Understanding chronic pain: why your brain plays a key role.

You have had back pain for months. All examinations were normal – no slipped disc, no wear and tear, nothing structural. And yet it hurts. Every day. Sometimes even worse than at the start.

Or you recovered from an injury years ago – but the pain has stayed. What is going on? The answer is not always where the pain is. It often lies in the way our nervous system evaluates and processes signals.

What actually is pain?

According to the International Association for the Study of Pain, pain is “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.”

“Sensory and emotional experience” means that pain can be perceived in very different ways – for example as burning, stabbing, boring or tearing. At the same time, pain can be very distressing emotionally and feel tormenting or exhausting.

Even though pain is usually experienced as negative, it is vital for survival. It is a real, meaningful signal from our body: “Something is wrong here – watch out!” But this signal does not arise automatically from an injury.

Acute vs. chronic pain — an important difference

Acute pain: for example with a sprained ankle. The pain makes sure we protect the foot so the tissue can heal. As healing progresses, the pain decreases again.

Chronic pain (longer than 3 months): here the pain persists – often regardless of how well the tissue has already healed. Many patients then ask themselves: “Why is that?”

Sensitisation — when the alarm system is set too sensitive

So-called sensitisation processes in the nervous system often play a role here. This means the system becomes “oversensitive” – like a burglar alarm that is set too sensitive.

Our sensory cells can actually only detect stimuli such as pressure, stretch, temperature or chemical changes. The meaning of these stimuli only arises in the brain. So when people say “pain is created in the head”, it does not mean you are imagining the pain. On the contrary: the pain is real – but processing in the nervous system has changed.

Which factors can increase chronic pain?

• Stress and psychological strain: under stress the brain evaluates pain signals differently
• Lack of sleep: chronically poor sleep lowers the pain threshold considerably
• Avoiding movement: if you move less and less for fear of pain, you train the brain for danger
• Catastrophising: the belief that the pain will never stop demonstrably increases the experience of pain
• Social isolation: pain is social – alone it often feels worse

How can physiotherapy help with chronic pain?

Modern pain physiotherapy takes a holistic approach. It considers not only physical but also psychological and social factors. In our practice we use a combination of:

• Clear education about pain – you understand what is happening in your body, and that alone can bring relief
• Targeted pain management – individual strategies to cope better with everyday life with pain
• Individually adapted exercises – a safe increase in load so the nervous system learns to see movement as harmless again
• Manual techniques – targeted treatment of muscles, joints and fascia to relieve pain

Our certified pain therapist Sebastian has specialised in this field over several years. If you have questions or are unsure, please talk to us – we take time for you.