Chronic pain is a condition that affects millions of people worldwide, disrupting daily life, work, and relationships. Unlike acute pain, which typically resolves within weeks, chronic pain lingers for months or even years and systematically reduces the quality of life of those who suffer with it.

In this blog, we’ll explore:

• The differences between chronic and acute pain.
• How chronic pain develops and persists.
• The brain’s role in pain perception.
• The biopsychosocial factors influencing chronic pain.
• Practical strategies to manage chronic pain effectively.
• And more

The Difference Between Chronic and Acute Pain

Most of us, me included, have been brought up with the idea that pain is BAD and without a doubt it is bad when we experience it. Nobody wants pain, however, if we can reframe pain as our body’s signalling system letting us know that something is not right, then we get the opportunity to see pain from a different viewpoint and perhaps one that’s less scary.

Pain is our bodies alarm system going off, it’s a defence system warning us that we need to be vigilant, to try to find the source of pain and to address that to resolve the pain. In acute pain situations this signalling system is actually our friend. Consider the scenario where you twist your ankle, immediately when we feel pain we take the load off to prevent us doing more damage, the signal serves its purpose to allow us to rest and for healing to take place.

We could say that when our body sends a pain signal its’ doing what it’s best at, making sure that we have information that could be useful to us and that could ultimately keep us safe or at least serve as a warning to investigate further.

Chronic pain, however, is a different story, here our signalling system has become skewed and can lead to changes in the nervous system (brain/spinal cord), often referred to as central sensitisation. Simply put, our brain becomes more sensitive to pain signals while at the same time it also becomes more vigilant in general. This can lead to an amplified pain experience, even with minimal to no stimuli or danger. (7)(8).

A more sensitised nervous system may mean a persons pain becomes more widespread throughout their body or more generalised and diffuse or perhaps other symptoms can begin to show up. At this stage a person is often caught in a negative feedback loop of pain & sensitivity as well as a raft of highly charged emotions (anger, frustration etc.). These charged emotional states feed fuel to the fire of an already sensitive nervous system. 

This distinction is crucial to understanding why chronic pain as opposed to acute can feel so relentless and disconnected from an identifiable cause.

No Brain, No Pain: Understanding the Complexities of Chronic Pain and Brain Perception

Pain is processed in two parts of the brain: one area deals with the actual sensation of pain, while another handles our emotional reaction to it. That’s a pretty big deal when you think about it. People’s pain experiences vary depending on their emotions, their personality, their cultural background and even based on how they saw pain and pain tolerances expressed by those closest to them as they developed.

In summary, pain is not simply a physical sensation; it’s a complex experience influenced by the brain. The process of pain perception involves two key areas of the brain:

1. The Somatosensory Cortex: This area processes the sensory aspects of pain—its location, intensity, and nature.
2. The Limbic System: This region governs the emotional and psychological response to pain, explaining why the same injury might feel more unbearable when you’re stressed or upset. (3)(6).

Understanding this dual pathway is essential. It highlights how pain is not just a biological event but an emotional and psychological one as well.

How Trauma and Chronic Pain Are Connected

Did you know that trauma, whether physical or emotional, can have a lasting impact on chronic pain? For some, a physical injury or surgery triggers lingering pain that doesn’t go away even after the body has healed. For others, emotional trauma, like abuse or significant life stress, leaves its mark by overloading the nervous system, making it more sensitive to pain signals.

When we experience trauma, our body’s natural stress response kicks into high gear. Hormones like cortisol flood the system, preparing us to fight, flee, or freeze. While this is helpful in the short term, long-term activation of this “fight or flight” system can wreak havoc on how we process pain. The brain and spinal cord may start to amplify even minor pain signals, leading to central sensitisation. This is why trauma survivors often report widespread or unexplained pain, even when there’s no obvious physical cause.

Trauma and chronic pain often go hand in hand, creating a vicious cycle. Pain increases stress, and stress makes pain feel worse. Addressing trauma isn’t just about healing the past—it’s a key part of breaking free from chronic pain. Therapies like somatic experiencing, trauma-focused CBT, and EMDR can help calm an overactive nervous system, reduce pain sensitivity, and provide a pathway to recovery.

