Still in Pain? You Might Be Making More Progress Than You Think

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Pain isn't always the first sign of improvement.

When something hurts, understandably, the change you're probably waiting for is for that pain to go away.

So when you've started treatment or rehab and you're still sore, it can be really easy to think:

“This isn't working.”

But then we start talking about everything else that's changed.

“Well… I can walk for longer now.”

“It doesn't wake me up as much.”

“Actually, the flare-ups aren't lasting as long.”

“I got through my whole workday before I noticed it.”

Suddenly, the picture looks quite different.

Pain isn't the only way we measure progress

Pain matters. Of course it does.

But a pain score is only one piece of information.

Pain is a personal experience influenced by a combination of biological, psychological and social factors. This means that how much pain you feel doesn't necessarily give us a simple measurement of what's happening in the tissues underneath.¹

That's particularly important when pain has been around for a while.

So if we're only asking:

“Is the pain gone yet?”

…we can miss some really meaningful signs that things are heading in the right direction.

What else does progress look like?

Depending on what we're working on, I might be just as interested in whether:

• your pain is happening less often

• a flare-up settles more quickly

• you can walk, sit or stand for longer

• you're sleeping better

• you're getting stronger

• you're moving more comfortably

• you can tolerate more exercise or activity

• you're getting back to work, sport or hobbies

• you're having fewer “bad days”

• you're thinking about the painful area less

• you're feeling more confident using your body again

Modern approaches to persistent musculoskeletal pain don't just consider pain intensity. Function, activity, participation and overall wellbeing are important outcomes too.

And sometimes, those are the changes we notice first.

Imagine your pain is still a 5/10…

Previously, your back started hurting after 10 minutes of walking.

Now you can walk for 40 minutes before you notice it.

Your pain might still reach a 5/10.

But your capacity has changed.

Or perhaps your back still flares occasionally, but instead of that flare lasting three days, you're feeling much more comfortable again by the following morning.

You technically still “have back pain”.

But I'd absolutely want to know about that change.

This is one reason I don't like relying on a pain score alone when we're deciding whether you're making progress.

Research in people with chronic musculoskeletal pain also suggests that pain intensity and physical function don't necessarily move together in a simple, predictable way.

Recovery isn't always a straight line

You might have a really good week followed by a flare.

You might increase your exercise and notice some soreness.

You might sleep badly, have a stressful week at work or suddenly do much more activity than usual and notice your symptoms more.

That doesn't automatically mean you've damaged something or undone all of your progress.

Pain is influenced by many factors, and fluctuations can occur even while your overall function is improving.

I'd usually be more interested in the trend over time.

Are you gradually able to do more?

Are flare-ups becoming less frequent or easier to manage?

Are you getting stronger?

Are there things you're doing now that you couldn't comfortably do a month ago?

Those questions can give us valuable information that a single pain score can't.

Do you need to be pain-free before you start doing things again?

Not necessarily.

For many musculoskeletal conditions, rehabilitation involves gradually rebuilding strength, movement and tolerance to activity rather than waiting for every symptom to disappear first.

For chronic primary low back pain, for example, the World Health Organization recommends approaches including education and exercise as part of care.³ Research examining exercise for chronic musculoskeletal pain has also found that experiencing some pain during exercise does not necessarily prevent improvements in pain or disability, although the certainty of that evidence is limited.

That doesn't mean you should ignore pain or push through everything.

There are absolutely situations where worsening or persistent symptoms need to be reassessed, particularly if the presentation is changing or new symptoms appear.

The appropriate amount of activity, and whether pain during it is acceptable; depends on the person and what we're treating.

So, if you're frustrated because you're still sore…

Look back a little further.

Instead of only asking:

“Does it still hurt?”

Try asking:

“What can I do now that I couldn't do before?”

Maybe you're stronger.

Maybe you can walk further.

Maybe you're sleeping better.

Maybe your flare-ups don't last as long.

Maybe you've returned to the gym.

Or maybe you've simply stopped thinking about your back, shoulder, knee or neck quite as often.

Those changes matter.

Being pain-free can absolutely be a goal. But it isn't the only sign that you're getting better.

Sometimes when we zoom out and look at the bigger picture, we realise you've already made far more progress than you thought.

If you've been dealing with pain and you're unsure whether things are actually improving, an assessment can help us look beyond the pain score; at your movement, strength, function, activity tolerance and what you're trying to get back to.

I offer osteopathy and individualised exercise rehabilitation at Osteo Wellness Studio, inside Back In Motion Burleigh Waters on the Gold Coast.

References

1. Raja SN, Carr DB, Cohen M, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. PAIN. 2020;161(9):1976–1982. The revised IASP definition emphasises that pain is a personal experience influenced to varying degrees by biological, psychological and social factors.

2. International Association for the Study of Pain. Definitions of Chronic Pain Syndromes. IASP. Chronic pain is recognised as multifactorial and may involve functional disability and interference with everyday activities and participation.

3. World Health Organization. WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings. Geneva: WHO; 2023. The guideline includes education, exercise and other interventions within person-centred care for chronic primary low back pain.

4. de Rooij A, van der Leeden M, Roorda LD, et al. Prognostic factors for physical functioning after multidisciplinary rehabilitation in patients with chronic musculoskeletal pain: a systematic review and meta-analysis. Journal of Pain. 2019;20(2):131–151. The review found baseline pain intensity was not associated with long-term physical functioning following multidisciplinary rehabilitation, supporting the distinction between pain and function as outcomes.

5. Tran I, Gibbs MT, Yu N, Powell JK, Smith BE, Jones MD. Effectiveness of painful versus nonpainful exercise on pain intensity, disability, and other patient-reported outcomes in adults with chronic musculoskeletal pain: an updated systematic review with meta-analysis. J Orthop Sports Phys Ther. 2025;55(8):1–11. The review found no clear difference between painful and non-painful exercise for pain or disability outcomes, although certainty of evidence was low to very low.