Coping with chronic Pain

Chronic pain can impact on all aspects of your life. There's no magic pill or cure, but it is possible to control chronic pain rather than have it control you. By embracing an approach that draws from multiple health professionals, you may be able to improve your day-to-day function and lead a fulfilling life.

What is chronic pain?

Chronic pain is pain of known or unknown origin that lasts longer than three months. It includes pain that outlasts the period of healing from a known cause, i.e. pain continuing after an injury has healed. Common chronic pain conditions include headaches, low back pain, cancer pain, arthritis pain, neurogenic pain (resulting from chronic inflammation or ongoing disease), neuropathic pain (resulting from nerve injury) and psychogenic pain (pain not due to past disease, injury or visible damage).

Difference between chronic and acute pain

Acute pain lasts a short time and is caused by tissue damage, e.g. minor and major injuries, post-surgical pain, burns. It usually resolves within three months by treating the cause or using analgesics. If acute pain is not managed well, it can progress towards chronic pain.

Chronic pain is more difficult to treat, as the underlying cause often cannot be identified or cured. The International Association for the Study of Pain (IASP) acknowledges that pain is a very personal experience and may be influenced by emotions: "Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage... Pain is always subjective.... It is unquestionably a sensation in a part or parts of the body, but it is also always unpleasant and therefore an emotional experience".

Impact on quality of life

Chronic pain doesn't just affect physical function – it has a huge financial, social, personal and psychological impact on people's lives.

Physical: Decreased physical activity and fitness are common. Chronic pain is also linked with abnormal sleep. Lack of sleep can cause fatigue, irritability and exaggerated pain perception. However, the idea that bed-rest is the only way to recover is a myth. Extended rest can worsen physical function and create secondary muscle and bone problems. Pain medication side effects can also impact on physical function. "Some people become addicted to medication and start taking it for effects other than pain relief," says Professor Peter Drummond, of Perth's Murdoch University. "Greater tolerance levels may lead to a cycle of addiction where higher doses are taken." Chronic pain can sometimes result in activity avoidance e.g. not being able to work might provide an incentive not to get better. Similarly, a partner who takes on all the household chores might actually reinforce activity avoidance.

Financial: Time off work due to injury may necessitate living on reduced income, alongside paying expensive medical bills. "If you are hurt at work, there are often legal issues and some employees may have to fight to receive workers compensation payments," Peter says.

Social: Living with constant pain can make it difficult to have fun. Injured people with strong social networks through sport will suddenly have to restructure their activities. A guitarist with a chronic groin injury may have difficulty performing their stage act, or an older person with semipermanent paralysis may struggle to interact with grandkids. Friendships may also be tested if pain inhibits normal shared activities.

Personal relationships: Significant strain is often placed on close relationships. The impact of chronic pain depends on the previous quality of relationships and level of responsibility in the work environment and family unit. "People who maintain their self-esteem often have a more positive outlook and continue to maintain respectful relationships," chronic pain consultant at Monash Medical Centre, Dr Debra Devonshire reports. "Sexual relationships are also affected by chronic pain – especially if a person is depressed."

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" Rather than diminish the physical complaint by saying 'You've always got a headache', it would be more useful and understanding to say, 'Is this headache worse than usual? Can I do something that would make you more comfortable?"

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Psychological: Disappointment and frustration often result from treatments that don't cure the pain. "Family and relatives may be supportive but if offers of help are met with bad temper, they may start to avoid the person with pain. This may lead to a downward spiral including mood and behaviour changes, withdrawal, social isolation, depression and psychological problems. These psychological states make pain feel worse," Peter says. Chronic pain can also highlight pre-existing personality issues, e.g. anger, sadness.

Impact on families and carers – and how they can help

Debra encourages family members to attend pain clinics with their loved one as they can help provide a complete picture of how chronic pain is affecting their lives, both physically and psychologically.

Respite centres for older people living with chronic pain are a valuable resource for carers who aren't coping or experiencing carer fatigue. Even a few hours away from home, a dose of sunshine or listening to music can provide a much-needed break and prevent a crisis. "Carers or family members require support and advice on appropriate responses to chronic pain," Debra says. "A referral to their GP or a psychologist may be recommended, especially if a carer or partner is depressed."