Factors That Influence Pain Perception

1. Personality: A person’s personality plays a big role in how they experience pain. People with an anxious attachment style, for instance, tend to feel more pain when their needs for comfort and support aren’t met. (4)
2. Thoughts: How we think about pain also affects how we feel it. If a person expects the worst, like believing their pain will never go away, they’re likely to feel pain more intensely. This is known as catastrophic thinking. (5) (10)
3. Beliefs: Beliefs about pain, such as feeling in control (or not) and trusting that a treatment will work (placebo effect), can change the way people experience pain. When someone believes a treatment won’t work (nocebo effect), they may feel more pain than expected.(5)
4. Sociocultural Factors: Things like gender, age, and cultural background can influence pain. Studies show women often report feeling more pain than men, and pain tolerance tends to increase with age.(5) (6)
5. Learning: Pain can also be a learned behaviour. If certain pain behaviours, like grimacing or complaining get attention or relief, they can become reinforced and harder to break.(6)
6. Emotional Reactions: Anger is a common emotional response in people with chronic pain, and it can make the pain feel worse. People who struggle with anger may have trouble developing empathy for others, but this is a skill that can be improved.(5) (6)
7. Pain modelling: How pain was handled, expressed and dealt with by family, peers and societal norms can influence current pain tolerances and manifestations of pain.

The Bio-Psycho-Social Soup of Chronic Pain

The biopsychosocial model of health looks at health and illness as a combination of biological, psychological, and social factors. Interestingly, Chinese medicine and eastern philosophies have always recognised this. Modern health practices are now shifting from viewing conditions like chronic pain as purely physical to understanding the broader influences that shape how we experience and manage health challenges. 

Chronic pain often leads to a range of biopsychosocial issues that impact physical, emotional, and social well-being. Ultimately the original factor of pain can become just one of any number of ingredients in a soup of reduced quality of life.

Biological Issues

• Sleep disturbances: Difficulty falling or staying asleep due to pain, leading to fatigue and worsened pain sensitivity.
• Decreased physical mobility: Pain may lead to reduced physical activity, causing muscle weakness, weight gain, and worsened physical health.
• Medication dependency: Reliance on pain medications, potentially leading to tolerance, dependence, or side effects.
• Increased pain sensitivity: Chronic pain can lead to central sensitization, where the nervous system becomes more sensitive to pain signals.(7)(8)

Psychological Issues

• Catastrophizing: Tendency to anticipate the worst, magnify the threat of pain, and feel helpless, which can amplify pain perception.
• Anxiety and depression: Chronic pain often co-occurs with these, impacting mood, motivation, and daily functioning.
• Fear of movement (kinesiophobia): Fear that certain activities will worsen pain, leading to avoidance and further physical deconditioning.
• Loss of self-efficacy: Feeling a lack of control over pain can lead to a sense of helplessness and hopelessness.
• Cognitive impairment: Persistent pain can affect concentration, memory, and decision-making.(9) (10)

Social Issues

• Isolation and withdrawal: Chronic pain can lead to social withdrawal due to difficulties participating in activities, leading to loneliness and loss of social support.
• Work-related challenges: Difficulty maintaining employment due to pain, which may cause financial strain and identity loss.
• Strained relationships: Chronic pain can put stress on relationships with family and friends who may not fully understand the experience.
• Reduced quality of life: Pain affects many aspects of life, from recreational activities to social engagement, impacting overall well-being. (9) (14)Understanding the Pain Persistence Loop: Breaking the Cycle of Chronic Pain

Understanding the Pain Persistence Loop

At times people in chronic pain can become fixated on finding a physical or biological trigger or answer as to why they’re experiencing such pain. This can lead to endless rounds of imaging, tests, medical interventions and experiences that can leave them drained physically, emotionally and financially, especially when no definitive answer can be given as to why they live with chronic pain.

To understand the complexity that is chronic pain it’s important to remember that we’re looking at more than just physical discomfort or more than just a body structure that’s injured or damaged in some way.

Chronic pain becomes a deeply ingrained experience that cycles through our physical, psychological and social realms, creating what is known as the pain persistence loop. 

This loop is a self-perpetuating cycle in which pain reinforces negative thoughts, emotions, and behaviours. These responses contribute to a diminished quality of life, increased pain sensitivity, and a weakened coping mechanism. All of which serve to magnify and sustain the pain experience. Understanding and disrupting this loop is essential for effective chronic pain management and improvement in quality of life.

