A Beginner's Guide to Chronic Pain: Part 1

Leonard Hazelwood
Apr 20
3 min read

Written by Lenny Hazelwood Clinical Exercise Physiologist | Strength & Rehab Specialist | Performance Coach

What is pain?

Pain is an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.

Pain is always a personal experience that is influenced to varying degrees by biological, psychological, and social factors.

It is important to note here, that in this brief description of the meaning of pain that:

Pain does not mean injury.
Injury does not mean pain.

Quote by Lorimer Moseley — Quote by Dr. Lorimer Moseley, Professor of Clinical Neuroscience and Foundation Chair in Physiotherapy at the University of South Australia

Are there different types of pain?

Through scientific research, we have identified that there are different types of pain. These have been categorised down below to name just a few:

Chronic pain
Acute pain
Nociceptive pain
Neuropathic pain
Nociplastic pain
Phantom pain
Referred pain
Radicular pain

And these can often overlap.

Absolutely essential pain facts to understand.

Essential pain fact 1:

Pain protects us and promotes healing.

Essential pain fact 2:

Persistent pain overprotects us and prevents recovery.

Essential pain fact 3:

Many factors influence pain.

Essential pain fact 4:

There are many ways to reduce pain and retrain the pain system.

Bonus:

If you are someone suffering from persistent back pain, I highly recommend reading this book:

Resolve Back Pain Handbook By Noi Group (Lorimer Moseley, David Butler, Hayley Leake, Ben Wand, James McAuley)

Rather than trying to sell you on the idea, check-out their book and decide for yourself. Click the link HERE to check it out.

How does exercise change for people with chronic pain?

In my own experience in working with a wide range of complex and chronic musculoskeletal pain syndromes, I've established 3 principles. They are as follows:

Listen and understand the person, not just their diagnosis. Understand and respect that pain is different for every individual, regardless of diagnosis. The "regardless of diagnosis" part is especially important. I can't count how many times I have had patients come in with the same diagnosis present differently in their severity of symptoms. A good example of this is a A: 15 year-old school boy vs B: a 40 year old tradie with a wife and kids coming in with a fracture in his humerus (arm). Lets say the severity of the fracture biologically was exactly the same, and in exactly the same location. The clinician they saw for diagnosis of the fracture was also exactly the same, and the communication they received was also identical. In example A, a 15-year old boy, the boy hears the news of the fracture and thinks "Wow, now I can't play sport. On the bright side, at least I get time off school, how good!" In example B, the 40-year old tradie with a wife and kids hears the news of the fracture and thinks "God! Now I won't be able to work! How am I supposed to financially provide and support my family? I am ruined!" Note that in both these scenarios, the injury was exactly the same, with the same diagnosis and the same communication given from the clinician yet the perceived pain or outcome of the injury was entirely different.
Ask questions to understand their current understanding of their injury or pain, and provide education on parts where they may be missing some information.
This one is pretty self-explanatory. The most important part is actually trying to understand where their current beliefs come from, rather than immediately trying to correct them.
Introduce a graded exposure approach to movement and loading.
Identify where they are currently at with movement, and start there. Educate that some pain is ok to push through, and some is not. For example, if someone struggled with severe back pain when bending over to pick a 20kg box off the ground - it may not be a great idea to start them with deadlifting 40kg off the ground. Instead, it may be a better idea to start them picking up a 10kg kettlebell from a box higher off the ground. Once they feel confident in doing, perhaps we keep the same height but increase it to 12kg, and then 14kg, then 16kg. Then we drop it back down to 10kg, but decrease the height of the box, and so on.