Understanding the Role of Physiotherapy in Chronic Pain Management

Understanding the Role of Physiotherapy in Chronic Pain Management

Feb 05, 2023

Anna Tempczyk

Everyone feels pain, which is a healthy response in the body. However, when pain persists, chronic pain may develop. Chronic or persistent pain is pain that carries on for longer than 12 weeks despite medication or treatment.


Most people get back to normal after pain following an injury or operation. But sometimes the pain carries on for longer or comes on without any history of an injury or operation.


Chronic pain can also affect people living with:

  • diabetes
  • arthritis
  • fibromyalgia
  • irritable bowel
  • back pain


Chronic pain often leads to physical deterioration, limited functional capacity, and emotional stress.


Chronic pain can be pain that exists outside the normal tissue healing process or in the absence of evidence of tissue damage or a biological cause for the pain symptoms. Chronic pain becomes a disease of the central nervous system.


There are several different types of chronic pain that can manifest as hyperalgesia, heightened sensitivity to pain, pain sensitivity to non-painful stimuli, or response to irregular abnormal sensations.


For many, chronic pain can have a detrimental effect on daily life. Sleep, work, home life, leisure activities and the ability to interact with children, family and friends will be affected. In cases where the pain is severe, chronic pain can keep sufferers from participating in social events and even affect their ability to work or play.


Psychological factors such as anxiety, depression and stress are closely related to chronic pain. Negative emotional events can cause a sensation of pain in the absence of tissue damage, which can worsen pain symptoms.


However, physiotherapists can play an important role in the management of chronic pain as our profession allows us to understand the limitations and dysfunctions that result from it.


By working with a physiotherapist who understands pain, you have the ability to treat symptoms holistically to improve your quality of life. The physiotherapist will set the patient with specific goals that can be achieved that suit their lifestyle. Physiotherapy must also consider the patient's particular condition and well-being to enable them to progress towards recovery.


From a physiotherapy point of view, chronic pain management requires a multidimensional approach coupled with the efforts of general practitioners, psychologists, orthopaedic specialists and rheumatologists to ensure greater benefit from treatment.



  • Patient education: Educating and increasing the patient's understanding of chronic pain is an important step in managing this condition.
  • Exercise: Often, due to the severity of chronic pain, participation in exercise is reduced due to fear of worsening symptoms. Patients are often advised not to go through pain due to fear of increased pain. Physiotherapists will be able to advise and prescribe pain-free or pain-relieving exercises to restore patients' mobility. A physical therapist can create a gradual approach to exercise based on a person's needs and to improve strength and flexibility.
  • Manual therapy: With restricted movements or limited exercise due to chronic pain, joints can become stiff and irritable. Your physical therapist can help by manipulating or mobilizing your joints to restore movement.
  • Soft Tissue Manipulation: Your physical therapist may opt for massage, trigger point therapy, myofascial release, and stretching to improve movement and reduce pain. Soft tissue treatment can desensitize the area of pain.
  • Pilates or posture exercises: Pilates with physical therapy can be an excellent treatment option, especially for chronic neck or back pain, as it is low intensity and helps build strength and control. Physical therapists may also offer patients a home exercise program with postural exercises.
  • Electrotherapy, Ultrasound Therapy: Treatment options can be effective in reducing pain.
  • Heat and cold treatment: This can be effective for pain relief. The heat helps relax muscles, stimulates circulation, and increases blood flow to the area, which can reduce pain. Cold therapy reduces the blood supply to the area, numbing the area and slowing down the transmission of pain from the nerves to the brain. Chronic pain patients can begin to control their pain and resume participation in daily activities. The goal of physiotherapy is to enable the patient to regain control over their life and to reduce the fear and avoidance associated with chronic pain