Chronic Pain When You've Tried Everything: Where to Start

When you've tried everything and you're still in pain, the problem usually isn't that you haven't found the right treatment yet. It's that nobody has helped you put the pieces together. The best place to start is often not yet another treatment, but working towards a clearer understanding of your own pain: what may be driving it, what makes it better or worse, and importantly what to actually work on first.

Most people I meet in clinic who say they've tried everything really have. Physio(s), massage, scans, tablets, injections, yoga, a chiropractor, an osteopath, an app or two, some books, a cousin's recommendation, and a few hundred social media videos (probably being conservative with that number too!).

Each of those can potentially help you understand or change something worthwhile. The trouble is that they usually arrive one at a time, from different people, with different explanations. Sometimes those explanations conflict with each other too, and even if you're lucky and they don't - you're still left holding a pile of disconnected jigsaw pieces and the box with the picture on it is missing.

So the default plan becomes: try the next thing.

And when that doesn't work either, you feel even more hopeless and stuck. And I'm gonna call out something here that happens far too regularly and I know this because it happened to me and I name it during client appointments - and they often confirm that they felt this way too. Failing a treatment plan or not feeling change from a course of appointments DOES NOT automatically confirm that the problem you have MUST be more serious, more severe and much trickier to make progress with.

That's a set of mental extrapolations that doesn't reflect reality and can increase your fear, worry and doubt about your future. This is not your fault - it's what often happens when care is fragmented.

A simple double analogy to understand this - Imagine buying a piece of furniture in IKEA but you get no instructions and no picture of what it's meant to look like. Which screws go where? Is this the front or the back or the bottom? (Side note: even with the manual it can and usually will be a nightmare to build!!).

Now imagine persistent pain like a recipe. We have potatoes representing movement, custard representing inflammation, sardines representing injuries, etc. Every person reading this will have a different recipe, using different quantities, all blended up to deliver what they experience.

Persistent pain can feel kinda like that. There's no perfect manual, and your recipe might not taste nice and at times, it might not be easily reverse-engineered to understand how to change it.

The flip side of this is that there's a lot more that can be understood than most people are ever shown, and that understanding changes what you do next. I'm a firm believer in this uber-logical next sentence: In order to overcome a problem, you must first understand the problem you are facing.

In clinic, after listening to someone's story, I almost always ask:

"What do you understand about how pain is created in your body?"

The answers range from an honest "I haven't a clue" to a patchwork quilt's worth of explanations picked up from previous therapists, Dr Google, friends and family. Very often the reply is: "Nobody has ever asked me that before."

Most of the offered explanations are structural in basis or almost structural. "Pain means something is damaged." "My back has gone out again." "Something must be wearing away."

Or if we ask them something like: "When pain is happening in your body, what process is physically changing or happening to cause the pain?"

Most often they will say stuff like: "That joint is rubbing off the bone", "the disc is getting squished out", "the muscle is ripping or tearing". All of these are structure-based ideas about what is causing pain.

Sometimes structure is part of the story. But when your scan doesn't show anything that meaningfully explains the pain you have, or if there was never an injury in that area of your body, or it's been going on for years, structure alone doesn't fit as an explanation for your pain.

And if you don't have another explanation, usually your unconscious will settle for the understanding or narrative that you currently hold. Which unfortunately usually means more worry, more protection and more searching for the one thing that will sort it once and for all.

If you'd like to understand more about scans & structuralist thinking in persistent pain, I've written about it here: Chronic pain but a normal MRI or scan.

One of the hardest parts of persistent pain is the contradictory advice. And boy oh boy is there a lot of it.

Here's an example I see a lot. Someone comes in with knee pain, wearing orthotics from a previous practitioner. They tell me their foot is flat, it "pronates" (rolls in), that this is causing their knee pain, and the orthotics are there to stop it. They will have been doing a bazillion glute exercises to make sure sleepy glutes haven't played a role here too.

I ask if they're open to a different view, and then say: "Pronation is a normal, healthy part of how your foot works. Your knee needs it."

That's a contradiction, and contradictions are confusing. To be fair to everyone involved, ideas like this have been widely taught in the past. But the effect of these explanations on the person in pain is real: a normal movement has been labelled as problematic and often their nervous system has learned to organise their movement around avoiding this.

That happens with almost every part of the body, from lower backs to big toes. And it's made exponentially more difficult by social media, where for every thousand accounts telling you something is wrong - you'll have another thousand saying it's not.

It might be a bit strange to hear this, but in my experience, some of the things people are most sure about regarding their bodies are the very things holding them back. The reassuring news is this: your body is usually far more robust, adaptable and capable than you've been led to believe.

Here's how I'd approach it if you feel you've tried everything.

1. Make sure the important things have been checked

If your pain is new, changing, spreading, waking you at night in a way that's different from usual, or comes with symptoms like unexplained weight loss, fever, numbness, weakness, or changes in bladder or bowel control, see your GP promptly. Self-management works alongside medical care, not instead of it.

2. Get clear on your own story

Write down your timeline. When did it start? What was going on in your life? What has made it better or worse? What have you been told, and by whom? Which explanations made you more worried, and which made you feel safer? Is there a narrative that's been built up around these symptoms that might be playing a part too?

Getting clarity on how your story, symptoms and life have woven together is the first priority. If you don't know where you're starting from, it's very hard to find the direction you need to travel. If you need a little bit of help with this, you can begin gently with our free Clarity Report.

3. Update your understanding of pain

Don't worry, you won't need a degree in neuroscience or pain management here. Just enough to know what pain is, that it's always 100% real, that it isn't a direct readout of damage, and that sensitivity, sleep, stress, beliefs and habits all have a say. People who understand their pain better often find movement less frightening, and there is even research that suggests that pairing pain education with structured movement guidance can help more than relying on either alone.

4. Build evidence of safety about your body and do it consistently

You don't need to do everything. You need a few things that help you "build evidence of safety" for your nervous system. And get them done as consistently as possible: walking, gentle movement or strength work that feels safe, better sleep, calming your stress response, and time doing things you enjoy. Anything that allows the painful body area to move in a way that doesn't increase symptoms can technically count as evidence of safety!

5. Watch the trend, not the day

Persistent pain goes up and down. A bad day isn't proof that nothing is working. Tracking over weeks shows you what's actually changing, and the trend is more important than the event.

6. Have one plan, not ten

Ten disconnected strategies pull you in different directions. One connected plan, where your understanding, movement, flare plan and daily habits support each other, is easier to follow and easier to stick with.

As mentioned above, getting clear on what may be driving your pain is exactly what the free Clarity Report is for. It's a short conversation with BTP's AI guide, Biggie, that reflects your story back to you and suggests where to begin. It's often a much clearer place to start than "try the next thing".

If you've been through physio and still feel stuck, this may also help: What helps chronic pain when physio hasn't worked.

This article is general education, not a diagnosis or a substitute for care from your GP or healthcare team. If your pain is new, getting worse, or comes with symptoms that worry you, please get it checked.