5 tips for managing your chronic pain
1.Get clear on your diagnosis
Sometimes when you’ve had pain for a long time and seen lots of health professionals with different opinions, it can become difficult to know what your exact diagnosis is - and with it, what you should and shouldn’t be doing.
Getting clear on your diagnosis is the logical first step to navigating a tricky chronic pain problem.
We know that with long term pain problems, pain can persist even in the absence of ongoing injury in the body - your injury might have healed, but the pain hasn’t gone away. We call this an “overprotective pain system.”
Pain after an acute injury is a very helpful tool. For example, if you strain a hamstring muscle when running, you might feel immediate pain which signals that you need to rest to allow your body to heal. However, if your hamstring pain is still there 12 weeks afterwards, despite the muscle strain having healed, then that pain is potentially no longer as useful, and might actually be inhibiting your recovery!
If you have had pain for a long time, the first question you want answered is “is there ongoing injury in my body (e.g. a bone stress fracture, underlying inflammatory condition) that is contributing to my pain, or is my pain more likely to be a result of my pain system being “overprotective”?
Seeing a qualified health professional who can take a thorough history of your pain problem, complete relevant tests and refer on for any necessary investigations is a great place to start.
2. Function before pain
Often with recovery for a long term pain problem, people will notice their function (i.e. the things they can do with their body - for example their fitness, or strength, or ability to bend over, lift things up, squat etc.) will improve before their pain does.
Having less pain is a very reasonable and logical goal, and one that most people come to see a physiotherapist with.
Focusing on improving your body’s function, and ability to move and complete relevant, meaningful activities can help you to stay engaged with the process even if your pain is not yet improving in the way you’d like.
In this early phase of recovery, it would be normal to see someone’s function start to improve, whilst their pain potentially remains the same. It can be really challenging to stay motivated during this time.
3.What are your goals?
“Function before pain” leads perfectly into point 3… what are your goals?
Having a clearly defined goal is the perfect way to allow you to maintain focus on your functional recovery.
If you aren’t sure what your goals are, a good question to ask yourself might be…”If I had no pain, what would I be doing now that I am currently not?”
By identifying your goal, you can clearly work backwards from the destination to where you are currently at, and figure out the small, incremental steps you will need to take to achieve your goal.
For example, your goal might be to run 5km continuously in 6 months time, but you can currently only run for 400 metres without pain. Your plan might first involve a block of strength training to build lower body capacity and robustness, before transitioning to a jog:walk program, slowly building up your distance and intensity until you achieve your 5km goal.
Again, working with a qualified professional can help a lot with this, as it can be difficult to know where to put your energy, how fast to progress your plan and so on.
4.Smart small and build from there
Assuming you have had pain for a long time, and thorough investigations have ruled out any sinister underlying pathology that might be a cause of the pain, then completing activities with a low level of pain/discomfort can actually be safe - and an important part of the recovery process!
When people have been in pain for a long time, they can change the way they move or even stop exercising completely, which can lead to deconditioning and weakness that can in turn make the pain worsen over time.
When you start to move your body again after a long period of inactivity, starting off small can be a nice way to build confidence again.
In the clinic we call this “getting wins on the board” - which means dipping your toes back into exercise or movement in a controlled way without flaring up your symptoms significantly.
Once you have a few wins on the board, confidence increases and we can start to slowly ramp up the effort and intensity of exercise to keep working towards achieving the goals we mentioned in point 3.
5.Consider lifestyle factors
Make it stand out
Last but not least, it’s worth thinking about lifestyle factors such as stress, sleep, mental health, diet, alcohol intake and smoking, and how these might be a part of the bigger picture of your chronic pain problem.
There is a strong body of evidence suggesting that high levels of stress can impair healing processes Walburn et. al (2009), and similar evidence exists for the impact of poor sleep and food intake on recovery (Schwarz et. al 2013). Alcohol and cigarettes are also both pro-inflammatory substances which can affect recovery and pain system function.
It’s rare that one of these lifestyle factors alone will be the whole picture, but taking a wider view will allow you to identify more targets for intervention.
Making adjustments to these factors might improve pain symptoms, or it might just improve your body’s ability to recover, meaning you can implement more movement based strategies in your day to get things heading in the right direction.
References:
Schwarz, P., Graham, W., Li, F., Locke, M. and Peever, J. (2013) 'Sleep deprivation impairs functional muscle recovery following injury', Journal of Sleep Research, 22(4), pp. 366–371. Available at: https://www.sciencedirect.com/science/article/abs/pii/S1389945713018534 (Accessed: 29 April 2025).
Walburn, J., Vedhara, K., Hankins, M., Rixon, L. and Weinman, J. (2009) 'Psychological stress and wound healing in humans: A systematic review and meta-analysis', Journal of Psychosomatic Research, 67(3), pp. 253–271. Available at:https://www.sciencedirect.com/science/article/pii/S0022399909001317