6 Key Elements of the Pain Persistence Loop

1.     Pain Sensation

• The persistent sensation of pain not only causes physical discomfort but also creates an initial psychological response that the pain will continue indefinitely.
• In chronic pain, the nervous system may become sensitised, responding more intensely to even mild stimuli, thus amplifying the pain sensation. This biological factor lays the groundwork for the loop.(7).

2.     Catastrophising

• Catastrophising is a psychological response where the person magnifies the threat of pain, expecting the worst possible outcomes, and feeling helpless in managing their pain. This can lead to:
  • Increased emotional distress, which heightens pain perception.
  • Reduced coping mechanisms, causing the person to feel less in control of their pain.
• When individuals catastrophise, they often believe their pain will worsen or that it will significantly limit their abilities. This mindset not only worsens the pain experience but also fuels further negative behaviours and thoughts.(5)(10)

3.     Fear-Avoidance Behaviour

• Catastrophising often leads to fear of movement, or kinesiophobia, where individuals avoid activities, they believe will exacerbate their pain. This can be anything from exercising to basic daily activities.
• Avoidance behaviour reinforces a sedentary lifestyle, which can lead to muscle weakness, reduced mobility, and de-conditioning. These physical changes increase the sensation of pain, which perpetuates the cycle.
• Additionally, avoidance and sedentary behaviour often increase feelings of isolation and helplessness, which fuel anxiety and depression, further impacting pain perception.(4)(9).

4.     Anxiety and Depression

• Anxiety and depression are common co-occurring conditions in chronic pain, creating a complex feedback loop. Persistent pain can cause feelings of sadness, frustration, and worry, leading to:
  • Reduced motivation to engage in daily activities, which can worsen physical health and pain.
  • Increased sensitivity to pain due to lower pain thresholds associated with depressive and anxious states.
• Emotional distress directly impacts pain perception. When anxiety or depression is present, pain can feel more intense, reinforcing the catastrophic thoughts that perpetuate the pain persistence loop.(5)(9).

5.     Social Withdrawal

• Social isolation often follows the cycle of avoidance and fear. Individuals with chronic pain may withdraw from social activities, fearing that they’ll be a burden or that they won’t be able to keep up.
• This social isolation exacerbates feelings of loneliness, despair, and frustration. Social support has been shown to have a protective effect against pain intensity, so without it, the individual is left without a valuable coping resource.(9)(14).

6.     Loss of Self-Efficacy

• Self-efficacy, or the belief in one’s ability to manage and control aspects of their life, is critical in pain management. However, as the pain persistence loop deepens, individuals may feel helpless or incapable of breaking the cycle.
• The belief that they cannot manage or overcome their pain can make the loop seem impossible to disrupt. This loss of self-efficacy then feeds back into the cycle, reinforcing behaviours that keep the loop intact.(9)(10).

Interrupting the Pain Persistence Loop: Key Factors in Disrupting the Cycle of Chronic Pain and Improving Quality of Life

The essential news for those experiencing chronic pain is that the pain persistence loop can be interrupted. While chronic pain may not completely disappear, there are various ways and approaches (physical, mental, emotional) that can help reduce its impact and improve one’s quality of life. 

A 7 Step Guide for Seeking Help  – A Holistic Approach

1. Start with Awareness and Education

• Begin by learning about chronic pain, particularly the pain persistence loop, which includes biological, psychological, and social factors. Resources such as books, online materials, and pain education programs can provide insights into why pain persists and how it can be addressed.

2. Consult Your Healthcare Providers

• If you haven’t already done so, schedule an appointment with a trusted GP or pain specialist to rule out underlying medical conditions and to receive a thorough diagnosis.
• Ask for referrals to multidisciplinary clinics or specialists, such as physiotherapists, psychologists, or acupuncturists, who focus on chronic pain relief & management.

3. Incorporate Complementary Therapies

• Explore treatments like acupuncture, mindfulness, and physical therapy to complement traditional medical approaches. Practices such as Traditional Chinese Medicine (TCM) can address imbalances and promote relaxation while working alongside more standard approaches.

