We listen closely to our clients to gain a thorough understanding of their unique needs.


  • A Physiotherapist with post graduate qualifications in Pain Management has extensive post graduate training that enables them to better diagnose and manage patients with chronic or complex pain
  • Chronic (persistent) pain is not simply acute pain lasting a long time. Therefore it is important to consider all systems in the body that are involved in the pain experience in order to successfully help patients with chronic pain
  • Goal setting and patient education are essential components of any treatment plan
  • A Physiotherapist with post graduate qualifications in Pain Management can provide advice on subjects such as medications and strategies to improve your sleep, which are not included within traditional, undergraduate training

A 38 year old patient had been removing shelving in his shed when he “bashed” upwards on a shelf to remove it from the bracket. He felt sudden pain in his right wrist and hand and over the next two days he developed swelling and an increase in his pain. Following a GP consult, an x-ray, ultrasound and MRI scans were performed which revealed some calcification in his wrist ligaments along with a “floating” fragment of bone. Over the next four months, the patient underwent conservative rehabilitation involving immobilisation in a splint as well as hand therapy. A Pain Specialist was also consulted and the patient was prescribed strong medication to try and help with the pain. Unfortunately, after extensive rehabilitation and medication, the patient was still struggling to “use his arm normally at home or at work.”

Four months after the initial injury, it was recommended that the patient see a Physiotherapist working primarily in Pain Management. Persistent (chronic) pain is defined as “pain lasting beyond the expected time for tissue healing, generally accepted to be 3 months.” Chronic pain is highly complex and involves entire body systems, not just the local joints and muscles at the original site of injury. Therefore, it requires an holistic or all around approach to achieve good recovery.

During the initial assessment with the Physiotherapist at Biosymm, the patient was asked to explain not only how the injury occurred, but how their current condition was affecting their life. The Physio made sure to give the patient enough time to tell the story of their injury so far while prompting them for specific information to achieve a detailed and thorough history. Based on an outcomes questionnaire completed by the patient, he scored as being “highly disabled.” The patient and Physio worked as a team to identify the following major symptoms/problems:

  • Pain initially confined to the right wrist and hand, gradually becoming more widespread and affecting his forearm, upper arm, shoulder and neck
  • “Random” shooting pains into his right arm not related to use of the arm/activity i.e. these could attack even while sitting, watching the TV
    • Fatigue
    • Less movement
    • Poor sleep – he reported getting less than two hours’ of sleep each night and waking unrefreshed. The patient considered this one of his biggest issues
    • Irritability – he found he was “on a short fuse all the time” which affected his relationship with his partner and children
    • Low mood – felt he’d become depressed
    • Anxious – started getting panic attacks if he was in a crowded area (e.g. shopping centre)
    • Reduced appetite (but despite eating less, he was gaining weight)
    • “Digestive/gut issues” – constipation and diarrhoea
    • Reduced libido


    Following the very detailed assessment with the Physio, the first step in the management of the patient’s pain was an explanation of exactly what chronic pain is. It is much more than just acute pain lasting for a long time (like a car alarm going off for months or years); rather, it affects ALL systems in the body and involves what is called an un-dampened stress response. This means, the body is in a constant state of fight, flight or freeze for 24/7, which then results in the physical symptoms listed above. The patient was able to relate to many aspects of the chronic pain explanation and stated he could “tick every box” on the list, demonstrating an un-dampened stress response. Prior to the explanation of chronic pain by the Physio, he had assumed his unpleasant ongoing symptoms were side-effects of the medication. When the patient had heard for the first time, a logical explanation for his ongoing symptoms – and the good news that there are strategies which he can learn to actually reverse this - he was keen to “jump on-board” and try this new approach.

    During his initial and follow up review with the Physio, the patient was asked directly – “What are your goals?” His most important goals were:

    • Getting a decent night’s sleep
    • Getting his life back, specifically his social life and hobbies which include fishing and golf


    The Physio was able to address his sleep at the initial consultation as although “sleep hygiene” is not covered as part of traditional physiotherapy training, it is an important component of post-graduate studies in pain management.

    By including goal setting, treating all systems involved in the pain experience and making sure a patient’s specific needs are addressed; direct improvements to their overall function can be achieved.

    If you have had pain for 3 months or longer and can tick most or all of the 10 symptoms listed above, you would likely benefit from an assessment by a Physiotherapist with post graduate qualifications in Pain Management.