, cancer, or an auto-immune condition can create chronic pain, too.
There are hundreds of potential contributors to chronic pain. However, research has identified several key elements that can predispose individuals to chronic pain:
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Genetics: if you have family members with chronic pain conditions, your risk of developing similar issues may increase due to genetic factors.
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Stress: stress is a well-known contributor to various health problems, including pain. Prolonged high stress levels can lead to tension and discomfort, making existing pain worse, or causing a nervous system or immune response leading to new onset pain.
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Poor Sleep: lack of quality sleep is often linked with stress and can exacerbate pain conditions, creating a cycle that’s hard to break.
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Lifestyle Choices: unhealthy habits such as smoking, poor diet, a lack of exercise or bad posture can transform a simple injury into a complex chronic pain condition.
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Traumatic Events: many people are unaware that traumatic experiences, whether from childhood or adulthood, can play a significant role in developing or maintaining chronic pain.
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Inactivity: failing to move or stay active can lead to joint stiffness, muscle weakness and increased pain, potentially worsening the situation over time.
Recognizing the Symptoms of Chronic Pain
So how can you determine if you have chronic pain? Here are some indicators to consider:
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Duration: chronic pain typically lasts longer than three months. If you’ve been experiencing pain for this duration, it may be an indication that your nervous system has adapted and is responding in a way that is no longer helpful.
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Treatment Response: if your pain isn’t responding to treatments as expected—such as medications or physical therapy—it could be a sign of that your pain has become ‘stuck’.
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Impact on Daily Life: chronic pain often significantly affects your ability to engage in daily activities. A concerning sign would be feeling unable to do things you want or need to do.
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Nature of the Pain: pay attention to how your pain feels. Is it spreading or moving? Does cold therapy seem to make it worse instead of better? In acute pain situations, ice typically provides relief, but with chronic pain, it can exacerbate discomfort.
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Sensitivity: Increased sensitivity to touch, light, sounds, or smells can indicate a change in your pain experience. For example, if a simple hug feels painful or overwhelming, it may suggest changes to your nervous system.
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Cognitive Changes: Chronic pain can impact cognitive functions, leading to difficulties with memory, attention, and concentration. Many individuals report feeling like they are losing their mental clarity or focus.
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Mood changes: feeling irritable, depressed or anxious
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Fatigue: chronic fatigue or bouts of extreme fatigue often accompany chronic pain.
If you identify with several of these indicators, your pain may have evolved into a chronic condition that requires more comprehensive management. Note that symptoms may vary based on the type of chronic pain experienced. If you are concerned about your symptoms please contact one of our clinicians for advice.
Managing Chronic Pain
Treatments for chronic pain symptoms
Chronic pain is a multidimensional phenomenon and hardly ever responds to just one treatment. Multimodal (combination) treatments have been proven to be most effective for the management of chronic pain and your treatment might consist of an individualized combination of any or all of the following:
Medication
A doctor might prescribe medication to help manage pain, so that it’s easier to start making some of the other changes, like exercising more, changing your diet, or getting enough sleep.
There are different types of medication prescribed to treat different kinds of pain. These include anti-inflammatories, analgesics (pain killers) and adjuvants (other types of medication). It is important to learn what each medication is supposed to do, and what the kind of pain is that it should be treating. You should also know how much of it you can and should take, and for how long, and learn about potential side effects and risks.
Therapy approaches
Therapies for pain management, prevention and treatment may include (but are not limited to) physiotherapy, occupational therapy, biokinetics, and dietetics. Your healthcare team will help address the physical, functional, and nutritional aspects of pain, helping you lead a more active and pain-free life. Treatment provided by the therapy team is known as non-pharmacological treatment, and can be effective for the management of nociceptive, neuropathic and nociplastic pain.
Learn more about physiotherapy, occupational therapy, dietetics and biokinetics, and how a combination of the right treatment options can address your unique type of pain.
Pain Procedures
Pain procedures are effective in managing nociceptive pain and some aspects or types of neuropathic pain. These procedures are often used to treat chronic pain secondary to an underlying condition, like osteo- or rheumatoid arthritis.
Pain procedures are not effective for nociplastic pain, but if your pain is mixed, turning the volume down on the nociceptive components can give you the brain space to work on the nociplastic pain in other ways, ultimately providing significant chronic pain relief.
A pain procedure does not treat the underlying condition, but aims to reduce the severity of pain.
The aim of a pain procedure is to reduce your pain so that you can make the necessary lifestyle changes to manage the underlying condition. The effect is temporary, and you may need to repeat the procedure when the effect wears off, as your underlying condition that causes your pain, such as osteoarthritis, does not go away.
Fortunately, procedures that use radio frequency technology can give pain relief that lasts between 6 and 24 months.
Surgery
Surgery may be one of the treatment options that your doctor will discuss with you, as some conditions do require surgical management. Read more about when you might need surgery here.
The importance of consulting with healthcare professionals
Treating chronic pain is more complex than treating acute pain, as there are so many layers, factors, and differences in how people experience their pain. This means that the best way forward is a multi-disciplinary approach, from a united but diverse medical team.
The Pain Collective is home to experienced healthcare professionals and chronic pain specialists, including physiotherapists, occupational therapists, biokineticists, neurosurgeons, psychiatrists, and more. Once your tailor-made team has been formed, they work closely with each other to make sure your condition is approached from all angles, in a fine balance of Western treatment and holistic management.
Understanding the different types of chronic pain, causes and symptoms is an excellent first step in addressing your condition.
We’re here to support you - to answer questions, provide treatment, get those pain levels down and bring back quality of life.
Call 087 550 0644 or email info@healthcollectiveheal.com for an appointment at any clinic.