1. Introduction / Plain Theory

Chronic pain is pain that persists beyond the expected period of tissue healing — usually defined as lasting longer than 3 months.
Unlike acute pain, which serves as a protective warning signal, chronic pain is often no longer directly linked to ongoing tissue damage.
Instead, it represents a complex interaction between the nervous system, immune system, emotional regulation, and movement patterns.

Globally, chronic pain affects more than 20% of adults and is a leading cause of disability and reduced quality of life.
It can manifest as musculoskeletal pain, headaches, pelvic or visceral pain, or generalised sensitivity — often without a single identifiable cause.

Modern pain science views chronic pain as a multisystem condition involving both body and brain, influenced by biological, psychological, and social factors — the biopsychosocial model.

2. Typical Symptoms and Functional Impact

• Persistent or fluctuating pain lasting months or years.

• Pain that is disproportionate to physical findings.

• Fatigue, sleep disturbance, or “brain fog.”

• Heightened sensitivity to touch, sound, or temperature.

• Mood changes, anxiety, or frustration related to ongoing pain.

• Stiffness or loss of confidence in movement despite normal scans.

Functional impact:
Chronic pain often affects all aspects of life — work, relationships, energy, and self-image.
It can lead to avoidance of activity, loss of physical conditioning, and increased emotional stress, creating a vicious cycle that sustains the pain experience.

Red flags:
Sudden neurological changes, unexplained weight loss, fever, or night pain still require medical assessment to rule out underlying pathology before assuming chronic pain mechanisms.

3. Contributing Factors / Underlying Causes

Chronic pain arises from changes in how the nervous system processes pain signals, not merely from structural injury.
Key mechanisms include:

• Central sensitisation: heightened responsiveness of pain pathways in the brain and spinal cord.

• Autonomic dysregulation: altered sympathetic activity affecting circulation and muscle tone.

• Emotional stress and trauma: amplifying pain perception and reducing recovery.

• Immune and inflammatory changes: low-grade inflammation sustaining sensitivity.

• Deconditioning: fear of movement leading to weakness and stiffness.

• Sleep disruption and fatigue: impairing the body’s ability to regulate pain.

The longer pain persists, the more neuroplastic (learned) it can become — meaning the nervous system continues to signal “pain” even when tissues have healed.

Osteopathic care aims to address this by restoring regulation, safety, and movement confidence across all body systems.

4. Osteopathic Approach

Osteopathic management of chronic pain is gentle, integrative, and patient-centered — focusing on helping the body and nervous system regain adaptability rather than simply “removing pain.”

An osteopathic assessment may include:

• A detailed case history to understand the full pain context — physical, emotional, and behavioural.

• Evaluation of posture, breathing, and global movement patterns.

• Gentle manual techniques (functional, cranial, myofascial) to improve fluid motion, vagal tone, and body awareness.

• Gradual reintroduction of safe, confident movement to reduce fear-avoidance.

• Collaboration with physiotherapists, psychologists, or pain specialists where needed.

• Patient education on pain physiology — understanding why pain persists can itself reduce sensitivity and anxiety.

The aim is not to “fix” a structure but to rebalance the body’s regulatory systems, enhance resilience, and help the patient move toward a more adaptable, less fearful relationship with their body.

5. Scientific Evidence & References

Recent neuroscience has transformed our understanding of chronic pain.
Studies confirm that persistent pain is driven by neuroplastic and biopsychosocial factors — and that interventions combining manual therapy, movement, and education can significantly improve outcomes.

Osteopathic approaches are supported as safe, integrative treatments that may help modulate autonomic balance, pain perception, and functional capacity in chronic pain populations.

References

1. Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011;152(3 Suppl):S2–S15. Link

2. Moseley GL, Butler DS. Fifteen years of explaining pain: the past, present, and future. J Pain. 2015;16(9):807–813. Link

3. Tracey I, Bushnell MC. How neuroimaging studies have challenged us to rethink: is chronic pain a disease? J Pain. 2009;10(11):1113–1120. Link

4. Gatchel RJ, Peng YB, Peters ML, et al. The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull. 2007;133(4):581–624. Link

5. Cerritelli F, Esteves JE, Martelli M, et al. The effect of osteopathic manipulative treatment on chronic pain and autonomic regulation: systematic review and meta-analysis. J Pain Res. 2020;13:433–449. Link

6. Franke H, Fryer G, Ostelo RWJG, et al. Osteopathic manipulative treatment for chronic musculoskeletal pain: systematic review and meta-analysis of randomized controlled trials. Pain Physician. 2021;24(3):205–216. Link

7. Esteves JE, Zegarra-Parodi R, Cerritelli F, et al. The role of osteopathy in the management of pain: integrative review. J Bodyw Mov Ther. 2021;27:277–287. Link

8. Xie Y, Chen Z, Yang Z, et al. Comparative efficacy and safety of manual therapy interventions for chronic musculoskeletal pain: a network meta-analysis. Front Pain Res. 2024;15:1507322. Link