What is persistent pain?

Persistent pain refers to pain in any joint/area of the body that is felt on most days of the month for more than three months. (Train Pain Academy, 2023)

Pain itself is defined as: “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”. (Raja et al 2020)

Most injuries of body tissues heal naturally within three months but if pain continues, it no longer acts as a type of warning system alerting us that something is wrong. We then have to look at structures outside of the originally damaged tissue, as this ongoing pain is made up of more than just danger signals from the nerves of the damaged body tissues – it now includes:

  1. how the brain processes pain;
  2. how we feel emotionally;
  3. the meaning behind the pain; as well
  4. as our social experiences and circumstances at the time.

Persistent pain is like a broken alarm clock.

Persistent pain alarm clock illustrationImagine that your morning alarm clock goes off at 7 am and you roll over to switch it off, but it doesn’t go off like it’s supposed to do. You try banging the snooze button, unplugging the clock, taking out the batteries, and even throwing it out the window, but it still keeps ringing. You’re clearly awake now, so the ringing alarm clock is no longer serving a purpose, but it just won’t turn off.
The “pain alarm” in our body can be just like this broken alarm clock. It can just keep ringing and ringing even though it’s not helping us in any way or if there is no danger present for it to warn us about. (Coakley and Shecter, 2013)

How do patients recover?

Persistent pain seesaw illustrationThe recovery from chronic pain (persistent pain) is like learning to balance a seesaw. In this recovery process it’s important to get the skills and tools you need to keep the “seesaw of pain” balanced.

Sometimes people may have a really good day and the seesaw tilts up high. On such days, people may deny that pain is a problem at all, overdo activities, stay up too late, or skip medications altogether. This type of behaviour can, unfortunately, lead to one or more really bad days when the seesaw tilts down too far. So on a really bad day people may feel they can’t do any activity, feel they are sick, and believe they cannot function in their daily life.

The goal is to keep the seesaw balanced by pacing oneself with new activities and maintaining slow, steady progress from treatment.

Some of the tools to keep the seesaw in balance can include:

  • Medication;
  • Physiotherapy; and
  • Cognitive behavioural therapy. (Coakley and Shecter 2013)

So, if you have pain that feels like it won’t go away no matter what you do or feels like it is getting worse or spreading, even though it has been less than three months, make a booking with one of our physios and tell them that you think you may have a persistent pain condition.

  1. Coakley, Rachael & Schechter, Neil. (2013). Chronic pain is like… The clinical use of analogy and metaphor in the treatment of chronic pain in children. Pediatric Pain Letter. 15.
  2. Parker R, Bolton B, 2023. Concepts of pain. Module 1: Principles of pain. Lecture notes from Train Pain Academy. Delivered on 22 April 2023.
  3. Raja, S.N., Carr, D.B., Cohen, M., Finnerup, N.B., Flor, H., Gibson, S., Keefe, F.J., Mogil, J.S., Ringkamp, M., Sluka, K.A., Song, X.-J., Stevens, B., Sullivan, M.D., Tutelman, P.R., Ushida, T. and Vader, K. (2020). The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. PAIN, Articles in Press(9). doi: https://doi.org/10.1097/j.pain.0000000000001939.