If you’ve had pain that’s stuck around for more than three months, you’re far from alone. Persistent or “chronic” pain is one of the most common reasons people walk through our doors here on the Tweed Coast — and one of the most misunderstood.
The good news? Modern pain science has completely changed how we understand and treat it. Pain that lingers isn’t a sign you’re broken, and it very rarely means there’s ongoing damage. Here’s what’s really going on, and what the evidence says actually helps.
What counts as “chronic” pain?
Pain is usually called chronic (or persistent) when it lasts longer than three months — beyond the time tissues normally take to heal. It might be constant, or it might come and go in flare-ups. It can show up as back pain, neck or shoulder pain, hip and knee pain, headaches, or widespread aches that are harder to pin down.
Persistent pain is genuinely common. Around one in five Australian adults lives with chronic pain, and the likelihood increases with age. So if your pain has outstayed its welcome, it’s a well-trodden path — and a treatable one.
Pain doesn’t always equal damage
Here’s the idea that surprises most people: pain is not a reliable measure of tissue damage.
Pain is produced by your nervous system as a protective alarm. In the early days after an injury, that alarm is helpful — it makes you rest and protect the area while it heals. But sometimes the alarm system stays switched on long after the tissues have recovered. The nervous system becomes more sensitive, almost like the volume has been turned up, so it produces pain in response to things that wouldn’t normally hurt.
This is called central sensitisation, and it’s a big reason pain can persist. It also explains why two people with the exact same scan can have wildly different pain experiences — and why “hurt” doesn’t always mean “harm.”
Why a scan rarely tells the whole story
Many people come in convinced their MRI or X-ray holds the answer. The reality is more nuanced. Studies repeatedly show that findings like disc bulges, mild arthritis and “wear and tear” are extremely common in people with no pain at all. These changes are often a normal part of ageing — a bit like wrinkles on the inside.
That doesn’t mean scans are useless; they’re important for ruling out specific problems. But for most persistent pain, the picture on the screen is only one small piece of the puzzle.
Pain is influenced by more than your body
Modern physiotherapy uses what’s called a biopsychosocial approach — a slightly clunky word for a sensible idea. Your pain is shaped by:
- Biological factors — the tissues, nerves and how sensitised your system is
- Psychological factors — stress, mood, worry about the pain, and past experiences
- Social factors — sleep, work demands, support around you, and how much you’re able to keep doing the things you love
None of this means the pain is “in your head” — it’s very real. It simply means there are far more levers we can pull to help than just the painful body part.
What actually helps
Decades of research point clearly toward active, self-empowering approaches:
- Understanding your pain. Learning how pain works genuinely reduces it for many people. When the alarm feels less threatening, the system tends to settle.
- Movement and graded exercise. This is the most strongly supported treatment we have. Gentle, gradually increasing activity retrains the system that “movement is safe.”
- Pacing, not pushing. Finding a sustainable baseline and building slowly beats the boom-and-bust cycle of overdoing it then crashing.
- Sleep, stress and mood. These directly turn the pain dial up or down, so they’re part of the treatment, not a side note.
- Hands-on therapy as a helper. Manual therapy can ease symptoms in the short term and make movement more comfortable — most effective alongside an active plan, not instead of one.
You don’t have to manage this alone
At Pottsville and Cabarita Physio, we help people across Pottsville, Cabarita Beach and the wider Northern Rivers take back control of persistent pain — with a clear plan built around your life, not just your scan.
If pain has been running the show, book an assessment and let’s map out a way forward together.
Melissa Macdonald Physiotherapist, Pottsville and Cabarita Physio