Chronic pain (or persistent pain) is a term that relates to a pain problem that persists beyond 3 months.
Common examples of chronic pain are back pain, pelvic pain, neck pain, headaches, jaw pain, knee pain, hip pain, foot pain, tendon pain and widespread pain or ‘fibromyalgia’. Chronic pain can be very distressing, exhausting and it can disrupt many aspects of a person’s life. It can impact on a person’s sleep, mood, ability to concentrate as well as their functional capacity, including activities of daily living, work, social activities and physical activity.
- How common is it?
- Chronic pain risk factors
- Myths & facts about chronic pain
- Approaching chronic pain
- Assessing chronic pain
- Treating chronic pain
- Professor Peter O’Sullivan talks about chronic pain – it’s impact and the latest evidence on best care.
How common is chronic pain?
Between 10-30% of people have some form of persistent pain. In some cases, this pain may arise from an injury such as a joint sprain or fracture, but the pain persists beyond natural healing time (6-8 weeks). In many other cases, pain may emerge in the absence of an injury, at a time of stress, emotional distress, fatigue and lack of sleep. This means your nervous system is hyper-alert, making you more likely to feel pain. This is a bit like an over sensitive ‘alarm system’ that has a very low threshold to being triggered.
Risk factors for chronic pain
The causes of chronic pain are complex. Genetic factors that influence the way the nervous system processes pain are known to play a role, as does early life stress factors including significant life stress events and poor family functioning. These factors can pre-sensitise the nervous system leaving a person more vulnerable to pain at a later time in their life.
Other factors know to be a risk factor for chronic pain are high levels of pain and emotional distress associated with the pain event. A person’s emotional and physical response to pain is also very important. For example, it is known that a negative mindset towards the pain (such as the belief that the pain will never get better), poor sleep, fear of pain, worrying and focussing on the pain, depressed mood, as well as avoidance of activity and movement make people more susceptible to it. Together these factors can over time lead to widespread changes in the nervous system resulting in tissue hypersensitivity, muscle guarding and pain persistence.
The myths about chronic pain
✖ This type of pain is a sign of ongoing tissue damage
✖ Scans are needed to diagnose it
✖ Chronic pain means more rest is needed
✖ Activities that provoke pain should be avoided
✖ The body needs more attention when pain is chronic
✖ Tensing the body and holding ‘good’ posture is important to manage chronic pain
✖ Strong drugs such as opioids are effective for treating it
✖ Surgery is needed to fix this sort of pain
✖ Chronic pain means the pain is in my head
✖ There is no effective treatment for it
The facts about chronic pain
✔ Chronic pain is rarely only predicted by ongoing tissue damage. In fact, this type of pain can occur in the absence of tissue damage
✔ Scans are usually poor predictors of chronic pain
✔ Too much rest can actually make it worse
✔ Avoidance of movement and valued activities makes people more disabled
✔ Engaging in activities that are fun, distracting, valued and physically active is important
✔ Opioids are not effective for treating chronic pain in the long term
✔ Unless there is a clear pathological basis to the pain, surgery is often not effective for chronic pain
✔ There are effective treatments for managing chronic pain (see cognitive functional therapy)
✔ The best treatments for chronic pain involves coaching the person to help them actively get back in control of their life
Approaching chronic pain
It’s very important to understand that treating a chronic pain disorder is more complex than just treating a specific body part. It requires an approach that is centred at the person’s goals and needs, and that targets modifiable factors that contribute to the person’s pain experience. See the infographic below for more information on what you should know when approaching chronic pain.
It also requires active engagement of the person in pain to take control of their pain. This is why treatments such as manipulation, massage, needling, medication, injections targeted at the sore body part often only provide short term pain relief. In fact, directly treating and protecting specific structure’s may be unhelpful in the long run as it can get in the way of more effective treatments.
Assessing chronic pain
The first and most important thing for us is to take time to hear your story and pain experience in your own words. We want to know where your pain is, how you think and feel about your pain, and how it impacts on all aspects of your life. We will also ask you about your sleep, activity levels and goals, so we can help you get healthy and get back doing things that are important to you. We will also screen you to ensure the pain isn’t caused by serious health problems.
Following this we will conduct a comprehensive examination. This will usually involve looking at where you hurt, how sensitive your body is to touch and movement, we will look at your ability to relax and move your body as well as assessing your strength and fitness if this is indicated. We know that many people with chronic pain report negative experiences with being examined and treated as this can make their pain worse. We are very sensitive to tailor the examination and treatment to each person’s pain and sensitivity levels.
Treating chronic pain
Because chronic pain influences our thoughts, emotions and bodies responses to pain, a holistic approach to understanding and targeting all these factors is really important.
Our physiotherapists at Body Logic Physiotherapy play a very important role in the treatment of chronic pain.
Based on the examination, we will explain to you in simple language the factors that are contributing to your pain, and discuss the best treatments options available to you.
We know that the best treatments involve coaching people to understand the causes of their pain, control their emotional and physical responses to their pain and get a plan to get back to living. This is not a band-aid quick fix. Rather, it is a journey that is unique to each person.
This involves identifying the key factors linked to your symptoms, and usually involves coaching you in body relaxation, breathing techniques, relaxed movement, graded activity and sleep rehabilitation.
A long-term plan is the key to controlling this problem and it may take up to 3-6 months to make this plan work. We also work with your doctor and/or a clinical psychologist if additional care is needed.
If you are experiencing this type of pain, get in touch with our team today and see what we can do for you.
‘Understanding pain in less than five minutes’: Breaking down how to handle and understand chronic pain in under five minutes:
‘Understanding pain: choosing an evidence-based, active approach’:
‘Understanding opioids’: Brainman discusses why opioids are no longer recommended for chronic non-cancer pain:
‘Understanding Persistent Pain’: This booklet discusses how you can turn down the volume on persistent pain.