Chronic upper limb pain (CULP) is relatively prevalent in the general population and is associated with physical dysfunction in patients [1]. Some studies estimate that about 30% of the population will suffer from CULP [2], which increases with age and varies depending on some factors related to activity, being more frequent in those with jobs that involve repetitive movements or intensive use of the hands [3].

The diagnosis of CULP is often complex due to the variety of factors that contribute to its development. Musculoskeletal injuries have been traditionally linked with diagnosed disorders such as shoulder tendinitis, adhesive capsulitis, lateral epicondylitis, and more specifically, when dealing with hand pain, carpal tunnel syndrome or de Quervain’s disease [4]. However, psychosocial factors and patient context have been identified as prognostic factors in this type of disorder [5, 6], therefore, these factors may play an important role in the management of CULP.

Regarding treatments, traditional approaches to the treatment of chronic pain have included the use of pharmacology and manual physical therapy techniques [7]. However, recent evidence suggests that interventions combining pain neuroscience education (PNE) and therapeutic exercise (TE) may have more lasting effects on reducing pain and improving function in these complex patients [8–10]. Furthermore, integrating an appropriate, well-designed, biopsychosocial model, has been shown to offer a promising framework for the comprehensive care of individuals with musculoskeletal pain conditions [11].

This case report describes a multimodal physiotherapy treatment approach grounded in a biobehavioral perspective for a patient with CULP. It is one of the first studies to utilize a biobehavioral framework for this patient profile, contrasting with more traditional physiotherapy methods, which had not provided any previous improvement to the patient presented. Thus, the objective of this case report was to describe the assessment and treatment of an actual patient with CULP by using a multimodal physical therapy treatment based on a biobehavioral approach, as such an approach is grounded in a patient-centered biobehavioral model.

This case report provides a comprehensive description of the multimodal physiotherapy treatment administered to an adult female patient with CULP, along with the results achieved. The proposed treatment successfully eliminated the intensity of pain. Furthermore, significant improvements were observed in the somatosensory, motor-functional, and affective-cognitive abilities.

In the literature, there are other case reports in which physiotherapy has been employed to alleviate hand pain, such as the case described by Özüdoğru and Ceylan [20]. In contrast to our report, this case focuses on a more conventional approach to physiotherapy, utilizing only passive techniques.

Moreover, this is not the first time that this approach is able to obtain significant improvements in a patient with chronic pain. There are previous reports focused on chronic non-specific neck pain [21], which have gotten positive results. Marcos-Martín et al. [22] and Forner-Álvarez et al. [23] also obtained significant improvements when applying this kind of multimodal intervention in patients with chronic cervico-craniofacial pain and chronic low back pain, respectively.

Notwithstanding sharing the same basis of clinical reasoning and management, this report differs from the one mentioned above, and other ones reported, in some key points. Firstly, the patient presented with chronicity in topographically separated locations. Despite there is plenty of literature describing the link between upper limb and neck disfunctions [24], this patient’s clinical history implied greater complexity when reasoning and subsequent decision-making.

Furthermore, despite having literature that explores the biopsychosocial approach to address the loss of upper limb functionality [25], the literature has traditionally focused on structural reasoning approaches when dealing with hand pain [26] that persist to our days [27], proposing frameworks which leave aside patients who are not governed by provocative orthopedic tests, as the one presented in this case. In this sense, this report provides a correct management guide aligned with the proposed biopsychosocial approach, which has previously been successful in other pathologies, and which here demonstrates to do so in the same way.

As for the motor-functional aspect, focusing on hand strength, the significant improvement in this outcome after the implementation of the therapeutic intervention may be caused mainly by TE, as seen in the current literature [28–30].

Regarding the somatosensory factors, some studies have pointed out that these factors are directly related to the symptoms of pain, such as intensity or expansion [31, 32]. Therefore, the significant pain score regression presented in this case could be linked to the somatosensorial management developed. In line with our proposal, the use of the MRMs has been used before in other kinds of conditions dealing with upper limb disfunction, achieving positive results [33, 34].

As for the affective-cognitive aspects, multimodal intervention based on TE and PNE may explain the results obtained. Similar to previous literature, besides its hypoalgesic effect [35], TE has been employed as a useful tool, expecting to downgrade the patient’s disability [36]. Otherwise, the improvement observed in catastrophism or kinesiophobia could be partly explained by the employment of the PNE [37].

From a broader perspective, considering the combined effects of these techniques, the therapeutic potential of the biopsychosocial model in generating neurophysiological changes is highly relevant to clinicians. Since chronic pain induces changes in the neurocognitive domain [38], physiotherapists’ clinical reasoning should be guided by models aimed at producing central-level changes [39, 40]. Strong evidence already supports the added benefits of combining therapies within this model, such as exercise and education [41, 42] or showing how manual therapy can be applied not merely to achieve peripheral effects on the treated area but rather to modulate the pain process under this framework, emphasizing the patient’s interpretative process as a key factor to achieve these neurophysiological goals [43, 44].