Because pain cannot be 'seen' and is often experienced over a long period of time, clear and confident communication is required from both carers and people living with chronic pain. For example, a carer might explain that doing all the housework has become too tiring. This might lead to a discussion about arranging cleaning or shopping assistance through an agency or the local council.

"Try to gain a clear understanding of the person's pain experience – especially during a flare-up," Peter says. "Rather than diminish the physical complaint by saying 'You've always got a headache', it would be more useful and understanding to say, 'Is this headache worse than usual? Can I do something that would make you more comfortable?'"

Treatment of chronic pain

A multi-disciplinary approach draws from three treatment categories according to specific needs. A pain clinic usually consists of doctors, e.g. geriatrician, rehabilitation doctor, pain specialist, drug and alcohol nurse, anaesthetist, physiotherapist, occupational therapist and psychologist. If surgical treatments are being considered, vascular surgeons and/or neurosurgeons are involved.

Physical: Physical treatments include physiotherapy, occupational therapy, hydrotherapy, chiropractics.

Psychological: Psychological treatments recognise that pain is more than a sensory experience. They help you learn how to predict and manage pain, including coping skills to minimise pain and how to have positive life experiences despite its presence. A combination of psychological treatment techniques can address emotional issues around living with pain, as well as important factors like disability, financial stress or loss of employment.

Pharmacological: Low doses of multi-modal (multiple methods) analgesia are the most effective. "Pain has different pathways and each needs to be addressed," Debra says. "Paracetamol may not be effective alone but may be effective in combination with other drugs." Categories of pain medicines include; paracetamol, non-steroidals, opiates, epilepsy or depression medications and NMDA receptor medications.

Coping Strategies

• Accept and understand your pain but don't accept that it will ruin your life!
• Alter any expectations of 'cure' to 'management'.
• Adopt a problem solving approach. Be aware of your limitations, learn to identify pain triggers and avoid things that make pain worse.
• Exercise (within your limits) is a very important part of pain management. If exercise makes your pain worse, see your physiotherapist, as a change in technique or activity might be needed.
• Socialise – socialising and fun activities are great distracters from pain. Continue to catch up with friends – even brief outings are beneficial.
• Maintain your hobbies – do them on a smaller scale or for shorter periods if necessary e.g. knitting, quilt-making, walking, clubs.
• Protect relationships by continuing to do enjoyable things and communicating effectively.
• Being positive provides the opportunity to improve your situation and those trying to help you. If you feel any of your relationships are in crisis, seek professional help.
• Recognise your emotions – if you're feeling down, have a ready-made list of enjoyable activities, e.g. listen to upbeat music. Happy feelings dampen pain signals. A psychologist can help with strategies for dealing with emotions.
• Learn relaxation techniques – these exercises take time to learn but if you do them well, you are more likely to sleep better and feel calm and in control.
• Maintain good sleeping habits – a specialised sleep clinic can provide specific sleep techniques and investigate insomnia if sleep is a problem. Avoid sleep reversal (sleeping during day instead of night) – a regular routine is ideal.
• Continue to work if possible, even if it's light duties within a supportive work environment.
• Set realistic goals – this may involve breaking a larger goal into manageable steps e.g. initially return to work part-time rather than full-time.
• Ask for help but avoid adopting a 'sick role' – staying too dependent will do more harm than good in the long term.
• Maintain a healthy weight – being overweight can exacerbate pain conditions and cause additional joint or muscle problems. A dietitian can help with healthy diet recommendations.
• Maintain open and honest communication with your treating health professionals – avoid 'doctor shopping' and/or being secretive about medication use.
• Manage and minimise stress – the first step is mood awareness and understanding. If you recognise you're upset, take time out to do something you enjoy

For more help

Visit your GP, who may recommend a referral to a pain specialist, surgeon or psychologist.

Specialised pain psychologists often work in pain clinics, or call the Australian Psychology Society (APS) on 1800 333 497 for help to find one. Severe or prolonged cases may benefit from referral to a multidisciplinary pain clinic.

For general information, visit www.chronicpainaustralia.org  or call the national phone support and information line 1800 218 921.

Content Updated November 2010