Chronic Pain Management: Long-Term Relief

Atlanta Hawks forward Jalen Johnson  is defended by Dallas Mavericks center Daniel Gafford in the fourth quarter at State Farm Arena. Mandatory Credit: Brett Davis-Imagn Images

Chronic pain is a persistent issue that practitioners regularly encounter in athletes. Unlike acute injuries, where physical treatment and rest often lead to recovery, chronic pain frequently remains unresolved despite conventional physical interventions and treatment options. This pain can last for months or even years, reducing the athlete’s ability to perform, train, or engage in daily activities. For athletes, managing this kind of pain becomes more complicated because they are often conditioned to push through pain to succeed, which can exacerbate the problem. The failure of purely physical interventions highlights the need for alternative approaches. Integrating psychological principles into physical rehabilitation offers a holistic approach that considers the interplay between mind, body, and environment in achieving long-term relief.

Pain and Central Sensitization

Acute pain is typically short-term and serves as a protective response to injury, alerting the body to tissue damage and initiating healing processes. It usually resolves as the injury heals. Chronic pain lasts for an extended period (often beyond the normal healing time) and can persist even after the initial injury has healed (see figure 1)⁽¹⁾. Chronic pain results from changes in how the brain and nervous system process pain signals. Over time, the brain may become hypersensitive, interpreting normal sensations or minor discomfort as severe pain^(2,3). For athletes, this can lead to psychosocial challenges, as traditional rest or physical treatment approaches fail to alleviate the pain⁽⁴⁾.

“To make complex pain mechanisms more accessible, it’s important to use metaphors and analogies…”

Central sensitization refers to the process by which the central nervous system (CNS) becomes sensitized to pain, amplifying pain signals beyond their original intensity⁽⁵⁾. This occurs when neurons in the spinal cord and brain undergo changes that increase the body’s sensitivity to stimuli, even when the original injury is healed. In athletes with chronic pain, the CNS can continue to send pain signals even without ongoing tissue damage, causing them to experience pain during normal movements or activities. This phenomenon complicates rehabilitation because standard treatments like physical therapy or pain medication target the site of pain, rather than addressing the nervous system’s role in amplifying it⁽⁵⁾.