Are you suffering from chronic pain? 1 in 5 Australians struggle with Chronic pain. Read how you can manage your chronic pain.

 

Back pain when driving

 

What is Pain

Pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage.

Many believe that pain is just a physical sensation. This is not the case. Pain is influenced by your personality, attitudes, beliefs and social factors. Chronic pain sufferers will also comment on how it can affect your emotional and mental wellbeing.

Although two people may have the same pain condition, their experience of pain can be very different.

There are 2 main categories of pain: acute and chronic.

Acute pain

Acute pain lasts for a short time and occurs following injury, trauma or other potentially harmful stimulus. It acts as a warning to the body to seek help or avoid further harm. It usually improves as the body heals, although in some cases pain can persist.

What is Chronic Pain

We’ve written previously about Chronic Pain and how to reduce your pain here. The terms chronic pain and persistent pain are often used interchangeably. Pain is termed chronic if it persists beyond the normal healing time of about three months. ‘Chronic’ simply means ongoing and doesn’t tell us much about the severity or quality of the pain.

You may be new to the notion of chronic pain because you have been  taught that pain goes away when tissues heal after an injury or illness. However, this is not the case for 1 in 5 Australians, where their pain may not lessen when the healing process is complete.

Sometimes, it is not possible for doctors to pin point the cause of the pain and it can be frustrating not to have a diagnosis. Chronic pain is complex because it involves the nerves and nervous systems, including the brain and spinal cord.

Chronic pain occurs because of changes to the nerves or nervous system which keeps the nerves firing and signalling pain. However, there are likely to be other precipitating factors with chronic pain including genetics, gender and previous episodes of acute pain.

Chronic pain can be intense and unrelenting and is a condition in its own right because of the changes in the nervous system unrelated to the original diagnosis or injury.

Biopsychosocial model

It is widely accepted in the medical/health professions that management should be holistic, involving all aspects of the client’s life. A model of assessment and management is now used call the biopsychosocial model.

a) Bio – biological: your physical body should be assessed for changes or injury.

b) Psycho – psychological: your current mental health including anxiety and stress should be addressed.

c) Social – aspects of your social situation and home/work environment should be considered.

These 3 aspects will have a bearing upon your pain experience. However it is not possible to decide how much each contributes to the pain.

Team approach

The most important person in managing your pain is you!

It has been shown that the more you understand about the mechanisms of pain; the better you can control the pain. There are many health professionals that can help you with pain. They should all be able to consider the 3 aspects outlined above (bio-psycho-social), but will probably only be an expert in one field. They may include doctors, physiotherapists, psychologists, and social workers.

Below are three areas of pain management that you will need to consider. Although, all 3 may not be needed in every situation:

  1. Medication
  2. Physical activity
  3. Psychology

Medication

Medication is only one part of the overall management strategy for chronic pain. Medications can be effective for some types of pain, but not all pain responds completely to medication alone, so physical and psychological methods of pain management should be combined with medication for the best effect.

Constant pain is best managed with regular medication to provide 24 hour control. Taking medication regularly, usually results in better pain control using the lowest possible 24 hour doses, whereas waiting until the pain is very severe to take a tablet results in taking larger doses with poorer control over the 24 hours.

Many people have chronic pain at a constant level throughout the day which can be satisfactorily managed with background pain control, however there will be times that the pain increases either due to physical activity, position (standing, walking, sitting), or some other event. At times of increased pain there is the need to use medication which is fast acting with short duration of effect. Therefore it is best to have a combination of background medication and medication for exacerbations.

Physical Activity

Our bodies are made for movement and movement gives the nervous system and the brain a lot of feedback about your body. This background information helps to normalise the nervous system, which can downregulate your pain response.

Movement also helps with many other systems of the body. It helps to keep your heart and lungs healthy, improve muscle and joint function and improves mental function. Chemicals will also be released which reduce your sensitivity to pain.

Increasing your activity so that the impact of pain is not so severe may need to be guided by your physiotherapist. You may need to stretch tight or tense muscles, strengthen specific muscles or cut down the amount of activity that you do before taking a rest (this is called pacing).

Graded exercise is where you slowly increase the amount of general exercise you perform to re-condition your muscles and nervous system. This can help people with persistent pain.

With people that are highly de-conditioned or fearful of movement these types of activities can be very difficult to perform due to aggravation of pain and therefor need to be monitored or guided by a physiotherapist.

The 80% Rule – graded exercise should be around 80% of your painful threshold. Eg. if your pain starts to get worse after 30 minutes of walking then start with around 25 minutes and build up from there.

Psychology

Ongoing pain can heighten emotional responses and it is common to experience increases in anxiety, irritability, frustration, depression, and anger. These elevations in emotional states can also exacerbate your pain.

Pain can interfere with sleep, activity levels, your normal roles and responsibilities, work, relationships, socialising, recreation and finances.

Frequently people with pain will be referred to psychologists or psychiatrists to help them to deal with their emotional responses and to learn strategies to cope and manage their pain more effectively. A common thought is that this referral means the your doctor of physiotherapist thinks your pain is imaginary or made up. But this is not true.

As a result you may feel anxious and angry about the referral. Your doctor of physiotherapist should take the time to provide reinforcement that the pain is accepted as real and explaining the bio-psychosocial model is important and can allow a shift in focus to management of the pain.

One of the important aspects of pain management is learning to behave and think differently about your condition and other aspects of life. This involves modifying or changing routines, responsibilities, the type, amount and way activities are undertaken and unhelpful thoughts and attitudes.

You shouldn’t try to change things too quickly as this can result in pain flare-ups. A more gradual systematic approach is required with small increments of activity. It therefore takes time and patience for you to learn and effectively implement new pain management strategies. Learning to deal effectively with flare-ups of pain is an important part of the management.

Take Home Tips

Stretching and walking – Moderate daily exercise will keep your muscles conditioned and improve your pain levels. If you haven’t been active in a while, start small and increase your activity over time. Pacing is key to pain management so take breaks as you need.

Relaxation techniques – To reduce muscle tension, you can use simple deep-breathing techniques, or take a yoga or meditation class, to learn techniques to use at home.

Practice mindfulness – Mindfulness is about learning to accept all your thoughts and feelings, including pain. It can help you live with pain more successfully.

Desensitisation – Learning not to react to your pain in a negative way. This retrains the way your brain thinks about pain, which can improve the experience of pain and pain levels.

Distraction – is focusing on something other than the pain, often something pleasant or something you enjoy doing, such as listening to music.

Sleep – A good night’s sleep will help you cope with your pain. If you are having problems sleeping, try implementing a bedtime ritual, and keep your bedroom peaceful and relaxing.

Diet and exercise – Maintaining a healthy weight can improve symptoms of chronic pain. Your GP or a registered dietician can help you develop a weight-loss plan.

 

Resources

http://www.painaustralia.org.au/about-pain/what-is-pain

https://www.painmanagement.org.au/resources/about-pain/common-forms-of-pain.html

About Nick Dewey

Nick graduated from the University of Canberra with a Masters of Physiotherapy after completing his Bachelors in Applied Science in Human Biology. Nick’s special interests include rehabilitation from sporting injures, management of work related injuries and functional strength and conditioning for injury prevention. Nick grew up playing basketball and has represented the ACT playing with the ACT Academy of Sport and the Canberra Gunners Academy.