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The complexity of chronic pain requires a thorough medical work up to determine the factors contributing to the condition as well as to match the underlying condition with the appropriate treatment.  The goals of the chosen treatment may include general pain relief, improvement in function and mobility, and psychological and emotional strategies to cope with the pain.  It is also important to prevent secondary musculoskeletal conditions.  Months or years of pain can alter muscles, joints, and nerve sensitivity, resulting in changes in posture, strength and mobility.
The goal of chronic pain treatment is to improve the quality of life of the patient.  This might mean giving them the skills to cope with some measure of pain, including sleeping tips, stress-reducing tips, and things that can be done to help them return to more regular activities.
Some of the more common treatments for chronic pain include:


Patients may also want to consult with their doctor or pharmacist regarding the use of over-the counter- pain relief or anti-inflammatory medication such as acetaminophen, NSAIDs (nonsteroidal anti-inflammatories, like ibuprofen) or aspirin.  If the pain does not go away with the regular use of an over the counter treatment, your doctor may prescribe something stronger.  Most doctors will work with you to determine to lowest dose of the medicine with the least amount of side effects that will decrease your pain to a level you can live with.  The medicine prescribed may be an anticonvulsant, an antidepressant or one of the many opioid analgesics.  One of the negative aspects of this type of treatment for chronic pain is that it treats the symptoms, but not the underlying condition [8].  In order to continue to receive relief from the pain, the treatment must be continued. Ongoing monitoring of the kidneys and liver are essential when taking long-term medications.  Even over-the-counter medications can have significant risk when taken over time, so be sure to tell your health care provider the type of medication, the amount you are taking as well as how long you have used the medication for pain relief.


It is critical that your health care provider refer you to a physiotherapist for a clinician-directed therapeutic exercise program designed especially for your needs.  There are a variety of exercises and activities that increase strength, range of motion and mobility but they must be appropriate for you and your needs. By performing gentle stretching or non-weight-bearing exercises such as swimming regularly, your muscles and joints will get stronger.  A study performed in 2006 showed that patients with chronic low back pain benefited from a specific Pilates-based exercise program [9].

Neural Downregulation

Neural downregulation is the technical term for treatments that change the messages the brain sends the body about pain and discomfort.  Things such as yoga, meditation, guided imagery, biofeedback and cognitive behavioral techniques play a critical role in changing the brain’s response and perception of pain.  The patient can use these techniques to choose their response to pain, which may result in a reduction of perceived pain levels.  These techniques can be a complement to more traditional therapies and have been shown to benefit people suffering from chronic pain [10,11].  In a 2008 study by Carrico, participants with chronic pelvic pain listened to a guided imagery CD which resulted in significant reduction in urinary urgency and pain in individuals with interstitial cystitis [12].

Healthy diet

A diet rich in vitamins and minerals and other needed nutrients and low in fat and sugar can help reduce pain.  In cases of pain caused by IBS, a diet high in fiber has been shown to be beneficial [13].  Optimizing your nutrition by avoiding processed foods and alcohol, as well as emphasizing lean protein, vegetables and fruits will not only reduce risk of further disease, but improve overall health.  Caffeine can elevate levels of anxiety and stress, which can thereby increase myofascial pain.  Conversely, caffeine has been shown to increase the pain-killing effects of aspirin and acetaminophen (Tylenol) by 40% [14].

Quit smoking

Smoking reduces oxygen in your heart and lungs, which slows the ability of the body to heal.  Smoking can result in smoker’s cough, which can increase pressure in the spine, abdomen, brain and eyes.  Nicotine also can increase the body’s perception of pain.  Quitting smoking is one of the most significant steps you can take to reduce your pain and improve your overall health.


This treatment is gaining ground as a viable option for those suffering from chronic pain.  People adding acupuncture to their treatment regimen show a marked improvement in results [15,16].  Results were even greater for women for whom other treatments did not work and who had a positive experience with acupuncture in the past [15].

TENS treatment

TENS, or transcutaneous electrical nerve stimulation, is thought to alter the pain signals as they travel to the brain.  For some people, it is a very effective treatment, but for others it seems to have no effect.  Research on the effectiveness of TENS treatment is also inconclusive [17].


Physiotherapy encompasses many different types of treatment starting with a comprehensive evaluation of your body’s systems, mobility and functional abilities. Based on those findings, your physiotherapist will choose specific techniques and interventions appropriate for your condition.  These may include manual therapy to increase range of motion of joints, ligaments and muscles; exercises to maintain strength, flexibility and mobility; postural correction; hands-on soft tissue mobilization; modalities such as interferential, cold laser, heat or cold therapies.  One of the most important interventions you can receive is education about the origins of chronic pain and the brain’s response to pain over time.  The book Explain Pain by David Butler and Dr. Lorimer Moseley is an extraordinary book for clients to understand the response of the brain to pain and how to change it.
Physiotherapy as a treatment for chronic pain can be very effective as it encompasses many of the other treatments discussed. It has also been shown that receiving encouragement from a therapist during treatment will increase motivation and ultimately improve results [18].  By working with a physiotherapist, instead of on your own, you will receive a customized rehabilitation program as well as encouragement and accountability to carry on with the treatment. Working with a highly trained physiotherapist gives you a better chance of success.    
In Balance Physiotherapy provides services for physiotherapy in Toronto.

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