Neuropathic and Chronic Pain: What are they?

Acute pain, neuropathic and chronic/persistent pain: How Physiotherapy helps

  1. Nociceptive pain is the feeling you have immediately when your sprain, burn or bruise you tissue. This settles within normal guidleines for tissue healing
  2. Neuropathic pain is related to underlying nerve pathology
  3. Persistent or chronic pain is influenced by your beliefs, thoughts and emotions and previous experience

Chronic pain is challenging to treat. This is often because by the time you consult me you have tried and abandoned many other unsuccessful treatments. Your fear and beliefs may have become entrenched by false information and bad experiences.

Maladaptive pain

Recent pain research tells us that the original reason for pain (any damage or strain to tissues) has healed. But the brain and nervous system remember the pain and the way you moved initially to protect the pain source. This is a maladaptive pattern.

Chronic pain: Treatment

At In Touch Physiotherapy I approach pain treatment and management with a dynamic plan.

  • I help you change your beliefs and improve your understanding of how pain works
  • This leads to the best outcomes for you

rom the posters in my next blog;

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  • you can see a path you may have travelled
  • If you are ready we can work together to choose a new path 

When you first felt pain, depending on your past experience and beliefs, your brain put it in the context of:

  • a burn/blister
  • a minor sprain or
  • a warning that something disastrous was occurring in your body

Your nervous system then carries the message that something has happened to a tissue or area of your body. The message is accurate, quiet and precise when it starts from the source of your injury or strain.

Thought viruses

With time when recovery does not occur as fast or completely as you wish, or if your beliefs that something serious is wrong amplify the messages. Thought viruses take over.

You then take more evasive actions to protect the "injury"

The messages to your brain become stronger until they dominate your day and you stop doing anything because of fear

A you've experienced, chronic pain does not improve on its own.

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My approach to improve your pain management is to look at your belief systems and help you to understand what the pain represents, and how you can learn to move again and enjoy life.

Retraining your brain is possible.

I take a systematic approach including:

  • Seeking medication or advice from your medical specialists to help your sleep quality, pain and depression if needed
  • Consulting a psychologist if you need more assistance with specific reactions or life circumstances

I will be delighted if you choose to work with with me to walk on a new path to recovery. Enjoy life again.

2. Neuropathic Pain

Neuropathic pain starts from a neurological lesion or disease of the bodies' sensory system and grows with misinformation, fear and anxiety. It needs different treatment approach to an acute pain injury.

The nervous system becomes sensitised over time (as it does in fibromyalgia, after poor sleep or when you have multiple physical or social problems). You can probably picture how grumpy you are after a few nights of deprived sleep).

There are no signs of nerve damage on neurological testing during our consultation. This means you can get better.

  • Neuropathic, persistent pain and acute nociceptive pain need specific treatment
  • An accurate diagnosis is essential 
  • Matching your goals with my plan will optimise your improvement
  • There are medications to help persistent pain. I can discuss these with you so that you can then talk to your doctor. 
  • Low-dose amitriptyline (Endep/Dothep) is a first-line treatment of neuropathic pain and is a first line treatment often prescribed by your doctor. If you see on Google that it is an antidepressant - don't be misled. Neuropathic pain treatment needs only 10-20 mg whereas antidepressant doses maybe >300mg

Examples of Neuropathic Pain

  • My physical examination establishes the link between the pain and a fault with the nerves feeling/sensory system.
  • I use a stepwise approach to build evidence by excluding other problems to confirm the true diagnosis of neuropathic pain.
  • The most important change you can make for yourself is learn about pain and how our minds and bodies respond.

Neuropathic Pain Diagnosis

Neuropathic pain is a possible diagnosis if you have:

  1. A history of a relevant neurological lesion (like herpes zoster or a traumatic nerve injury)
  2. Pain descriptors such as burning, shooting, pricking and pins and needles
  3. Non-painful numbness or tingling
  4. Pain area explainable by a lesion or disease in the somatosensory system, or typical of an Medication underlying neuropathic disorder

I do tests to find if you have true sensory changes in specific areas.


Panadol and anti-inflammatories do not work for neuropathic pain. More specific medication is needed. They act slowly and you will need to balance the effect gained with the side effects.

I will teach you strategies to treat, manage and live life despite pain.

Please see /pain -

Diagrams about paths to chronic pain,

How to pace you activity,

Challenging thought viruses and

Taking control.

Amitriptyline for nerve pain: fact sheet for patients

Helping patients live with neuropathic pain: patient action plan

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