Chronic Pain Syndrome a complex, multifactorial condition that affects around 1 in 5 Australians over the age of 45. It is the third largest cause of disease burden (after cancer and cardiovascular disease) and costs an estimated 139 billion dollars through reduced quality of life and productivity losses.
What is chronic pain?
Typically, pain is a normal sensation in response to illness or injury, and it settles once the underlying cause has resolved. Chronic pain is different. It can develop when acute pain or injury is not well managed and persists for more than three months, or it may feel like constant, never?ending pain.
Chronic pain can also arise from a range of conditions, including:
- Arthritis and other joint problems
- Back pain
- Headaches
- Muscle strains and sprains
- Repetitive stress injuries (repeated movements that overload a body part)
- Fibromyalgia (widespread muscle pain)
- Nerve damage
Chronic pain is usually about much more than just physical pain and reduced movement. It is often accompanied by psychological symptoms such as stress, anxiety, depression, pain catastrophising (expecting the worst) and fear or avoidance of movement. This makes management more complex. Practitioners need to address not only the biological and structural aspects of pain, but also the psychological and social factors. This is known as the biopsychosocial model of chronic pain.
These biological, psychological and social factors all influence pain, and pain in turn influences them. This two?way relationship helps explain why treating only the structural side of pain often does not provide the long?term relief people are hoping for.
The mind map below shows how all factors (biological, psychological and social) affect pain, and how pain affects them right back – highlighting that treating the structural factors of pain usually won’t provide the long term benefits that patients are looking for.
In this blog, we will focus on just two of the many factors that influence chronic pain: pain catastrophising and fear?avoidance.
Pain, the brain and fear
When you experience pain or injury, peripheral nerves send signals up through the central nervous system to the brain, where they are processed and interpreted. The amygdala is the part of the brain that links certain events with fear and anxiety. For example, if you bend over to pick something up and feel a sharp pain, your brain may start to associate that movement with danger. The amygdala can then create fear and anxiety around bending in the future.
In the acute stage of injury, this response is helpful. It encourages you to move less and protect the area while it heals. However, if fear of movement and catastrophic thinking continue long after the tissues have recovered, they can contribute to ongoing pain and disability.
This is the basis of the fear?avoidance model of chronic pain. In simple terms:
- Pain leads to fear and worry (“this is serious”, “I’m damaging myself”)
- Fear leads to avoidance of movement and activity
- Avoidance leads to deconditioning, stiffness and more sensitivity
- Increased sensitivity and weakness lead to more pain
Over time, this cycle can cause central sensitisation—where the nervous system becomes more sensitive and reactive to pain signals. This can increase pain intensity, reduce function and raise the risk of long?term disability.
The fear-avoidance model of chronic pain based on the fear-avoidance model of Vlaeyen and Linton, and the fear-anxiety-avoidance model of Asmudson et al. (picture taken from Domenech, Julio & Sanchís-Alfonso, Vicente & Espejo, Begoña. (2011). Influence of Psychological Factors on Pain and Disability in Anterior Knee Pain Patients. 10.1007/978-0-85729-507-1_9.)
The take?home message
Your pain is real, and it is valid. It hurts, and it affects your life. At the same time, the way we think about pain and the fear we attach to it can make a big difference to how it behaves over time.
The more we focus on pain, fear and avoidance, the more likely we are to get stuck in a chronic pain cycle. Instead, the goal is to:
- Understand that pain is a normal biological process
- Recognise the role of thoughts, fear and avoidance
- Gradually and safely reintroduce movement and activity
With the right support, education and a graded approach to movement, it is possible to reduce pain, improve function and regain confidence in your body. Book your appointment HERE.
References:
Australian Institute of Health and Welfare. (2020). Chronic pain in Australia. Canberra: AIHW
Domenech, Julio & Sanchís-Alfonso, Vicente & Espejo, Begoña. (2011). Influence of Psychological Factors on Pain and Disability in Anterior Knee Pain Patients. 10.1007/978-0-85729-507-1_9.
Craig A. Wassinger, Gisela Sole. (2021) Agreement and screening accuracy between physical therapists ratings and the ?rebro Musculoskeletal Pain Questionnaire in screening for risk of chronic pain during Musculoskeletal evaluation. Physiotherapy Theory and Practice 0:0, pages 1-7.
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