Pain is something everyone encounters at some point in their life, whether it be a headache, aches, and pains from a tough workout, or persistent and chronic pain. It is understood that 1 in 5 Australians over the age of 45 experience significant persistent ongoing pain.
The treatment of pain differs significantly with options ranging from over the counter and prescription medications, surgeries, physiotherapy, alternative therapies, and so much more according to extensive evidence based guidelines and literature. The outcomes for the treatment of pain vary greatly as a result.
If we look at the basics, pain is defined as an unpleasant sensory and emotional experience associated with potential or actual body tissue damage. The initial pain reflex is designed to protect us from further damage. However, pain that continues beyond the normal healing time and no longer serves as the warning sign function or protection against potential damage is what is termed as chronic or persistent pain.
There are two broad pain categories – acute and chronic. Some important differences should be understood:
- Acute pain typically gets better with time, treatment, or a combination of both. It usually resolves in around 3 to 6 months and is linked to healing i.e. when the tissues repair, the pain resolves. It is usually predictable in pattern and responds well to simple pain medication and rest. It is relatively straightforward to treat.
- Chronic pain extends well beyond the typical 6 month healing time and no longer serves as a protective mechanism. The pain will often continue well after the body has healed and doesn’t respond particularly well to medication. Due to its “invisibility” (lack of swelling, bruising, etc.), its persistence leads to significant psychological impacts resulting in other emotional effects such as depression, anger, and anxiety.
So why do we need to know about chronic pain?
Pain can be both frightening and exhausting. By understanding and explaining pain it is possible to reduce anxiety and provide insight into what to expect long-term. Fear and anxiety arise from a lack of understanding about the pain which in turn contributes to the degree of physical restriction in our lives. For example, someone with chronic pain can limit or stop activities including everyday tasks e.g. cleaning or socialising out of fear that they will do more damage and as a result be in worse pain. By understanding that pain is not always linked to harm can reduce fear and subsequently improve the quality of life of people experiencing chronic pain.
How does chronic pain arise?
In short, the research is still continuing and there are many theories. What we do understand is that the pain experience comes from an “alarm system”. It’s a system that responds to potential or actual tissue damage. Sometimes, for unknown reasons, the system can become too sensitive resulting in a pain warning sign even when there is no true threat. The system works too hard to protect us to the point where it becomes unhelpful. In turn, small movements, light pressure, temperature changes, loud noises, stress, and even a hug can be enough to trigger the alarm. There doesn’t always have to be a physical stimulus to generate a pain response. Another fact that we are aware of is that physical and/or emotional trauma are often pre-cursors to developing chronic pain conditions. A brain is a complex machine that takes into account past experience and memories, stress, self–beliefs, and surrounding influences including our opinions of others.
How to overcome chronic pain and reduce symptoms
Chronic pain is often invisible to the human eye and its origins can’t often be detected on scans either, as often the cause of the initial pain has now gone. This doesn’t mean the pain isn’t real or that we are “making it up”. Whilst people experiencing chronic pain are desperate for answers, scan findings are often ineffective and can lead to more frustration and disappointment when they do not show signs of abnormality. Again, this is NORMAL. Our brain and nervous system are still sending those signals even when the cause is taken away.
Pain impacts us physically and emotionally, which is why it is important to involve a team around the person at the centre of it. We need to consider the physical, practical, and psychological impacts of pain. This is not something that can be solved by one person. A team of professionals with different skill specialities will be the most effective way of overcoming chronic pain and reducing symptoms. The most important in this process are:
- Physiotherapists and Exercise Physiologists: Appropriately guided movement is critical for recovering from most types of pain. Physiotherapists and Exercise Physiologists will introduce programs and graded movements that will improve daily, improve strength and flexibility, and clarify our understanding of the triggers of pain by explaining the normal mechanism of pain behind each movement.
- Occupational Therapists: Understanding how to modify or alternative strategies for performing our everyday occupations of life is important for people living with chronic pain. Occupational Therapists are experts in assistive technology, home modifications, functional and activities of daily living strategies, and much more. Gaining this type of assistance is so important so that we can continue to engage in functional tasks, and live as independently as possible. This can increase recovery outcomes and reduce the timeframes, but most importantly supports our emotional wellbeing by living as “normally” as possible throughout this experience.
- Psychologists: We cannot underestimate the psychological impact of chronic pain, and the role that our mental health and cognitive functioning have on our ability to recover from it. We now know that “retraining” our brain is possible, and despite there being no quick cure for chronic pain, living well mentally and practicing emotional regulation is a critical part of the most well supported recovery practices.
These are just some of the experts who can help in the recovery journey, and with reducing the impact that pain has on our lives.
It is important to understand that pain is a very individual experience, and the key to recovery is ensuring that there is a strong personal and professional support network in place with the person experiencing pain at the centre. Physical and emotional well-being is equally important. The aim is for this process to be as short as possible until the moment is reached when symptoms begin to resolve.
Learning and Development Manager- Physiotherapy, Exercise Physiology and Workplace Rehabilitation and Health
David has 19 years’ experience working for the NHS in the UK as a physiotherapist, specialising in spinal conditions and neurosurgery before relocating to Australia. After completing his Masters in Advanced Practice he worked as a Service Manager in a Neurosurgery Specialist unit. David has worked as a team leader across many settings within public health and brought his advanced practice knowledge and skill to work as a Team Lead working in the Australian health sector including workplace rehabilitation, NDIS and DVA. David has also worked as an Honorary Lecturer for the University of Liverpool lecturing on the under and postgraduate programmes.
David has a passion for service development through innovation and nurturing the development of staff and service users alike.