This week marks “Pain Week” in Australia, so in conjunction with this and for the first PFMC education blog, we thought we would briefly explore chronic pain, what it is, how it is different to acute pain, what are the management options and how the team at PFMC can help. Chronic pain is common and costly, with 1 in 5 people in Australia experiencing it and costing the health care system $34 billion per year.
Pain can be defined as a subjective, unpleasant physical, psychological and emotional experience in the body. Acute pain is associated with perceived damage and acts as a protective mechanism to limit the damaging process. Chronic Pain, by contrast, is much more complex, in that it is pain that persists longer then the expected healing time. In this way it does not follow the same rules as acute pain.
Chronic pain may be associated with specific disease states such as arthritis, or cancer, it may be a consequence of an injury or trauma, or sometimes the ongoing symptoms may not be indicating ongoing disease or damage. What is common, no matter the underlying causes of pain, known or unknown, the longer it persists the more body systems become involved, e.g. the nervous system, gut, hormone system etc.
In the case of chronic pain, the theory goes, that the body becomes sensitised to pain. What this means is the ability for a stimulus to cause pain, lessens, thus less activity activity causes pain. The effect of this often starts a vicious cycle of activity avoidance due to discomfort, which leads to deconditioning, fear of movement, and stiffness, which further sensitises the system. Additionally, context has an enormous impact on pain, in that emotional, psychological and social factors will cause changes in pain.
It is for these above reasons that management of chronic pain issues is different to management of acute pain. In chronic pain the aim is not elimination of pain, because this is likely not able to be achieved, the aim is to improve lessen the impact and disabling effects of pain, in order for you to do all the things that you value. In this way the management is best performed in a multidisciplinary way, with the GP acting as the care coordinator and support.
Allied health services play an extremely active role in the management of pain. Physiotherapy, exercise therapists, and psychologists are extremely important parts of the care team.
Physiotherapy and exercise therapists aim to get us moving again, advising an educating on correct movement and providing graded exercise plans in order to build exercise and movement into our everyday lives.
Psychologist also play a very important role. Often this can be difficult for you to understand, and often people develop the misperception that the reason psychology is involved is that the doctor believes the pain “is in your head.” This is not the case. Psychology is important for several reasons. First, our mental and emotional state has a very large impact on pain, therefore learning strategies to address this is important. Secondly, fear is quite common in people with chronic pain conditions. Psychological strategies such as Cognitive Behavioural therapy or Acceptance and Commitment therapy can address this. Finally, and understandably, many people with chronic pain also develop mental health issues, which psychologists are perfectly positioned to assist with.
Medication can form an important role in chronic pain management. Medications include paracetamol, anti-inflammatories, anti-seizure medications and anti-depressants. For certain specific conditions, specific medications are indicated and are often prescribed long-term. For others medications for part of the management plan for acute flares. The issue often encountered through the use of medications is the risks associated with side effects. Additionally, certain medications that have been used for chronic pain, such as opioids, can be addictive, can lessen in effectiveness over time and in fact lead to further sensitisation of the body to pain, thus worsening pain in the long term. For further information of the risks, benefit and role of medications, please discuss with your doctor.
Chronic pain often follows a trajectory similar to other chronic illnesses, in that at times it can be quiescent and controlled, and at others it can flare. At PFMC, the GP’s role is to assist you along your chronic pain journey. Some of the tools at our disposal include the develop of chronic disease management plans and referral to specialist and allied health services.
If you are keen to discuss your pain and understand more, please make an appointment with one of our doctors today. Alternatively see below for several web resources.