International Standards of Care

International guidelines (IASP, NICE 2021, European Pain Federation) agree that chronic musculoskeletal pain is best managed with a multimodal approach. Medication alone does little. The gold standard is a combination of:

• Patient education and pain neuroscience understanding

• Exercise and physiotherapy to restore confidence in movement

• Somatic and mind–body practices that target the nervous system directly

• Psychological support to address fear, stress, and coping

• Lifestyle interventions around sleep, stress, and activity pacing

The focus is not on “curing pain” but on restoring function, confidence, and quality of life.

Medical Management

Doctors may prescribe medications such as:

• Neuropathic pain agents (duloxetine, pregabalin)

• Short courses of NSAIDs for flare-ups

• Occasional low-dose antidepressants for sleep or pain modulation

But evidence shows these medications have only modest benefit in chronic pain, and they work best as an adjunct to rehabilitation and self-management.

Exercise and Physiotherapy

Louis Gifford’s work emphasised that in chronic pain, the system is overprotective, not necessarily damaged. Muscles may be tight, joints may feel fragile, but the real issue is that the nervous system is amplifying normal signals.

Exercise works because it recalibrates this system:

• Movement provides the nervous system with new, non-threatening input.

• Graded exposure reduces fear by proving that safe movement does not equal harm.

• Strengthening builds tissue resilience, reducing the risk of flare-ups from everyday tasks.

• Aerobic exercise improves blood flow, endorphin release, and immune modulation.

But the difference lies in how exercise is delivered. Generic “just go to the gym” advice often backfires — patients push too hard, flare, and lose trust in their bodies. A skilled physiotherapist guides you in finding the right entry point, pacing progress so you build capacity without setbacks. This process restores not only function but also confidence.

Pain Neuroscience Education

David Butler and Lorimer Moseley’s work has shown that when people understand that pain is an output of the nervous system, not a measure of damage, fear decreases and recovery improves. Education is not an “extra.” It changes the brain’s interpretation of signals, making every other intervention more effective.

At Neurokinetica, pain neuroscience is woven into treatment. You learn why your pain persists, how the nervous system creates protective responses, and most importantly, how to retrain it. Patients often describe this knowledge as the moment everything “clicks.”

Somatic and Mind–Body Practices

This is where chronic pain rehabilitation has changed most in the past decade. Research now confirms that practices like yoga, mindfulness, and somatic methods such as Feldenkrais are not “alternative” but evidence-based tools for pain management.

Why they work:

• They improve interoception: the brain’s ability to interpret internal signals. In chronic pain, interoception is often distorted — normal muscle tension or fatigue is misread as danger. Somatic practices retrain this perception, teaching the nervous system to feel safe again.

• They reduce sympathetic overdrive: Chronic pain keeps the body in fight-or-flight mode. Breathwork, mindfulness, and guided relaxation activate the parasympathetic system, allowing recovery and repair.

• They re-establish movement variability: Feldenkrais and similar methods explore gentle, novel movements that give the nervous system new options, breaking rigid, protective patterns.

• They target both mind and body together, reducing not only pain intensity but also fear, anxiety, and fatigue.

Evidence:

• Clinical trials show yoga reduces pain intensity, improves function, and lowers psychological distress in chronic back and neck pain.

• Feldenkrais-based interventions improve movement efficiency, proprioception, and perceived pain in long-term musculoskeletal conditions.

• Mindfulness-based stress reduction (MBSR) reduces pain interference and improves mood in chronic pain populations.

These are not “relaxation add-ons.” They are central strategies that directly modulate the pain system.

Psychological and Lifestyle Support

Chronic pain is sustained not only by biological processes but also by stress, sleep disruption, and unhelpful coping patterns.

• CBT improves function by changing pain-related thoughts and behaviours.

• ACT helps patients commit to valued activities even with ongoing symptoms.

• Sleep optimisation is crucial, since poor sleep heightens pain sensitivity.

• Stress management reduces immune and nervous system overactivation.

Rehabilitation at Neurokinetica

At Neurokinetica, we understand that chronic musculoskeletal pain is not about a “bad back” or a “dodgy knee.” It is about a nervous system that has learned to stay on high alert, making every movement feel risky. Patients often tell us they feel stuck between avoiding activity out of fear and pushing too hard only to pay for it later.

Our approach is designed to break that cycle. We help you:

• Understand your pain through clear, science-based education

• Rebuild confidence with graded, tailored exercise that strengthens without flaring

• Explore safe, novel movements through yoga-based therapy and somatic practices like Feldenkrais

• Use breathwork and relaxation to regulate your nervous system and reduce background stress

• Develop pacing strategies so energy is spread more evenly across your days

• Build long-term resilience, so you are not dependent on short-term fixes

Patients often leave sessions not just with less pain, but with a sense of clarity — finally understanding why their pain persists and how to move forward. Over time, they regain not only mobility but also the trust that their body is capable of more than they thought possible.

Our goal is not temporary relief. It is to give you the knowledge, skills, and physical and nervous system capacity to live more fully with less pain.

If you are seeking chronic pain treatment in Cork, and want a professional approach that combines pain neuroscience, exercise, and somatic rehabilitation, book a session to get an assessment and learn more about our programmes.