Living with pain that does not go away is exhausting. It affects work, sleep, relationships and mood, and it is made worse when tests come back normal and people around you seem to doubt that anything is wrong. Many people with chronic pain have seen several clinicians, tried many treatments, and been told different things by each.
Our understanding of chronic pain has advanced a great deal over the past few decades. We now know a lot more about why pain persists after an injury has healed, and why it sometimes appears without any injury at all. That understanding has led to treatments that genuinely help. This article explains the science in plain language and describes a practical, evidence-based path forward.
What counts as chronic pain
Pain is described as chronic when it persists for more than three months, beyond the normal time for tissues to heal. According to the Canadian Pain Task Force, about one in five Canadians lives with chronic pain, making it one of the most common health problems in the country.
Chronic pain takes many forms: persistent low back or neck pain, pain after surgery or injury, arthritis, headache disorders, pelvic pain, nerve pain and widespread pain conditions such as fibromyalgia. Although the causes vary, many share common features in how the nervous system processes pain, and that shared biology is what modern treatment targets.
Pain is a protector, not a damage meter
A helpful starting point is to understand that pain is not a direct measure of tissue damage. Nerves detect potential threats — pressure, heat, chemical changes — and send signals to the brain. The brain then weighs these signals together with everything else it knows: past experiences, beliefs, emotions, the situation, sleep, stress. If it concludes that the body needs protecting, it produces pain.
This explains why a paper cut can hurt more than a serious injury in the heat of a sporting moment, and why pain is worse when you are tired, anxious or stressed. In acute injury, this protective system works well. In chronic pain, it often becomes over-protective, producing pain in response to movements and activities that are not actually harmful.
Central sensitisation
When pain persists, the nervous system itself can change. Nerve cells in the spinal cord and brain become more responsive, and the systems that normally dampen pain signals become less effective. This is called central sensitisation. It is like a car alarm that has become so sensitive that it goes off when someone walks past.
Signs of sensitisation include pain that spreads beyond the original area, pain that is out of proportion to activity, sensitivity to light touch, temperature changes or pressure, and pain that fluctuates with stress and sleep. Importantly, sensitisation is real, measurable physiology, not imagination — and because the nervous system is adaptable, it can be gradually calmed and retrained.
Fibromyalgia
Fibromyalgia is a chronic condition characterised by widespread pain, fatigue, unrefreshing sleep and often difficulties with concentration and memory, sometimes called fibro fog. Many people also experience headaches, irritable bowel symptoms and sensitivity to noise, light or temperature. It is more commonly diagnosed in women, but affects men too.
Fibromyalgia is diagnosed clinically from the pattern and duration of symptoms, after other conditions such as thyroid disease or inflammatory arthritis have been considered. There is no blood test or scan for it. It is not a degenerative disease and does not damage joints or muscles, but its impact on daily life can be substantial. Central sensitisation is considered a key mechanism.
What the evidence supports
International recommendations for fibromyalgia, including those from the European Alliance of Associations for Rheumatology, place exercise as the one treatment with strong evidence. For chronic pain more broadly, the most effective approaches are active and combine several elements, rather than relying on a single passive treatment.
| Approach | Role in treatment |
|---|---|
| Graded exercise and physical activity | Core treatment — strongest evidence |
| Pain science education | Reduces fear and helps people engage with activity |
| Sleep improvement | Core — poor sleep amplifies pain |
| Pacing and activity planning | Reduces boom-and-bust cycles |
| Psychological therapies (e.g. CBT) | Helpful for coping, mood and function |
| Medication | Supporting role for some, guided by a physician |
| Passive treatments (massage, heat, TENS) | Short-term relief, best alongside active care |
Starting to exercise when everything hurts
For many people with chronic pain, the idea of exercise is daunting. Previous attempts may have caused a flare that lasted days. The key is to start well below what you think you can manage and build very gradually. This is called graded activity or graded exercise.
Begin with a baseline: an amount of activity you can do on a bad day without a significant flare — perhaps five minutes of walking or gentle cycling. Do that consistently, then increase by small amounts, such as ten percent, every week or two. Gentle aerobic exercise, water-based exercise, strength training and movement practices such as Tai Chi or yoga are all good options. The best exercise is the one you will keep doing, so enjoyment matters.
Expect some increase in pain at first. Mild, temporary increases that settle within a day are acceptable and do not mean harm. Over weeks, the nervous system adapts and tolerance grows.
Breaking the boom-and-bust cycle
A common pattern in chronic pain is boom and bust: on a good day, you catch up on everything, overdo it, and then spend several days recovering. Over time this leads to less activity overall and a sense that pain controls life. Pacing breaks the cycle.
- Break large tasks into smaller chunks with planned rests.
- Set activity limits by time rather than by pain — stop before the flare, not after.
- Do roughly similar amounts on good days and bad days.
- Alternate demanding and lighter activities through the day.
- Plan ahead for busy days and build in recovery afterwards.
- Keep a simple diary to spot patterns between activity, sleep and pain.
Sleep, stress and mood
Sleep and pain have a two-way relationship: pain disrupts sleep, and poor sleep makes the nervous system more sensitive. Regular sleep and wake times, a wind-down routine, limiting caffeine after midday and keeping screens out of the bedroom are simple starting points. If insomnia is persistent, cognitive behavioural therapy for insomnia is an effective treatment worth asking your physician about.
Stress, anxiety and low mood are common in chronic pain and also feed it. Attending to them is not a suggestion that the pain is psychological; it is recognising that the brain integrates all of these when producing pain. Relaxation techniques, breathing exercises, mindfulness, psychological therapies and social connection all have roles.
Flare-ups
Flares are part of living with chronic pain, even when things are generally improving. Having a plan in advance makes them less frightening. A flare plan might include temporarily reducing but not stopping activity, using heat or gentle movement, prioritising sleep, using relaxation techniques and medication as advised by your physician, and returning to your normal routine gradually over a few days. Remembering that a flare is a sensitive system reacting, not new damage, helps reduce the fear that can amplify it.
When to check in with your doctor
Chronic pain should be reviewed by a physician to ensure nothing else needs treating. See your doctor about new or changing symptoms, unexplained weight loss, fever, night sweats, new weakness or numbness, swollen hot joints, or changes in bladder or bowel control. Your doctor can also discuss medication, sleep and mental health support as part of a coordinated plan.
Chronic pain physiotherapy in Woodbridge
At Med Wellness in Woodbridge, our physiotherapists take time to understand your history and goals, explain what is driving your pain, and build a graded programme that fits your life. We combine education, exercise, pacing strategies and hands-on treatment where it helps, and our registered massage therapists can add soft-tissue care. We work alongside your family doctor and other providers.
No referral is needed in Ontario, and physiotherapy and massage therapy are covered by most extended health plans. Call +1 (905) 605-8889 to book an assessment.
References
Written by Paramjeet Kaur Bassi, Registered Physiotherapist · Last reviewed August 11, 2026
This page is general health information reviewed by a registered clinician. It is not personalised medical advice and does not replace an in-person assessment. If your symptoms are severe, worsening or new, contact a healthcare professional.
