At a glance:
- Chronic pain is present for 3 months or longer
- The condition is very common in Australia, with around one in five people over 45 experiencing chronic pain
- Instances of people seeking help from GPs to manage chronic pain have increased 67% over the last decade
- Chronic pain may be caused by illness or injury but may also have no obvious physical cause at all
- People over 45, women, smokers, a lack of physical activity and genetic predisposition are all risk factors for developing chronic pain
- Chronic pain may not be curable but is manageable using a number of different therapies and medications
What is Chronic Pain?
Chronic pai n is common in Australia, with approximately one in five people over 45 (around 1.6 million Australians) experiencing the condition . People may think that the word “chronic” indicates that the pain is severe but this is not the case. Chronic refers to the duration of the pain.
Chronic pain is any pain that lasts far longer than the typical time needed to heal after injury or illness . The pain may last months and is present most days of the week. Causes may vary from accident, injury or illness to long term medical conditions, to no apparent physical source of pain at all. The only key defining feature of chronic pain is that it is ongoing.
While chronic pain may not always be severe, it may still be very debilitating or draining. The severity of the pain may change from day to day or over time. Due to the persistence of pain and the brain’s response, the source or location of the pain may also become less specific over time. This may be in terms of sensation - from throbbing to burning, for example - or the pain may change location.
Chronic pain may impact a person’s ability to work, socialise, exercise or function normally. In 2018, chronic pain was estimated to have cost Australia around $139 billion, due to loss of productivity, debilitation and loss of quality of life.
In 2017-18, 107,000 Australians were hospitalised for chronic pain. GPs have reported a marked increase in people seeking help with chronic pain, with consultations for pain rising 67% over a decade.
What Causes Chronic Pain?
Acute pain (short term pain) is a response to tissue damage from injury or illness. This pain typically ceases once the tissues are healed. In chronic pain, the sensations persist after the tissue has healed. Whilst there is no definitive identifiable cause, there are a number of theories as to why chronic pain may develop in people.
The nerves that carry pain sensations to the brain appear to become oversensitive in some people. This may cause them to continue to feel pain after the initial cause of the pain has healed. Neuropathic (nerve) pain may also arise from injuries or illnesses that directly affect the nervous system.
Another mechanism contributing to chronic pain appears to be changing levels of neurotransmitters such as dopamine, noradrenaline and serotonin. These brain chemicals transmit signals between the nerves in the brain, and changes to levels appear to be a significant contributing factor to the development of chronic pain.
Chronic pain may also be caused by long term disease or debilitation. Arthritis, fibromyalgia, migraines and endometriosis may all feature chronic pain symptoms. Pain from cancer is also classified as chronic pain but is treated differently to other types of chronic pain.
Whilst anyone may develop chronic pain, there are a few risk factors that contribute to this condition. Being over 45, being a woman, genetic predisposition, a lack of physical activity, smoking and having a long term medical condition are key risk factors in the development of chronic pain.
There appears to be a correlation between lower socioeconomic status and chronic pain hospitalisations. People from low socioeconomic areas are 1.7 times more likely to require hospitalisation than those in high socioeconomic areas. This could be because of lack of affordable home care treatments rather than lifestyle factors.
Complications of Chronic Pain
Chronic pain may impose severe limitations on a person’s life, affecting their ability to work, socialise, study and even perform tasks that others may find easy. In addition, people with chronic pain also frequently exhibit associated symptoms such as difficulty sleeping and mood changes.
Older people with chronic pain have a higher risk than others of falling, losing mobility or permanent disability. Oder people with chronic pain may also be limited when it comes to independent living and caring for themselves.
People with chronic pain are three times more likely than other Australians to be prescribed opioids or other pain medications, and it’s not uncommon for them to be misused. Reports indicate that up to 30% of people with opioid medications for chronic pain will misuse or abuse their medication.
There also appears to be a correlation between chronic pain and mental health, with people experiencing long term pain more likely to develop mental health conditions such as anxiety or depression. This connection may be reciprocal, with people displaying psychological symptoms having a higher risk of developing chronic pain.
If you’re experiencing prolonged pain, don’t continue to suffer and wait for it to subside spontaneously. Seek help and make an appointment to see a doctor .