4. Build a Support Team

• Seek support from family, friends, or peer support groups who understand your journey. Pain-focused support groups, either in person or online, can help reduce isolation and provide encouragement.

5. Develop a Personalised Pain Management Plan

• Collaborate with professionals to create a comprehensive plan that combines techniques like CBT, graded exercise therapy, relaxation strategies, and dietary changes tailored to your needs.

6. Take Small, Measurable Steps

• Progress may feel slow, but incremental steps—like adding gentle exercise, practicing mindfulness for five minutes a day, or attending a support group meeting—can lead to meaningful improvements over time.

7. Evaluate and Adjust

• Chronic pain management is dynamic. Regularly review your strategies with your healthcare team to ensure they remain effective, adjusting as needed.

How Some Interventions Target Different Components of the Pain Persistence Loop

1.     Acupuncture and Traditional Chinese Medicine (TCM)

Acupuncture is a core component of TCM and involves inserting thin needles into specific points on the body to stimulate nerve-rich areas, promoting the body’s natural pain-relieving chemicals like endorphins. Research suggests that acupuncture can be effective in reducing pain and inflammation, breaking the cycle of pain and physical discomfort.

TCM also uses herbal medicine and techniques like cupping and moxibustion (burning herbs near the skin) to promote healing, reduce inflammation, and balance the body’s energy, or Qi. Herbal formulas are personalised, targeting specific imbalances that may be contributing to pain.

By addressing underlying imbalances and enhancing circulation, TCM can reduce pain perception, alleviate physical and emotional distress, and promote relaxation, reducing both anxiety and fear of movement.(12)(13).

2.     Cognitive Behavioural Therapy (CBT)

CBT is effective in addressing catastrophising thoughts by teaching individuals to recognise and modify unhelpful thought patterns. By reframing thoughts, people can learn to manage their response to pain more constructively.

CBT can also help individuals regain a sense of control, improving their self-efficacy and reducing feelings of helplessness.(10) (14).

3.     Graded Exercise Therapy (GET)

Fear of movement often leads to physical de-conditioning. Graded exercise therapy helps individuals gradually increase their activity levels, which can rebuild strength, improve mobility, and boost confidence in their physical abilities.(9).

Over time, regular physical activity can reduce pain sensitivity and improve overall physical health, which helps to break the fear-avoidance cycle.

4.     Mindfulness and Relaxation Techniques

Mindfulness meditation, deep breathing exercises, and relaxation techniques can help individuals manage stress and reduce anxiety, which directly impacts pain perception.(9)(15).

Mindfulness practices can also improve an individual’s ability to cope with pain by encouraging them to experience sensations non-judgmentally and focus on the present rather than worrying about future pain.

5.     Social Support and Counselling

Social support, whether from family, friends, or support groups, can offer encouragement, reduce feelings of isolation, and provide practical assistance in managing pain.(9)(14). 

Can help individuals address emotional struggles, work through social withdrawal, and find ways to re-engage in life activities.

6.     Pain Education Programs

Education about the nature of chronic pain can help demystify the experience, reducing catastrophizing and fear. When people understand that pain does not necessarily indicate further injury, they may feel more empowered to manage their pain effectively.(9)(14).

Important Tips for People in Chronic Pain When Visiting Healthcare Professionals

Navigating healthcare visits can be challenging when dealing with chronic pain. Here are some practical tips to help you get the most out of your appointments and ensure your concerns are addressed effectively:

1. Prepare Ahead of Time

• Keep a Symptom Diary: Note when and where your pain occurs, its’ intensity, triggers, and what helps alleviate it.
• List Questions and Goals: Write down key questions or goals for the visit to ensure you don’t forget important details during the consultation.
• Bring Medical History: Carry a list of medications, supplements, previous treatments, and any relevant diagnostic reports.

2. Be Honest and Specific

• Describe Your Pain Clearly: Use terms like sharp, dull, throbbing, or burning to convey the nature of your pain.
• Share Emotional Impacts: Let your provider know how the pain affects your mood, relationships, or ability to work.
• Discuss What You’ve Tried: Be transparent about treatments you’ve attempted and their outcomes, whether successful or not.

