Persistent Pain – Part One

Part One: Pain Explanations

written by Kristie Norquay, physiotherapist

Pain can be a tricky thing. It’s very complex, especially persistent or chronic pain. Treating acute pain/injury is very different than treating chronic pain.  The whole pain system is much more than just treating the tissues or body part that is injured.  A more comprehensive, biopsychosocial (keep reading for more on this) approach can be much more effective in reducing chronic or persistent pain, than simply trying to solve the physical/structural “problem”.  

Let’s start with the definition of pain. One of the best definitions of pain is “an unpleasant sensory and emotional experience associated with actual or potential tissue damage”. 

I would like to point out two things here:

  1. Pain is sensory AND emotional 
  2. It is associated with actual or POTENTIAL tissue damage (meaning you can have pain with no damage)

Pain is a protective mechanism.  For example – pull your finger back until you start to feel pain – no actual tissue damage is happening here, we are just approaching damage, and pain is the signal for us to stop pulling our finger back. 

In a person with a healthy, proper functioning pain system, our pain signals are sent at the right time, and are a great source of communication to help us prevent injury and to heal appropriately. In someone with a sensitized pain system, these signals are sent much sooner (at a lower threshold), when we may not be anywhere near tissue damage.  This is very common after an injury – an actual tissue damage – where the pain system stays heightened and over-protective much longer than necessary.  This can also happen before an injury – if there is fear of causing tissue damage, the pain system kicks in too soon and over-protects.   

To make things even more complicated, pain is very much related to psychological elements. Things like the story behind the pain, the meaning we have assigned to it, the context in which it happened (paper cuts hurt more at work than at home – someone actually did a study on this), what’s going on in your head (ex. catastrophizing, hypervigilance, rumination), what you have been told about your condition/injury/pain, and behaviours (ex. “checking” if it still hurts – continuing the pain cycle by doing the painful movement repeatedly, or avoiding activities based on fear of pain). 

Pelvic pain in particular is highly correlated to psychosocial distress, and another interesting fact is that 25-50% of people with musculoskeletal injuries have depressive symptoms.  There is certainly more at play than just the physical/structural issue! 

So what do we do about all of this? As mentioned previously, persistent pain is very different than acute pain.  Start with a biopsychosocial approach.  

To break that big word down:

Bio – biology, the tissues involved, the physical body system 

Psycho – the mind aspects, acknowledging and addressing issues like depression, anxiety, stress, etc

Social – our relationships, support systems, people around us

Another big word to learn, and an important concept to consider: 

Psychoneuroimmunology – the study of the physical response to an emotional trigger. 

To break that word down:

Psycho – emotional components, depression, anxiety

Neuro– stress, sympathetic nervous system response (“fight or flight”)

Immunology – the immune system and inflammatory response

Depression, anxiety or stress can cause a physical, inflammatory response in the body.  It’s not “all in your head”. It’s actually in your body, influenced by what is happening in your central nervous system.  This is important!! You are not crazy! (well, we’re all a little crazy, but…you know what I’m saying)

Because chronic pain is different than acute pain/injury, it should be approached differently by medical practitioners.

Stay tuned for “Part Two: What To Do About It” for more practical advice on managing persistent or chronic pain.  

In the meantime, and for a personalized treatment plan, Kristie sees patients for Physio-Yoga & Pelvic Health appointments on Tuesday’s and Thursday’s at Element Therapeutics.  

Book with our receptionists by calling 250-344-6654 and asking for “Specialized Physiotherapy” with Kristie or booking online here

You can also check out the following resources for more information:

Ted Talk with Lorimer Moseley


Kristie Norquay is a pelvic health & orthopedic Physiotherapist, yoga teacher, and Certified Yoga Therapist. Her extensive trainings in Physiotherapy & Yoga have helped build a bridge between conventional western health care and a more holistic and all-inclusive healing approach. Kristie’s goal is to help people heal, strengthen, and better understand their bodies in a whole new way so they can flourish in life.

Kristie’s post graduate studies include certification in therapeutic yoga, pelvic pain and pelvic floor dysfunction, and courses on movement system impairments, breath, and pain science. Most recently, she completed her Level 3 through Pelvic Health Solutions, focused on treating pain. Kristie loves taking a holistic approach to her clients’ wellness. She has a passion for integrating the philosophy of yoga into her physiotherapy practice, and looks at injuries or illnesses in the context of an individual’s life. There is a connection between everything within us and around us, and Kristie loves to help you create awareness of the body-mind connection.