How to Turn Down the Volume on Persistent Pain A Practical, Neuroscience-Informed Approach for Physiotherapists
By: Maggie Bergeron, MScPT

Rethinking Pain in Physiotherapy Practice

Persistent pain is one of the most common—and complex—challenges physiotherapists face. Despite our best efforts with exercise, manual therapy, and modalities, many patients continue to experience ongoing pain long after tissues have healed.

This raises an important question: if pain persists beyond injury, what exactly are we treating?

In Mike Stewart’s live online Embodia course, A Practical Guide for Persistent Pain Therapy, you’ll learn how to help patients “turn down the volume” on their pain through evidence-based pain education, reconceptualization, and practical communication strategies.

From Acute to Persistent: Understanding the Difference

Acute pain is the body’s alarm system—it signals injury and protects us while tissues heal. But persistent pain is different. When pain continues beyond the expected healing time (usually 3 months), it’s no longer just a tissue issue—it becomes a nervous system issue.

Persistent pain occurs when the nervous system becomes sensitized, sending amplified danger signals even in the absence of ongoing damage. As Mike describes in his teaching, it’s as if the brain’s “pain volume knob” gets stuck on high.

Understanding this shift from tissue-based to neuroplastic-based pain is key for physiotherapists working in modern rehabilitation.

Pain as a Brain Output, Not Just a Body Signal

All pain—no matter where it’s felt—is produced by the brain. It’s the brain’s best guess about whether protection is needed. This process integrates:

• Sensory input from the body (nerves, joints, tissues)

• Contextual cues (thoughts, emotions, environment)

• Past experiences and beliefs about pain

This means that helping a patient with persistent pain requires more than correcting biomechanics—it involves helping them understand and influence the neurophysiology of their experience.

Pain is not an accurate measure of tissue health.

It’s an experience influenced by biology, psychology, and social context.

The Role of the Physiotherapist: Educator, Coach, and Collaborator

Physiotherapists are ideally placed to help patients change how they think and feel about pain. Education itself is a clinical intervention.

Through Pain Neuroscience Education (PNE) and guided movement, clinicians can:

• Reduce threat and fear associated with pain

• Encourage safe re-engagement with activity

• Support reconnection between body and brain

• Build patient confidence and self-efficacy

Mike’s course demonstrates how to communicate pain science in simple, meaningful ways—using relatable metaphors, practical demonstrations, and whole-of-life conversations.

Why Pain Persists: Unhelpful Changes in the Nervous System

Persistent pain can involve:

• Sensitization – nerves fire more easily, amplifying pain messages

• Neuroplastic changes – the brain strengthens pain-related pathways

• Learned associations – movement or emotion becomes linked with pain

• Stress and sleep disturbances – keeping the nervous system “turned up”

For example, a patient who hurt their back months ago may still feel pain when bending—not because of tissue damage, but because their nervous system has linked that movement with danger.

Understanding this helps clinicians move patients away from fear-based avoidance and toward confident, safe movement exploration.

Whole-of-Life Influences on Pain

Persistent pain rarely exists in isolation. It’s shaped by biological, psychological, and social factors, including:

• Stress, anxiety, and emotional distress

• Sleep disruption and fatigue

• Beliefs about pain and recovery

• Physical inactivity and deconditioning

• Social withdrawal and loss of meaningful activity
  
  

The most effective rehabilitation plans take a whole-of-life approach—addressing the nervous system, mindset, and lifestyle together.

Turning Down the Volume: Practical Strategies for Clinicians

Mike Stewart’s approach empowers physiotherapists to help patients “turn down” the pain experience using practical, neuroscience-informed techniques.

1. Reframe Pain Through Education
Help patients understand that pain is a protective response, not a direct reflection of damage. Knowledge reduces fear and threat.

2. Encourage Graded Exposure to Activity
Start small, celebrate success, and gradually reintroduce movement. This rebuilds confidence and desensitizes the nervous system.

3. Address Thoughts and Emotions
Use compassionate dialogue and motivational interviewing to explore beliefs, fears, and expectations around pain.

4. Support Lifestyle Change
Encourage better sleep, stress management, social engagement, and meaningful goal setting—all of which influence pain sensitivity.

5. Integrate Education and Exercise
Combine PNE with active movement practice. Patients learn not only why pain behaves the way it does, but also how to move safely within it.

Applying the Concepts: A Case Example

Consider a patient with long-standing back pain who avoids bending for fear of “damage.”

By helping them understand that pain is produced by the brain—not necessarily by harm—you can guide them through gentle graded movement, reframing the experience as safe exploration.

Over time, this reduces protective muscle tension, restores movement confidence, and literally “turns down” the nervous system’s volume.

Join the Live Course with Mike Stewart

This live online course, A Practical Guide for Persistent Pain Therapy, will give physiotherapists the tools and confidence to integrate pain neuroscience education into everyday clinical practice.

You’ll learn how to:

• Explain pain in clear, patient-friendly ways

• Use metaphors and analogies that resonate

• Build practical, biopsychosocial management plans

• Apply graded exposure and reconceptualization in treatment

📅 Live online November 22-23 2025
🧠 Instructor: Mike Stewart, MSc MCSP SRP (Physiotherapist, Pain Educator, and Researcher)
🎓 Hosted on Embodia — includes patient handouts, scripts, and resources for clinical use.

👉 Reserve your spot for the live course here.

Conclusion: Empowering Change Through Understanding

Persistent pain doesn’t always signal damage—it signals a nervous system doing its best to protect. By helping patients understand why pain persists and how to influence it, physiotherapists can shift the focus from damage to recovery, from fear to empowerment.

Education, empathy, and evidence-based communication can help turn down the volume on pain—one conversation, one movement, and one patient at a time.