Treating chronic pain

Treating chronic pain

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Condition

Chronic pain – understanding the whole picture

When pain lasts longer than three months, more than just the tissue is usually involved. The nervous system becomes more sensitive, and factors such as stress, sleep, worries, lifestyle and movement behaviour influence the pain.

That is why a cause-oriented therapy that takes all these areas into account and shows you active ways to change things yourself works best. Pain is real – even if «nothing» can be seen on a scan.

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Physiotherapy for chronic pain

How it works

Why pain can become chronic

Nervous systemSensitive alarmWith persistent pain, the nervous system often reacts more strongly than necessary – like an alarm that goes off in a light breeze.
BehaviourAvoidance and fearPeople who avoid movement for fear of pain become stiffer and weaker – and the pain stays.
Life circumstancesStress and sleepEveryday pressures, poor sleep and worries demonstrably increase pain.
Good newsChangeableThe nervous system can learn again. With understanding, gradual movement and new strategies, pain and limitations decrease.

Scientific evidence

What works for chronic pain

CFT · Lancet 2023Large, lasting effectIn the RESTORE trial with 492 patients, Cognitive Functional Therapy led to large and lasting improvements in chronic back pain – at considerably lower cost than usual care.
Three yearsThe effect lastsFollow-up showed that the improvements were still present after three years – a rarity in back pain treatment.
TrainingMovement as therapyA Cochrane review of 249 trials shows that exercise reduces persistent back pain clearly better than no treatment.

Our approach: We combine pain education (Explain Pain), gradual load progression, training and strategies for everyday life – tailored to your situation.

Assessment of chronic pain

Assessment and treatment

Our approach

  • Detailed analysis of the overall picture using the ICF
  • Specific questionnaires for a more precise classification
  • Analysis of movement behaviour and pain-related postural patterns
  • Clear information about pain and treatment options (Explain Pain)
  • Cognitive Functional Therapy (CFT)
  • Pacing: dosing activity wisely and increasing it gradually
  • Training and support in everyday life

FAQ

Frequently asked questions about chronic pain

Does more pain mean more damage?

With chronic pain, usually not. Pain is a protective signal from the nervous system and can be strong without tissue being damaged. Knowing this helps many people regain confidence.

Is my pain «all in my head»?

No. Your pain is real. The brain processes all pain – with persistent pain, this processing changes. That is exactly where modern therapies come in.

What is pacing?

Pacing means dosing activities so that you do not get caught in a cycle of overload and long breaks. You increase your activity gradually and in a planned way.

How long does treatment take?

Chronic pain takes time. In CFT studies, a few sessions over several weeks were enough for clear improvements. We plan your care together and adapt it to your progress.

I have tried everything – what is different with you?

We look at the whole picture instead of just one structure. For complex cases, we also offer an assessment and second opinion for you.

Understanding pain

Common misconceptions – and what research shows

Misconception«Pain always means damage.»With persistent pain, the intensity of pain hardly depends on the state of the tissue. The nervous system has become more sensitive – pain is a protective signal, not a measure of damage.
Misconception«The MRI shows where the pain comes from.»Wear and tear and disc bulges are also found in very many people without pain. Images therefore rarely explain persistent pain.
Misconception«When I am in pain, I should rest.»Prolonged rest makes you stiffer, weaker and more sensitive. Gradual, well-dosed movement is one of the most effective treatments.
Misconception«My back is vulnerable – bending and lifting are dangerous.»The spine is strong and adaptable. With targeted training, bending and lifting are safe – even with back pain.
Misconception«Stress and sleep have nothing to do with my pain.»Stress, poor sleep and worries demonstrably increase pain. The good news: these factors can be influenced.
Misconception«Persistent pain never gets better.»The nervous system remains capable of learning. With understanding, movement and new strategies, pain and everyday life improve considerably for many people.

More on this: Cognitive Functional Therapy (CFT) · Back complaints · Assessment and second opinion for complex cases

Sources: Kent P et al., Lancet 2023 (RESTORE trial) and Lancet Rheumatology 2025 (3-year results) · Hayden JA et al., Cochrane Review 2021 (exercise) · O’Sullivan PB et al., Br J Sports Med 2020 (facts about back pain) · Moseley GL, Butler DS, J Pain 2015 (pain education) · Brinjikji W et al., AJNR 2015 (imaging) · More information: Body Logic Physiotherapy (CFT)

Pain that won’t go away?

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