Why Won't My Pain Go Away? Understanding Persistent Pain

From mental health to nutrition—the overlooked factors that keep pain lingering longer than it should.

Why is my pain lasting longer than a few weeks? Is this going to be the rest of my life? Has it now become chronic? 

Most of us wait to see a health care provider when our pain doesn’t get better in a few weeks, or even if the issue has been niggling for months, but now it has gotten to the point that we can no longer tolerate it. And then it takes longer than anticipated to heal, even after we start treatment. 

First, if you aren’t seeing a change within three treatment sessions for massage, physiotherapy, chiropractic care, etc, then something is missing. Either the diagnosis is wrong, or part of the problem has been missed. This doesn’t mean that you will be cured in three treatment sessions, but at the very least, you should feel less pain, take fewer painkillers, or have improved mobility and function. But if no change has occurred, then we need to re-evaluate. And yes, sometimes things get a bit worse before they get better, even with treatment. 

Once you have ruled out any missed diagnosis regarding other tissues possibly involved, or perhaps the damage to the tissues is greater than anticipated (think an actual tear in the tendon rather than just tendonitis), we need to look at other factors.

Often, the missing links when it comes to lack of healing fall into things outside the scope of your chiro, physio, or massage therapist. Things like your mental health (because yes, trauma plays a role in healing – see a psychologist), hormonal health, or your nutritional health (see a registered dietician or nutritionist). If you are mentally struggling, if you are not feeding your body the nutrients it needs, or if you are not sleeping, you won’t heal. Simple as that.

Finally, pain is considered persistent when it has lasted for more than 3 to 6 months. Your therapist will look at objective measures (things that we can see and measure, not your reported pain scale) that will tell us if we are seeing neurological changes that could account for your pain.

Do not despair: there are further medical interventions from specialists such as physiatrists, anesthesiologists, neurologists, and rheumatologists. These require a referral from your family physician or sports medicine doc. Your therapist should be able to communicate clearly with your health care provider to help get you the appropriate referrals.