Why does your pain persist? – A letter to my patients suffering from chronic pain (part 1)

Therapists are welcome to link this post to their patients suffering from chronic pain.

First of all, I hate the word chronic. The word “chronic” sounds like the pain will last forever… but most of the time, it doesn’t. Furthermore, what does chronic even mean? The word creates debates even within healthcare professionals. Is it a pain lasting more than 3 months? 6 months? That will last forever?


I don’t like the word chronic. I prefer using the word persistent. The word persistent is less fear mongering and leaves hope. It’s more accurate. It only tells us that your pain has persisted, but doesn’t tell us that it will last forever.

If you have had pain for a while now, you probably went to see a lot of healthcare professionals so far. You might have seen a chiropractor, a doctor, an orthopedic surgeon, an osteopath, a physiotherapist, an acupuncturist… and the list goes on. All those might have given you a different reason for why your pain persists. A bone? A muscle? Something out of place? Some might not even believe your pain is real! All those might have given you a slight relief of pain but it comes back.

Your pain might now affect your social life, your mood, your appetite. Many people might think that you fake it, but you don’t.

Now let me tell you a few things. Your pain is real and your condition can improve.

The first step is understanding. A huge amount of research shows that understanding the mechanism of pain decreases pain.

(For the therapists, the actual research, a systematic review)

But it’s not only research! I have had a lot of patients with persistent pain. Some have had pain for more than 10 years!!! But we spent time talking, sharing and understanding. I explained to them what I am about to explain to you…  And hopefully this will help you as much as it helped them.

Mechanism of pain:
There are 2 main types of pain: Nociceptive pain and Central pain.

A nociceptive pain is often present with acute pain. It’s a pain that is associated with tissue damage. A fracture, a ligament tear, a herniated disc for example. The good thing is that all tissues have a healing time. A fracture takes around 6 weeks, a bad herniated disc can take up to 6 months… But they HEAL! So if you see abnormalities on your X-Ray or MRI, don’t freak out! Most of the time, they are not associated with pain… and if they are, those abnormalities will heal.

The central pain is a pain that is associated with hypersensitivity of the nervous system and is often present with more persistent pains. Understanding this is crucial.

Look at this diagram:

pain mechanism

Here, someone cut his hand. Nociception (a danger message) is sent to the brain. Once it arrives to the brain, the brain will decide whether or not it will create pain depending on many different factors (not just nociception!) –> This is crucial to understand!

Take for example, someone that walks on an iron nail. Do you think it will be painful if:

  1. He was casually doing a Sunday run
  2. He is followed by a dangerous lion that wants to eat him

… Well the pain will obviously be more intense in the first situation…. Regardless of the amount of tissue damage. This is explained by the fact the nociception (danger message – signal for tissue damage) can be modulated by the headquarter, in our jargon, the “central nervous system”. A small message can be amplified or decreased by the central nevous system. When the messages are amplified, we say that there is a hypersensitivity of the central nervous system (predominantly a central pain).

A small danger message can then create a big response.

This is especially true with phantom limb pains, a phenomenon in which amputated people feel the pain in their missing limb. Here, there is no danger message and there is still pain (Amazingly interesting if you are interested: https://www.youtube.com/watch?v=ySIDMU2cy0Y)

Now does it mean your pain is not real? NO! Your pain is real! It’s just that your pain is probably less linked to a tissue damage… but more linked to a hypersensitivity of your central nervous system. It’s a mechanism that is very similar to the mechanism of memory… when we learn piano for example. In a sense… you get a memory of pain. Pain is created more easily. As Albus Dumbledore once said:

“Of course it is happening inside your head. But why on earth should that mean that it is not real?”


Understanding this mechanism is the first step towards treating it. Understanding it decreases the hypersensitivity of the central nervous system.  Future posts will focus on what you and your therapist can do to treat this condition.

Now, feel free to ask questions! You MUST understand this.

In conclusion: 

  1. Pain is REAL.
  2. You can improve
  3. Nociception (danger messages or tissue damage) is not necessary nor sufficient to create pain.
  4. Pain is 100% created by the brain. Whether it’s an acute pain or a more persistent type of pain.
  5. Knowledge is power. Many researches show that understanding the mechanism of pain, decreases the sensitivity of the central nervous system.

Finally, a video to help you understand it even more:

I hope this helped,

your physiotherapist,

Olivier Lam



4 Replies to “Why does your pain persist? – A letter to my patients suffering from chronic pain (part 1)”

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