Complex Pain

Complex Pain Physiotherapy

Physiotherapy for persistent, sensitive or difficult pain presentations

Pain is unfortunately not always straightforward.

Sometimes pain lasts longer than expected. Sometimes the injury seems to have healed, but the pain remains sensitive. Sometimes a new injury becomes complicated by stress, poor sleep, fear of movement, work pressure, compensation processes, trauma, or previous pain experiences.

This may include chronic pain, persistent pain, repeated flare-ups, widespread symptoms, difficult recovery after injury, or acute pain presentations where the situation is more complicated than the injury alone.

This type of pain needs a more insightful and psychologically aware approach.

A psychologically aware approach

A psychologically aware approach does not mean “the pain is in your head". 

It means pain is understood 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. But in complex cases, it is also important to understand your as the person, the context, and the barriers to recovery.

Assessment may include discussion of:

• Your pain history and injury history

• What movements, activities or situations flare symptoms

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

• 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

Dr Kevin Ho has a particular interest in complex and persistent pain. His PhD explored sleep and chronic musculoskeletal pain, including spinal pain and osteoarthritis.

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

This helps guide a broader style of physiotherapy that considers not only the painful area, but also sleep, stress, sensitivity, confidence, function and the wider recovery context.

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

• 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, 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.