Is Chronic Pain a Life Sentence

The term chronic pain is often misunderstood and poorly interpreted by many patients. It is, however, a common term in medical vocabulary, used primarily to describe the duration of symptoms rather than their severity or prognosis. Although it may sound frightening, this term has a more subtle and technical origin than most people expect, and it does not automatically imply irreversible damage or a permanent condition.

Medical classification of pain conditions

In medicine, classification is essential. No medical management can take place without a clear, shared, and structured framework that allows professionals to communicate clearly and consistently. Classification acts as a common medical language and plays a central role in patient safety. While the term chronic pain may appear alarming, it should primarily be understood as a medical label rather than a judgment about the seriousness of a condition (1).

What does the term chronic pain mean medically?

When referring to a medical label, it can be helpful to think of a classification system similar to a library. A structured system is required to organise information and allow clinicians to understand the timeline of a patient’s symptoms. Chronic pain is generally defined as pain lasting more than 12 weeks, or more precisely, pain that has persisted for at least 12 weeks. This classification helps healthcare professionals situate the condition over time and adapt their clinical reasoning accordingly. But does crossing this 12-week threshold truly change anything from a physiological perspective (1)?

Central pain mechanisms and nociceptive processing

Once pain has been present for more than 12 weeks, the patient’s experience of pain becomes increasingly influenced by central mechanisms within the nervous system. Pain signals and their chemical messengers, the neurotransmitters, ultimately converge toward the central nervous system. In persistent pain states, the brain may begin to overinterpret these signals, creating a self-sustaining loop in which pain perception is amplified. At this stage, the pain experienced by the patient is no longer proportional to the nociceptive input coming from peripheral tissues. This process is consistent with the concept of central sensitisation and altered nociceptive processing described in chronic pain conditions (2). It can be compared to a volume control that has gradually been turned up over time, where the brain increases the intensity of pain perception even though the original peripheral injury is often already healed.

Physiotherapy management of chronic pain

Many patients have a very biomechanical view of pain. A joint hurts, and the physiotherapist is expected to treat the painful area using specific techniques so that everything returns to normal and pain disappears. While this approach may be appropriate in acute situations, it overlooks an important component of persistent pain. Pain that has become centralised within the brain can also be modulated through different actions. Lifestyle changes, for example, can influence pain perception. Aerobic activity improves cerebral oxygenation and stimulates the production of molecules and neurotransmitters known to reduce pain, such as endorphins and serotonin, which are widely associated with physical activity. Sleep pathways also interact closely with pain pathways, meaning that optimised rest can reduce the brain’s sensitivity to pain (3). For this reason, physiotherapy does not act solely on peripheral tissues. Through education, clinical reasoning, and targeted interventions, it also contributes to the modulation of central pain mechanisms while continuing to address peripheral factors when relevant.

Can chronic pain be reversed?

No, chronic pain is not a life sentence. Pain is a subjective experience, and it is entirely possible to become pain free even when pain has persisted beyond twelve weeks, and even when it has been present for several years. Mechanical improvement of a joint, restoration of joint-specific health, and progressive strengthening are all areas that are extensively studied in universities and research literature to improve joint function. At the same time, patient management strategies are also deeply studied to understand how pain can be reduced as effectively as possible. It is important to consider that the difference between action and inaction on the patient’s side can be fundamental. A patient may present with shoulder pain lasting two years, but if no targeted physiotherapy intervention or structured management has ever been applied, meaningful improvement cannot reasonably be expected. Physiotherapy is, above all, a structured management of patients and their joint pain. The physiotherapist works toward the same objective as the patient: returning to normal function and becoming free of pain.

I provide structured and evidence-based online physiotherapy for patients worldwide, offering clinical assessment, diagnosis, and personalised rehabilitation.

I also receive patients in person at my physiotherapy clinic in Phnom Penh.

You can begin your online physiotherapy session through the dedicated platform:

https://www.studiohealthon.com/online-physiotherapy

More information on clinical standards and supporting evidence is available here:

https://www.studiohealthon.com/online-physiotherapy-clinical-evidence

Yannick Sarton, MSc Physiotherapist

International Online Physiotherapy & In-Clinic Care, Phnom Penh

References:

(1) Treede RD, Rief W, Barke A, et al. A classification of chronic pain for ICD-11. Pain. 2015. PMID: 26244543.

(2) Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011. DOI: 10.1016/j.pain.2010.09.030.

(3) Nijs J, Kosek E, Van Oosterwijck J, et al. Dysfunctional endogenous analgesia during exercise in patients with chronic pain. Pain Physician. 2012. PMID: 22430660.