3. Advocate for Yourself

• Ask Questions: Don’t hesitate to request clarification if you don’t understand a term or treatment recommendation.
• Seek Second Opinions: If you feel your concerns aren’t being addressed, it’s okay to consult another provider.
• Be Persistent but Respectful: If a treatment isn’t working or side effects are intolerable, communicate this clearly.

4. Involve a Support Person

• Bring a Trusted Companion: A family member or friend can provide emotional support, help remember details from the visit, and advocate on your behalf if needed.

5. Stay Open-Minded About Treatment Options

• Explore All Avenues: Be open to discussing a combination of therapies, including medication, physical therapies, psychological support, and alternative treatments.
• Ask About Risks and Benefits: Understand potential side effects or what to expect from a recommended treatment.

6. Keep Track of Your Progress

• Monitor Changes: Note improvements or setbacks after starting a new treatment and share these observations with your provider.
• Celebrate Small Wins: Recognising progress, no matter how small, can keep you motivated.

7. Be Patient and Realistic

• Understand the Journey: Chronic pain management often requires time, multiple approaches, and adjustments to find what works for you.
• Focus on Quality of Life: Set realistic goals, such as improving sleep, mobility, or emotional wellbeing, rather than complete pain elimination.

8. Build a Support Network

• Engage in Groups: Consider joining support groups for chronic pain sufferers to share experiences and learn new strategies.
• Communicate Regularly: Stay in touch with your healthcare provider about changes or challenges in your condition.

Exploring Additional Avenues for Chronic Pain Relief and Support

Chronic pain management is a vast field, with emerging research and practices offering new hope and innovative strategies for those navigating the challenges of persistent pain. While the core interventions discussed earlier provide a strong foundation, here are some additional approaches that can play a significant role in holistic pain management:

1. Nutrition and Anti-Inflammatory Diets

The food we eat can significantly influence inflammation levels in the body, which are often tied to chronic pain conditions. Adopting an anti-inflammatory diet can complement other pain management strategies by addressing pain at its source.

• Key Foods to Incorporate: Omega-3 fatty acids (found in fatty fish, flaxseeds, and walnuts), antioxidant-rich fruits (like berries), leafy greens, and spices such as turmeric and ginger, known for their anti-inflammatory properties.
• Foods to Limit: Processed foods, refined sugars, and trans fats, which can exacerbate inflammation. Research suggests that improving gut health through probiotics and fiber-rich foods may also impact pain perception by regulating inflammation and supporting the gut-brain axis EatingWell
  National Council on Aging
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2. Sleep Hygiene and Pain Management

Chronic pain often disrupts sleep, creating a vicious cycle where poor rest amplifies pain perception. Developing strong sleep hygiene habits can be transformative:

• Establish a Routine: Go to bed and wake up at the same time daily to regulate your body’s internal clock.
• Create a Sleep-Conducive Environment: Keep the bedroom cool, dark, and quiet, and limit screen time before bed to minimize exposure to blue light.
• Mind-Body Techniques for Sleep: Practices like progressive muscle relaxation, gentle yoga, or listening to calming sounds can prepare the body and mind for restful sleep. Improving sleep quality has been shown to enhance overall physical recovery, reduce sensitivity to pain, and improve mental health National Council on Aging
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3. Physiotherapy and Manual Therapies

Physiotherapy focuses on restoring mobility, strength, and function in individuals dealing with chronic pain. A physiotherapist or exercise physiologist can design personalized exercise plans that:

• Improve posture and alignment.
• Strengthen muscles to support painful areas.
• Alleviate tension through techniques like massage, joint mobilization, or myofascial release. These therapies not only address physical discomfort but also help break cycles of inactivity and fear of movement National Council on Aging
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4. Explore Tai Chi

• Gentle Movement Therapy: Tai Chi combines slow, deliberate movements with deep breathing and meditation, offering a gentle way to enhance physical health and reduce pain.
• Improves Flexibility and Balance: Regular practice can increase range of motion, reduce stiffness, and improve overall body mechanics.
• Mind-Body Connection: The meditative aspects of Tai Chi can help alleviate stress and anxiety, which are known to exacerbate chronic pain. Studies suggest that Tai Chi may be effective for managing conditions like arthritis, fibromyalgia, and lower back pain Disease Prevention
  National Council on Aging
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5. Art and Music Therapy

Engaging in creative activities like art or music therapy provides an emotional outlet for individuals in chronic pain.

