Complex Pain

Complex Pain Physiotherapy

Physiotherapy for persistent, sensitive or complex pain, including when poor sleep is affecting recovery

Pain is unfortunately not always straightforward.

Sometimes pain lasts longer than expected. Sometimes an injury appears to have healed, but the area remains painful or sensitive. In other cases, recovery may be affected by stress, disrupted sleep, fear of movement, work pressure, compensation processes, trauma or previous pain experiences. 

This may include chronic or persistent pain, repeated flare-ups, widespread symptoms, difficulty recovering after an injury, pain that interrupts sleep, or acute pain presentations where the situation is more complicated than the injury alone. 

This type of pain may benefit from a more insightful and psychologically informed approach. 

A psychologically informed approach

A psychologically informed approach does not mean that “the pain is in your head.” 

It means recognising pain as a whole-person experience. The body, nervous system, emotions, beliefs, stress, sleep, work demands, relationships, compensation systems and previous experiences can all influence how pain behaves.

The painful area still needs to be assessed properly. However, in complex cases, it is also important to understand you as a person, your circumstances and the barriers affecting recovery.

Sleep and persistent pain

Sleep and pain can influence each other. Pain may make it difficult to fall asleep, find a comfortable position or remain asleep throughout the night. In turn, disrupted or insufficient sleep may contribute to greater pain sensitivity, fatigue, reduced concentration and difficulty managing exercise, work and everyday activities.

As part of a complex pain assessment, Kevin may explore:

• Whether pain is delaying or interrupting sleep

• Changes in sleep since the injury or onset of pain

• Overnight positioning, pillows and comfort

• Daytime fatigue and its effect on activity

• Sleep routines and factors that may be affecting recovery

• Whether further assessment by a GP, sleep physician or another healthcare professional may be appropriate

This does not replace medical assessment or treatment for a primary sleep disorder. Rather, sleep is considered as one part of the broader relationship between pain, health, function and recovery.

Assessment may include discussion of:

• Your pain history and injury history

• What movements, activities or situations aggravate symptoms

• How pain affects work, home life, exercise and sleep

• Whether pain wakes you or makes it difficult to get comfortable at night

• Your confidence with movement and activity

• Stressors that may be affecting recovery

• Previous treatment experiences

• WorkCover, CTP or return-to-work demands where relevant

• Your goals and what a meaningful recovery would look like

Experience in complex pain and sleep

Kevin has a particular interest in complex and persistent pain. He completed his PhD at the University of Sydney investigating sleep and chronic musculoskeletal pain, including spinal pain and osteoarthritis.

This research informs his understanding of the two-way relationship between sleep, pain sensitivity, physical function and recovery. Where relevant, sleep-related difficulties are considered alongside movement, strength, stress, confidence, work demands and other factors influencing the individual’s presentation.

Kevin is also undertaking the APA Pain Physiotherapy titling pathway, building further expertise in psychologically informed care for people with complex pain presentations.

Treatment focus

Treatment is usually aimed at helping you understand your pain, reduce sensitivity where possible, rebuild confidence and improve day-to-day function.

This may include:

• Clear education about your pain and recovery

• Graded activity and pacing strategies

• Strength, mobility or movement retraining

• Hands-on treatment where appropriate

• Strategies for managing pain that affects sleep or overnight comfort

• Planning activity around fatigue and disrupted sleep where appropriate

• Flare-up planning

• Return-to-work or return-to-exercise planning

• Communicating with your broader treatment team

• Practical goals based on what matters to you

The aim is not to push through pain blindly, nor avoid everything that hurts. The goal is to find a workable path forward.

WorkCover and CTP cases

Complex pain can be especially challenging when recovery is happening alongside a workplace injury claim, motor vehicle accident claim, legal stress, insurer requirements, medical reviews or return-to-work pressure.

These systems can add real stress to an already difficult situation.

Physiotherapy in this context may involve:

• Understanding the injury context and the compensable system

• Helping set realistic functional goals

• Supporting graded return to activity or work

• Providing clear clinical reasoning in reports to advocate for you

• Communication with other relevant parties such as your GP, specialist, insurer case manager, rehab provider and other treating providers

• Helping you feel more in control and less stuck

What to expect

Your appointment may include:

• Assessment of the painful area

• Discussion of your pain story and recovery barriers

• Education about pain sensitivity and flare-ups

• Movement, strength or functional testing where appropriate

• Hands-on treatment if suitable

• A graded plan for activity, exercise, work or daily life

• Practical strategies to manage setbacks

The plan is adjusted to you, the individual. Some people need reassurance and movement confidence. Some need careful pacing. Some need strength and conditioning. Some need help understanding why pain keeps flaring. Many need a combination.

Book an appointment

If pain is feeling complicated, persistent or difficult to manage, Physiotherapist Dr Kevin Ho can help you understand what may be contributing to it and what steps may help you move forward. 

If your case involves many areas of pain, a long consult (1hr) may be needed. Please let us know in advance if so.