Not all pain is the same.

Most of us are familiar with acute pain that comes with injury and eases over time as things come good with treatment or sometimes without it. Logical right?

What if the pain comes back even though there has been no major injury? What if pain seems to have no pattern to it, or seems to get worse even when at rest? This makes no sense in light of an acute pain model but it is a common experience for some and needs firstly to be understood before it can be addressed properly with any real hope of gaining control over it.

Chronic pain  is pain that lingers longer than the usual few weeks to months that it takes most conditions to heal. It's usually episodic and comes and goes with varying levels of intensity and frequency, gradually eroding one's confidence in that body area and limiting more and more of what one can do in life. 

Cognitive Functional Therapy (CFT) is an approach to pain management that deals specifically with this type of pain. Acute pain management is about facilitating the initial healing process after injury; CFT is about unlocking the key pain drivers that make chronic pain seem so elusive and frustrating.

CFT aims to restore functional ability and give you confidence in your body again. Often one must first be able to get comfortable in their body – hard to do when you’ve been fighting pain for a long time as your body can feel like a hostile environment.

Identifying and understanding pain drivers in your body gives you control. Some key pain drivers shown to be major influencers of pain states are fatigue, stress, body inflammation due to diet and poor fitness. Taking back control of your body is an amazing experience for those who have been hostage to pain for any length of time.

Recent advances in the understanding of the nervous system have identified certain immune cells that respond to pain events and can influence how we perceive pain as a result. These cells are called microglia, astrocytes, T cells, and natural killer cells.

Pain input in the presence of perceived or real danger can trigger a response from these cells and set the scene for long-term or chronic pain. It seems that one important facet of approaching this type of pain experience and defusing this response is to tackle the feelings of worry, stress, and being under threat. This de-escalates the immune-mediated pain and allows us to get on with normalising movement.

CFT takes a little more time than the standard physio consult. This is initially to allow the opportunity to properly screen and assess the pain history for likely pain drivers. It is a reflective process carried out in a non-judgmental way to assist in making sense of the pain.

The next phase involves looking at how the body has adapted to the pain in how it moves and functions.  How is pain shaping your behavior? What is it causing you to avoid; what are you doing differently because of it?

Then comes the challenge – to see if pain can be changed with subtle movement adaptations, breathing control, and staying relaxed and mindful. This is particularly confronting for some as one's beliefs about their body/injury need to be encountered and assessed during this process of exploring their pain triggers.

If pain control can be established in any way during this initial assessment this marks the beginning of a gradual process of restoring normal function one movement at a time. As one accumulates bodily proof that previously threatening movements and activities can be done with less pain, the whole system begins to normalize and things get exciting. Life can start to be fun again without the fear of pain getting in the way.

If your pain is not easy to understand, hard to identify; if it is hard to control and is unpredictable; if the pain is causing major changes in your life choices and making your future look gloomy….then CFT is going to be the most evidence-based method of addressing it.

These stories may help in understanding how it could help you:


Fremantle Physio

Level 1, 4/14 Phillimore St, Fremantle, WA 6160