• Art Therapy: Helps express feelings that may be hard to verbalize, reducing emotional stress and offering a sense of accomplishment.
• Music Therapy: Can directly impact pain perception by stimulating the brain’s reward systems, promoting relaxation, and reducing stress hormones. These therapies are especially useful for individuals who feel emotionally “stuck” or overwhelmed by their pain EatingWell
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6. Acceptance and Commitment Therapy (ACT)

A modern psychological approach, ACT helps individuals live a meaningful life despite chronic pain.

• Instead of trying to eliminate pain, ACT encourages individuals to accept their experience without judgment while committing to actions that align with their values and goals.
• Techniques include mindfulness, identifying core values, and defusion exercises to reduce the impact of unhelpful thoughts about pain. ACT has been particularly effective in reducing psychological distress and improving resilience in people with chronic pain Disease Prevention
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7. Biofeedback and Neurofeedback

Biofeedback and neurofeedback are cutting-edge tools that use technology to teach individuals how to regulate bodily functions associated with pain.

• Biofeedback: Uses sensors to monitor physiological markers like heart rate, muscle tension, or skin temperature, teaching individuals to consciously reduce stress and tension in real-time.
• Neurofeedback: Focuses on brainwave patterns, training the brain to shift from states associated with heightened pain sensitivity to more relaxed and balanced patterns. These techniques empower individuals to take control of their body’s responses, creating lasting changes that reduce the intensity of chronic pain EatingWell
  National Council on Aging
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8. Community and Nature-Based Therapies

Spending time in nature or engaging in group activities can provide emotional and physical benefits for those in pain.

• Green Therapy: Activities like gardening, hiking, or simply walking in a park can lower stress levels, reduce inflammation, and improve mood.
• Community Programs: Volunteering or participating in group-based projects fosters connection, combats isolation, and builds a sense of purpose—key elements in reducing the psychological burden of pain National Council on Aging
  Disease Prevention.

Moving Forward: A Holistic Approach to Chronic Pain

Chronic pain requires more than just physical treatment; it calls for a holistic, multi-faceted approach that addresses the biological, psychological, and social factors contributing to the pain experience. 

Recognising pain as both a physical and emotional experience allows for more effective and compassionate management strategies, moving beyond the cycle of suffering.

Combining evidence-based therapies such as cognitive behavioural therapy, mindfulness, acupuncture, and graded exercise with education about pain science can help individuals regain control and improve their quality of life. Traditional Chinese medicine, with its emphasis on balancing the body’s energy, also offers additional support, helping alleviate both physical and emotional distress. By targeting different points within the pain persistence loop, these methods empower individuals to reduce pain’s impact on their lives.

With the right support and tools, individuals facing chronic pain can build resilience, restore self-efficacy, and reclaim a sense of peace. Chronic pain may be challenging, but a comprehensive, individualised approach makes a fulfilling, active life possible, breaking the cycle and paving the way toward relief and renewal.

If you’re experiencing chronic pain and haven’t reached out for help or have reached out but have only been given painkillers or medication, then I would encourage you to do some research online into chronic pain education and chronic pain management as a starting point. 

Go to my resources page for some helpful links.

From my own personal experience of previously having lived with chronic pain for a long time and in my experience of working with people in chronic pain I can say the following with confidence.

Often people in chronic pain are vulnerable. Being in chronic pain means that sometimes your thinking is less than clear. People in chronic pain are often desperate to find something or someone that can relieve their pain. They have often invested lot of time, energy, money and effort into seeking help but have sometimes fallen prey to either unethical and/or uncaring practitioners and doctors. Gaslighting and patient blaming does happen when progress is not being made or when a clinician runs out of options.

At Kintsugi Therapies, you’ll be met with a compassionate, integrative approach. Whether through acupuncture, mindfulness practices, or personalised guidance and chronic education. We’re here to help you explore the possibilities for a fuller, freer life. I make no promises that I can relieve your pain however I do make a promise to be ethical and honest at all times in my practice and to practice with skill, care, empathy and understanding. If we’ve followed the treatment program and outlined timeframe and no progress is being made we’ll discuss this together and along with all your options for referral and future support. 

References

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