Chronic Pain Management 

Chronic pain in children and adolescents is real, complex, and often misunderstood. Unlike acute pain, which is linked to tissue injury and healing, chronic pain persists beyond the expected time for recovery and can significantly affect a child’s physical function, emotional wellbeing, school participation, sleep, and family life. 

At Kids Physiotherapy Waterford, chronic pain management focuses on helping children and adolescents understand their pain, regain confidence in their bodies, and return to meaningful activities in a safe, supported, and evidencebased way. 

What Is Chronic Pain? 

Chronic pain is pain that continues for weeks or months, often without ongoing tissue damage. In many cases, the body has healed, but the nervous system remains highly sensitive and protective. 

Pain is not simply a signal from injured tissues. It is an output of the brain, created when the nervous system perceives threat. In chronic pain, the brain and nervous system can become overprotective, producing pain even when movement or activity is safe. 

This does not mean the pain is imagined. The pain is very real — but the driver is the nervous system rather than tissue damage. 

Conditions Commonly Seen 

Children and adolescents may attend physiotherapy with a range of chronic pain presentations, including: 

• Complex Regional Pain Syndrome (CRPS)
  A condition involving persistent pain, changes in skin colour or temperature, swelling, and extreme sensitivity. CRPS reflects significant nervous system sensitisation and protective responses. 

• Functional Neurological Disorder (FND)
  A condition where the nervous system is not functioning correctly, despite normal scans or tests. Symptoms may include pain, weakness, altered movement patterns, tremors, or fatigue. These symptoms are real and reversible with appropriate care. 

• Widespread or persistent musculoskeletal pain
  Including ongoing limb pain, back pain, or pain following injury that has not settled as expected. 

• Pain associated with anxiety, stress, or medical trauma
  Where the nervous system has learned to remain in a heightened state of alert. 

How the Nervous System Changes in Chronic Pain 

Modern pain science shows that pain is influenced by: 

• Past injury or illness 

• Stress and emotional load 

• Fear of movement or reinjury 

• Previous pain experiences 

• How the brain interprets body signals 

Over time, the brain and nervous system can become very good at producing pain — even when danger is low. The body may adopt protective strategies such as muscle guarding, altered movement, avoidance of activity, fatigue, or shutdown responses. 

Understanding why pain is happening — and what it means — is a key part of recovery. Research by leaders in pain science, including Lorimer Moseley and colleagues, shows that changing the meaning of pain can directly reduce pain and disability. 

My Approach to Chronic Pain Management 

Chronic pain management is not about pushing through pain or ignoring symptoms. It is about restoring safety, confidence, and function within the nervous system. 

Each programme is individualised and may include: 

Pain Education 

• Ageappropriate explanations of pain and the nervous system 

• Understanding how healing has already occurred 

• Learning why pain can persist even when the body is safe 

• Reducing fear and uncertainty around symptoms 

Functional Rehabilitation 

• Gradual return to meaningful activities 

• Building movement confidence rather than focusing on pain levels 

• Retraining normal movement patterns 

• Improving strength, endurance, and coordination within safe limits 

Nervous System Regulation 

• Strategies to calm an overprotective nervous system 

• Breathing, grounding, and bodybased regulation techniques 

• Helping the body move out of constant fightorflight or shutdown states 

Graded Exposure 

• Carefully reintroducing activities that have become associated with pain or fear 

• Teaching the nervous system that movement is safe again 

FamilyCentred Care 

• Supporting parents to understand chronic pain 

• Reducing unhelpful fearbased responses 

• Helping families feel confident in supporting recovery 

Experience With Complex Paediatric Pain 

I have extensive experience working with children and adolescents presenting with complex and persistent pain conditions. Many of these young people have seen multiple professionals and undergone extensive investigations yet continue to experience significant pain and difficulty with daily function. 

My approach recognises that: 

• Chronic pain is real and distressing 

• Recovery is possible 

• The nervous system is adaptable and changeable 

• Children and adolescents are highly capable of relearning safe movement and regulation 

By combining pain science education, functional rehabilitation, and nervous system-informed physiotherapy, I support young people to gradually rebuild trust in their bodies and return to school, sport, social life, and independence. 

 

A Hopeful Message 

Chronic pain does not mean lifelong pain. 

With the right understanding, support, and rehabilitation approach, the brain and nervous system can change. Pain can reduce, function can improve, and children can get back to doing the things that matter most to them. 

If your child or adolescent is living with persistent pain, you are not alone — and help is available. 

Get in touch to discuss whether chronic pain physiotherapy support may be appropriate for your child or adolescent.