Treatment For and Living With Chronic Pain
Before chronic pain may be treated it is important to see a doctor to make sure there is no serious underlying condition causing the pain. Once either the condition, or lack thereof, has been diagnosed, pain management may begin.
Depending on the source or location of the pain, treatments may vary.
Medication For Chronic Pain
Pain relievers and other associated medications are often prescribed for the short term control of pain in conjunction with other, long term treatments. Possible medications include:
- Opioids - opioid medicines are effective for the treatment of pain caused by cancer but have far less efficacy when it comes to alleviating the symptoms of other chronic pain sufferers. Despite this fact, people with chronic pain have a higher chance of being prescribed opioid medications than the general public. In addition to being relatively ineffective for chronic pain relief, people may easily develop a dependence on opioids within a few weeks.
- Non-opioid Pain Relievers - painkillers such as paracetamol and nonsteroidal anti inflammatory drugs (NSAIDS) may provide effective short term pain relief. In some cases they may even be used as pain prophylaxis before performing tasks that frequently result in pain flare ups.
- Other Prescription Medications - some antidepressants and medications intended to manage epilepsy may be effectively used to relieve neuropathic pain.
- Medical Cannabis - some study has been done into the effects of medical cannabis in chronic pain. There is some evidence that it may help with neuropathic pain to a degree and increase quality of sleep, but the early evidence does look promising.
Psychological therapies may help with any mental health conditions that may have developed in relation to chronic pain, but may also help people deal with pain more directly.
- Cognitive Behavioural Therapy (CBT) - people experiencing chronic pain may work with a therapist to better understand their pain as well as their responses to it. The therapy itself may not reduce pain, but CBT may help people feel more in control of their lives and better cope with their symptoms, allowing them to live a fuller life.
- Other Therapies - Mindfulness and relaxation therapies, as well as hypnosis may also be used to help chronic pain sufferers come to terms with their condition or better deal with their pain.
Psychological treatments are an effective part of chronic pain management and are usually part of a frontline treatment plan alongside medication.
Occupational and Physical Therapy
Both physical and occupational therapy may play a role in the management of chronic pain.
- Physical Therapy - physical therapists have a number of tools and therapies that may aid in the management of chronic pain. TENS (Transcutaneous Electrical Nerve Stimulation), a therapy that uses low level electrical impulses to block pain sensations may be very effective in controlling chronic pain. Massage therapy, hot and cold packs, posture correction and carefully designed exercises may also serve as effective pain management. A new technique, PHYSIOKEY, involves a more directed form of neuro-magnetic stimulation & holds great promise for chronic pain syndromes.
- Occupational Therapy - rather than directly managing pain, occupational therapy may be used to educate people on ways to perform tasks in ways that don’t exacerbate pain. Occupational therapy may also involve specialised equipment or advised changes to living conditions intended to improve overall function.
In some cases, therapy may include invasive techniques to control pain, such as direct injections, nerve blocks or implantable devices. Your doctor will recommend these treatments if they are suitable.
No two home care regimes will be the same, as each person’s experience of pain and what helps to alleviate it may be entirely different. That said, self care for chronic pain often involves elements of many of the following:
- Exercise - light exercise and keeping active may help alleviate pain or limit symptoms. Unlike the condition that may have led to the pain, extended bed rest is not a recommended treatment for chronic pain.
- Relaxation - relaxation techniques may help people better cope with pain as well as reduce stress and anxiety caused by pain.
- Diet - Eating a healthy diet is recommended for everyone. Losing weight may also alleviate some forms of chronic pain.
- Sleep - While bed rest is not a treatment for pain, maintaining healthy sleep patterns is vital to maintaining both physical and mental health.
- Pacing and Prioritisation - deciding what tasks are most important allows you to pace your physical activity so as not to exhaust yourself or exacerbate pain but still achieve goals.
- Support - finding a support network, made up of friends and family or a chronic pain support group allows people suffering chronic pain to discuss their condition with an understanding, accepting group. Chronic pain may be an isolating experience, and a support network may help the person feel like they are part of a community. In addition, people in support groups may also offer valuable insights for living with or managing chronic pain.