Why Chronic Pain Is So Complex – And Why One Treatment Alone Rarely Works
Chronic pain is complex. It’s not just about tissue damage - biological, psychological, and social factors all play a role.
Conditions like fibromyalgia, complex regional pain syndrome (CRPS), and neuropathic pain are often linked to changes in the nervous system, rather than a visible injury. This makes diagnosis and treatment challenging for both patients and healthcare professionals.
Recently, Nicole and her colleagues from the Carrick Institute published a paper in the International Journal of Molecular Sciences reviewing the latest research on chronic pain treatment. Their work highlights several key points:
No single therapy works for everyone. A combination of medical, physical, and psychological approaches generally achieves the best results.
Advances in neuroimaging are helping us better understand how nerves, particularly in the head and neck, may contribute to chronic pain.
Emerging treatments like brain and nerve stimulation show promise in “retraining” the nervous system and supporting neuroplasticity.
Most importantly, involving patients in their own care—giving them tools and strategies to manage pain—can improve outcomes and quality of life.
At Coelevate, we embrace this holistic, multidisciplinary approach. We combine clinical expertise across therapies to support each person’s unique journey with pain, focusing on strategies that empower patients and address both the body and mind.
You can read the full article here: Beyond the Pain: Rethinking Chronic Pain Management Through Integrated Therapeutic Approaches—A Systematic Review
Below, we’ve broken down the research in plain language to highlight what it means for people living with chronic pain.
If you live with chronic pain, you’ve probably noticed something frustrating: there’s rarely a simple answer or a single treatment that fixes everything.
That’s because chronic pain isn’t just a problem in the muscles, joints, or nerves.
Research now shows it’s influenced by a combination of:
The body (nervous system, inflammation, injuries)
The brain (how pain is processed and amplified)
Emotions and stress
Lifestyle and social factors
In other words - chronic pain is multifactorial.
A large review of 138 research studies looked at modern treatments for conditions like:
Neuropathic pain (nerve pain)
Fibromyalgia
Complex Regional Pain Syndrome (CRPS)
Central sensitisation (when the nervous system becomes overly sensitive to pain)
And the main takeaway?
No single therapy works on its own.
The best outcomes come from a multidisciplinary, patient-centred approach.
Let’s break down what that really means.
When the Nervous System Gets “Stuck” in Pain Mode
Normally, pain is a warning signal. You touch something hot — your brain says “move away.”
But in chronic pain, the nervous system can change.
This is called neuroplasticity — the brain and nerves adapt over time.
In some people, these changes lead to:
Pain signals being amplified
Pain happening without clear tissue damage
Sensitivity to light, sound, touch, temperature, and movement
This is known as central sensitisation.
It explains why many people with chronic pain:
Hurt more than expected from an injury
Have pain in multiple areas
Feel exhausted, foggy, anxious, or low in mood
Are sensitive to everyday sensations
And why scans and blood tests often come back “normal” — even though the pain is very real.
Conditions Like Fibromyalgia and CRPS
The research highlights several common chronic pain conditions:
Fibromyalgia
A condition marked by widespread pain, fatigue, poor sleep, brain fog, and heightened sensitivity.
It involves changes in how the brain and nervous system process pain and sensation.
Neuropathic pain
Pain caused by nerve dysfunction rather than tissue damage — often burning, shooting, tingling, or electric-like.
CRPS (Complex Regional Pain Syndrome)
Usually starts after an injury but becomes driven by changes in the nervous system and brain, leading to severe pain, swelling, temperature changes, and sensitivity.
These conditions often overlap — which is why many people are given multiple diagnoses over time.
Why Medications Alone Often Fall Short
The review looked at many common treatments, including:
Painkillers (like paracetamol and NSAIDs)
Antidepressants and nerve medications
Opioids
Migraine medications
Steroid injections and nerve blocks
While some people get partial relief, the research consistently showed:
Medications rarely resolve pain fully
Many come with side effects
Benefits often decrease over time
This helps explain why so many people with chronic pain feel stuck cycling through different prescriptions without long-term improvement.
Promising Non-Drug Approaches
One of the most interesting findings was how many non-medication therapies can influence pain by changing the nervous system itself.
Some emerging and supportive approaches include:
Brain and nerve stimulation techniques (aimed at calming overactive pain pathways)
Visual and sensory therapies (like mirror therapy and graded motor imagery to retrain the brain’s perception of the body)
Movement and exercise (shown to reduce pain sensitivity, improve mood, balance, and nervous system regulation)
Gentle bodywork and touch therapies (which may influence pain processing and the nervous system)
Vagal nerve and nervous system regulation strategies (like breathing, yoga, and relaxation-based practices)
Nutrition and gut health (with early evidence that inflammation and the microbiome influence pain)
Psychological therapies - psychotherapy, hypnotherapy and pain education (which help reduce fear, hypervigilance, and the brain’s amplification of pain signals)
None of these are “magic fixes” on their own — but together they can significantly improve quality of life.
The Power of a Multidisciplinary, Patient-Centred Approach
Across all studies, the strongest message was clear:
Chronic pain responds best when treatment addresses the whole person.
That means combining:
Medical care
Physical therapies
Nervous system regulation
Psychological support
Lifestyle changes
Education and self-management
And importantly - involving the patient as an active partner in their care.
When people understand what’s happening in their nervous system and learn tools to influence it, outcomes improve.
A Shift in How We Think About Pain
For years, pain without clear tissue damage was often dismissed as “psychological.”
We now know:
The pain is real
The nervous system can change and become sensitised
The brain plays a major role in maintaining pain
This doesn’t mean pain is “all in your head.”
It means pain is created by the nervous system — and the nervous system can be retrained and supported.
The Big Takeaways
✔ Chronic pain is complex and involves the body, brain, and nervous system
✔ No single treatment works for everyone
✔ Medications alone usually aren’t enough
✔ Multidisciplinary, personalised care works best
✔ Education, movement, nervous system regulation, and psychological support are key
Most importantly:
While pain may not always be completely eliminated, quality of life can almost always be improved.
