Services: Chronic Pain Treatment

Toronto Physiotherapy Danforth and Chester Treatment RoomWe offer evidence-based treatment for chronic pain syndromes at our Danforth clinic.

Chronic pain treatment is provided by Eric Hammer, a Registered Physiotherapist and Registered Psychotherapist (Qualifying) with special interest and post-graduate training in chronic pain management.

Our goal is to help you permanently relieve your pain, or help you develop a self-management strategy that enables you to fully reengage in life.

An enormous variety of health care products, pharmaceuticals, treatments and health care professionals make claims about treating pain and chronic pain, and most of these will provide temporary relief of pain for patients suffering from a wide range of underlying health conditions. The challenge is finding a permanent solution to your pain, or an effective self-management strategy that relieves your day-to-day impairment and that doesn’t rely on unsustainable practices such as pharmaceutical-based management or expensive ongoing “maintenance” care.

What will work for you?

Treatment for Chronic Pain

You may be experiencing persistent pain from an unhealed injury, an unmanaged physical condition or disease, residual pain from an already healed injury, or pain that arises spontaneously. You may have received a diagnosis of Fibromyalgia or Complex Regional Pain Syndrome.

Effective treatment requires that we understand the source of your pain, and then apply the corresponding evidence-based strategies to treat it, or to help you better mange it.

The first question we ask is what is the source of your pain?

1. Do you have an unresolved injury causing your chronic pain?

Using an orthopaedic physiotherapy assessment and health history, we can rule-in or rule-out an underlying injury. If the pain is arising from an incompletely healed injury, this can be addressed with physiotherapy or in some cases referral to a medical specialist such as an orthopaedic surgeon, neurosurgeon, or other specialist.

2. Do you have an unmanaged physical condition or disease causing your chronic pain?

Using an orthopaedic physiotherapy assessment and health history, we can help rule-in or rule-out an underlying condition such as osteoarthritis, other degenerative joint conditions, nerve impingements, postural syndromes, and others.

In some cases physiotherapy may be used to help you better manage the condition, while for other conditions referral to a medical specialist such as an orthopaedic surgeon, neurosurgeon, rheumatologist, or other specialist for diagnosis and treatment may be required.

3. Is there no obvious physical explanation for your chronic pain?

Pain can be present even if there is no tissue damage, and pain can persist even after tissues heal from an injury. Your brain can create, amplify or diminish your experience of pain. This doesn’t mean that your pain is not real. All pain is real, and all pain exists only in the brain.

Pain that has no physical basis (no underlying tissue damage, inflammation, etc.) or that appears more painful than is warranted based on objective findings, is often referred to as “Central Sensitization Pain”1.

Central Sensitization Pain arises when the central nervous system becomes hypersensitive, interpreting otherwise normal stimuli as pain. In fact, the brain can even “feel” pain in tissues or limbs that no longer exist – a surprisingly common occurrence in amputated limbs (“phantom limb syndrome”). Treating hypersensitivity therefore requires a different approach than treating a physical injury.

If your chronic pain is not rooted in a musculoskeletal problem, or if the underlying injury has now healed, classic orthopaedic physiotherapy is not indicated as it is not likely to be effective long-term. Instead, chronic pain treatment focuses on desensitizing the nervous system using a whole-body approach that involves education, physical activity, behavioural therapy, and various patient-specific interventions.

Nervous system desensitization can retrain the brain to respond to sensation in a more measured way, and is the preferred strategy for treating conditions such as Fibromyalgia or Complex Regional Pain Syndrome.

If you are interested in participating in an optional 6-week program for treating chronic pain arising from hypersensitivity, we can guide you through a structured step-by-step homework-based program that includes patient workbook, videos, and weekly follow-up visits.

Frequently asked questions

  1. How do I get started? Call our Danforth Clinic to book in for a chronic pain physiotherapy assessment with Eric. In this one-hour session he will discuss with you your health history, perform a physical assessment and tests (as necessary), discuss with you his findings, and offer you a strategy for treating your chronic pain.
  2. What does it cost? A 60 minute initial assessment and treatment is $110 and is tax-free. Follow-up appointments are $75 for 30 minutes, $90 for 40 minutes, and $125 for 60 minutes. Our services are covered as “physiotherapy” under employee extended health insurance benefits and motor vehicle accident insurance, or qualify as a tax deductible medical expense on your tax return.
  3. Do I have to commit to a certain number of visits? Treatment for chronic pain is patient-specific. Eric will recommend an optimal treatment approach based on his findings. This will include home-based activities for you to do on your own, and may also include follow-up sessions. You are free to book follow-up visits according to your desired schedule and needs.
  4. Is chronic pain treatment at Toronto Physiotherapy based in physiotherapy or psychotherapy? We always approach chronic pain cases from the perspective of physiotherapy first. Physiotherapists trained in chronic pain use a variety of evidence-based orthopaedic, neurologic and behaviour-coaching approaches to treat chronic pain that arises from physical injuries or other physical conditions, as well as chronic pain that has no obvious physical explanation such as Fibromyalgia or Complex Regional Pain Syndrome. Since chronic pain either partly or fully-resides in the central nervous system, emotions such as fear of re-injury, stress, depression and anxiety can all increase nerve hypersensitivity and contribute to chronic pain. Chronic pain physiotherapy therefore necessarily includes some methods that are more classically associated with psychotherapy, for example, behaviour-coaching to help patients manage any fear-based activity avoidance. As a dual-registered therapist, Eric is uniquely positioned to maximize the benefits of chronic pain physiotherapy practices. In addition, a smaller number of chronic pain patients may benefit from strictly psychotherapy sessions.
  5. Is chronic pain treatment covered by OHIP? Regrettably it is not. Physiotherapy and psychotherapy services are tax-free and qualify as a medical expense for income tax purposes.
  6. Could chronic pain treatment be covered by my extended health care insurance? Yes, as a Registered Physiotherapist, physiotherapy treatment with Eric Hammer is covered under “physiotherapy”. For patients receiving strictly psychotherapy with Eric, as a Registered Psychotherapist this would be covered under “psychotherapy”.

References

  1. Latremoliere A., Woolf C.J. Central sensitization: a generator of pain hypersensitivity by central neural plasticity. J Pain. 2009 Sept;10(9):895.926. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2750819/