Chronic Pain Treatment

Toronto Physiotherapy Danforth and Chester Treatment RoomWe offer evidence-based treatment for chronic pain.  If a physical injury or condition is contributing, our thorough orthopaedic assessment and treatment approaches will work to address the physical component.  In many chronic pain syndromes however, there are other drivers of  pain, and often a sensitized nervous system is at play. When non-physical contributors to chronic pain exist, a more holistic approach is needed.  Developing self-management strategies that enable our patients to fully re-engage in their lives and activities is essential.

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 manage 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 due to the interpretation that occurs 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 manual therapy may not be indicated as it is not likely to be effective as a long-term solution. Instead, effective chronic pain treatment focuses on desensitizing the nervous system using a whole-body approach that involves education, physical activity and a tailored exercise program, 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.  A particularly effective aspect of the approach to chronic pain is the development of a specific exercise program to improve the body’s tolerance to different functional activities.  Our physiotherapists have expertise in tailoring an exercise program to improve activity tolerance and function, and reduce the impact of pain on our patients’ lives.  Our physiotherapists will also develop a plan with you that includes strategies to use should a pain flare-up occur.

Our physiotherapists use a variety of evidence-based orthopaedic techniques, exercise therapy, 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. We work with each of our patients to develop an individualized plan of care that can include a combination of physiotherapy approaches, exercise programming, and other patient-specific strategies, in order to enable patients to have effective self-management strategies for their chronic pain for the long-term.


  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.