Pain Management

Pain Management

Persistent pain influences individuals differently. When a person experiences pain, it affects their physical being, thought patterns as well as their emotions and relationships. Behaviour and cognitive responses such as fear, anxiety and perceptions about the future becomes part of their pain experience. 

Tackling persistent pain with short term solutions and traditional strategies can result in further frustration and hopelessness. Modern pain science tells us that a different approach is imperative when addressing ongoing pain. We are complex beings and pain is a multi-faceted emergent experience which therefore warrants an approach that looks beyond our tissues.

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Pain in me | Tamar Pincus

“Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage”


“Pain is an opinion on the organism’s state of health rather than a mere reflexive response to injury”

Norman Doidge

“When the BRAIN concludes that there is more credible danger or threat related to your body than there is credible evidence of safety or non-threat to your body, you will experience PAIN”

David Butler

Pain Explained

We need to reframe pain. Instead of giving it a negative connection, what if we perceive it as an alarm that prompts action? When we experience PAIN, the brain is sending us an alarm or warning, alerting us to change how we are feeling, thinking and behaving, so we can protect our well-being. Our nervous system is then on alert and sensitised. Pain is thus a protector and not an accurate indicator of damage.

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Tame the beast

There is a lot that can be done!

The first step towards reversing your pain experience is a commitment to change. Pain is a complex  phenomenon influenced by a great number of things. Thus, there are many avenues for positive change and opportunities for recovery. Our bodies are designed to heal itself, provided that we give our bodies the right tools to do so. 

On your journey to heal, consistency and daily positive habits lead to small improvements that will turn into bigger improvements. The power lies in switching paths from a downward spiral of PAIN and SUFFERING to a slow and steady road to recovery.  There are usually no QUICK fixes, but there are management strategies that require patience, persistence, perseverance, courage and coaching. 

This tried and tested route to recovery is centred around threat identification and graded exposure with the assistance of an interdisciplinary team of clinicians that will coach you while you are on your journey to recovery.

Our Approach

Our practice embraces an individually tailored active approach to assist this client group. The type of coaching that will best suit an individual with complex pain, is determined by a baseline consultation. This consultation comprises of an interview and a bio-pshyco-social assessment. The aim is to identify the pain mechanisms invovled as well as possible contributing factors. Following the assessment, an individualised, tailored program will be designed to suit the individual’s goals and challenges.  


We offer individually tailored pain coaching sessions which focus on strategies that will assist with challenges in daily life and specific goal setting. These sessions follow an activity driven and cognitive behavioural approach to pain management with the primary aim of improving quality of life and function. Various pain management strategies are introduced and tailored to the individual’s needs in this process.

Interventions prescribed may include one or more of the following:


This is a cognitive intervention based on the work of various pain scientists which aims to purposefully shift patients’ understanding away from the traditional biomedical and anatomical models. It equip patients with a better knowledge and understanding of how pain works. Both research and our personal experience have demonstrated the effectiveness of this approach in improving a person’s pain and management thereof. This important clinical tool is often overlooked in other medical approaches.

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Understanding Pain in 5 Minutes


This programme is a uniquely evidence based programme, which are usually administered over a ten week period (involving one to one sessions) with the client. The primary aim is to assist the client to resume previous interests (where and if possible), provide strategies to implement adjustments by pre-determined specific goals and bridge the gap to resume working or stay at work (if possible). This program uses the principles of activity scheduling in order to facilitate moving away from under-activity patterns. This is centered around realistic and achievable goals to ensure success.


In most persistent pain conditions, the brain develops changes in its neural representation of the affected body part. This can be likened to a map that has become smudged and difficult to interpret. Specific ‘brain training’ techniques can be helpful to restore the clarity of the map. This includes, left/right discrimination training, imagined movements and mirror therapy.

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GMI video


Our bodies thrive on variability, movement and physical activity. A magnitude of research studies have revealed that physical activity and exercise is one of the most effective strategies to improve well-being and reduce pain. With complex pain conditions, however, participating in physical activity can prove to be challenging as pain often gets in the way. 

Graded exposure to physical activity and exercises involves designing a program that is based on realistic and achievable goals for the individual. The aim is to gradually condition the body’s ability to cope with exercise and to retrain the sensitised nervous system and ultimately the pain response associated with physical activity. This then allows the individual to make use of this powerful tool to self-manage their well-being without being inhibited by pain.


Sleep hygiene refers to practises and habits that influence the quality of our night time rest. Poor sleep hygiene can negatively influence our mental and physical health, and specifically also our pain experience. Various strategies can be implemented to improve the likelihood of effective, good quality sleep.


