Explaining Pain (Part 2): Chronic Pain


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In our previous blog, we looked at the processes behind pain, including the impact of chronic pain. Now, we will take a closer look at how chronic pain can be managed.

IMPORTANCE OF EFFECTIVELY MANAGING CHRONIC PAIN

Chronic Pain is pain that lasts beyond the expected recovery time (typically more than 3 months) for a certain injury, surgery or other condition. Employing an evidence-based, multi-disciplinary approach with an emphasis on self-management is essential in the management of chronic pain. Effective management of chronic pain is particularly important considering it is one of the leading causes of disability, it has a high prevalence (1 in 5 Australians live with Chronic Pain) and a dramatic impact on the economy ($34.4 billion per year).

The goals of this approach to management include controlling pain levels, reducing distress and subsequently improve quality of life by empowering individuals to participation in social and physical activities which are important to them.

THE ROLE OF PHYSIOTHERAPY:

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Physiotherapists have an important role in facilitating the management of chronic pain in areas of education, goal-setting, tailoring exercise programs as well as the use of adjunct modalities.

1. Education

Understanding the fundamentals of chronic pain is an essential step in its management. This includes:

A) What exactly is chronic pain? Education involves explaining the processes of pain, as we discussed in our previous blog. It also involves avoiding excessive investigations, such as repeated MRIs, to identify a sole physical cause of the pain. Reliance on imaging can reinforce negative pain beliefs and fear about an individual’s pain. For example, and MRI scan may reveal a herniated disc, the revelation of which may cause someone to view their discs as ‘slipping’, and their back as ‘damaged’, which can drive negative pain beliefs and fear. This can further contribute to the pain, despite evidence suggesting herniated discs have the capability of regressing on their own, and with conservative management including physiotherapy. Although MRI has a role in some instances, care must be taken to avoid over-reliance on imaging, particularly when recognising that imaging findings often does not correlate with the severity of pain.


B) Self-Managing Chronic Pain Being empowered to manage pain independently is a vital component to improve long-term outcomes. Three steps to self-manage pain, as outlined by Pain Australia include:

  1. Pain Acceptance – Accepting the pain and recognising that, although pain may not completely alleviate, there are strategies to minimise the severity of pain, and that restoring quality of life and social/physical participation is realistic..

  2. Changing Pain Beliefs – This involves ‘retraining’ the brain to recognise that pain in and of itself is not harm, and breaking down the instinctive, psychological negative response associated with harm.

  3. Pacing – Pacing involves maintaining a steady level of physical activity every day and avoiding large variations of physical activity to avoid deconditioning and exacerbations.

C) What should be expected from treatment? It is also important to understand the expectations and goals from management. Unlike pain from acute injuries, chronic pain is less likely to fully resolve. Ensuring expectations involve controlling pain, rather than eliminating pain, can improve confidence wit