Persistent pain is physically and emotionally stressful, and stress in turn can have a negative effect on our pain experience. Structured and purposeful relaxation or mindfulness techniques can break the stress-pain cycle. These strategies include breathing techniques, muscle relaxation, guided imagery and mindful focus on pain.


Cognitive restructuring is a process of learning to identify and dismiss irrational or maladaptive thoughts. In the context of persistent pain, these thoughts are challenged during functional training.

Pain is experienced when the brain perceives more ‘threat’ messages than ‘protective’ messages. We can therefore influence our pain experience by restructuring our thought processes to become more protective. Our brains have the wonderful ability to form new pathways with the right input. Cognitive restructuring involves challenging our negative thoughts associated with specific functional tasks, and replacing them with new protective processes. 

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Thought Viruses

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Pain is a complex multifaceted experience. It therefore often requires input from various disciplines in health care. As part of an individualised management plan, it will be determined whether referral to other professionals could be beneficial

These could include:

Pain Physician

For assistance in pharmacological strategies that specifically target the underlying mechanisms that are responsible for the pain experience


For guidance in adjusting dietary intake to reduce inflammatory levels

Occupational Therapist

For assistance with vocational specific rehabilitation, integration and sensory profiling


For assistance in pain education and returning to a goal orientated exercise strategy. Manual therapy as might be indicated.

Clinical Physchologist

For cognitive behavioural approaches to pain management, therapeutic management of psychological factors that influence pain as well as ACT (acceptance and commitment therapy)

Any enquiries relating to our pain management services can be made to:

Ms Mariet Smal HERE

Conditions Treated

Persistent Musculoskeletal Pain

This refers to pain experienced in specific joints or body areas that persists for more than 3 months after an injury or after onset. For example: chronic lower back pain; chronic ankle pain after a sprain, tennis elbow, persistent shoulder pain, ongoing knee pain post surgery, failed back surgery.

Whiplash Associated Disorders

WAD refers to a variety of symptoms associated with sudden forceful back-and-forth movement of the neck. This can include headaches, sensory changes, visual disturbances, dizzyness and neck pain. Research indicates that more than 80% of whiplash cases might have associated central nervous system changes that require a more comprehensive approach to management

Complex Regional Pain Syndrome

CRPS is a complex, chronic pain condition that affects one limb (usually the hand or foot) usually following an injury or surgery. It is believed to be related to mal-fcuntioning of the peripheral and central nervous system.

Phantom Limb Pain

Phantom limb pain refers to pain that is experienced in an absent limb after amputation. Since the ‘map’ of the body part still exists in the brain, it is still possible for your brain to experience pain in the physically absent limb. Graded motor imagery and pain Education has been shown to be a very effective intervention strategy for this interesting phenomenon


Headaches can be caused by various systemic and behavioural factors. Headaches that are recurring and or persistent (such as migraines and tension headaches) might not respond to single interventions and require a more comprehensive approach addressing the neural pathways of the central nervous system.

Entrapment Neuropathies

Eg. carpal tunnel syndrome, Ulnar nerve entrapment, Thoracic outlet syndrome. Entrapment neuropathy is a general term describing pathology affecting the peripheral nerves, meaning nerves beyond the brain and spinal cord. Post surgical ongoing symptoms like pain, tingling and severe sensitivity often does not respond to medication and manual therapies. A more comprehensive pain management approach has shown to have success


Fibromyalgia is a poorly understood central nervous system disorder characterized by widespread musculoskeletal pain without injury and general fatigue accompanied by brain fog. Research has identified changes in the way the brain processes threat signals in individuals with FM. The current evidence points towards exercise and modern pain management principles as the best intervention strategies


Osteoarthritis is a degenerative condition that affects our joints. It most often affects the hips and knees and can results in persistent joint pain. Although it can not be reversed, modern approaches to pain management can have a significant effect on function, quality of life and pain intensity.

Rheumatoid Arthritis

RA is an autoimmune disease where your body’s immune system attacks the joint tissues. It can affect multiple joints and is associated with pain and swelling in the affected joints. Although RA is a systemic disease that requires medical intervention, the application of pacing- and pain management principles can be of great value to improve quality of life

Chronic Fatigue Syndrome

CFS is a disorder characterized by extreme fatigue that can’t be explained by any underlying medical condition. It is often associated with pain that is worsened by exertion. It is a complex condition that requires an approach that considers and addresses a multitude of factors