Introducing chronic pain and how to treat it
Hello everyone, and welcome to our July blog! This month we are going to be talking about pain. We can’t believe it’s already halfway through the year. Time certainly does fly! But for the 3.24 million Australians living with chronic pain, it’s just more time spent battling the daily hurdles - getting out of bed, working, socialising, being a parent, everything really! Being in pain for a long time can be debilitating and have a huge impact on a person’s life.
Taking into account running healthcare costs, time and money lost at work, as well as decreased quality of life, the total cost of chronic pain in Australia in 2018 totaled $139.3 billion! It’s a growing problem with a prediction that over 5 million Australians will be affected by chronic pain by the year 2050. As Osteopaths, we work with and treat people who experience chronic pain day in and day out. It’s a complex topic, so we have devised a little introduction to break it down so you can understand more on chronic pain - all in the name of National Pain Week which is due to take place at the end of this month.
What exactly is pain?
Pain is an unpleasant experience. Ask 100 random people in the street if they like to experience pain, and there is a good chance 100% of those people will say “no”. However as unpleasant as it is, pain is an essential part of life. It is our protection mechanism. When we injure ourselves, we feel pain. Sometimes before we even get to the injury stage, we can feel pain… Pain will also stick around for a bit following an injury to remind us that healing needs to take place and that we need to protect the injured area from further damage. It’s a sophisticated alarm system and you have your brain to thank for all of this. Pretty cool huh?
Interestingly, there are people on this earth who cannot and have never felt any pain at all. These people may have a very rare condition called Congenital Insensitivity to Pain (CIP). They are basically born with the inability to feel pain. You might think this could be pretty beneficial - going your whole life without pain. How awesome would that be?! In reality, this is a very serious condition, and many who are born with it have a drastically shortened life. Mainly because injuries and illnesses can go unnoticed, potentially putting their life in danger. For example, cuts and burns will go missed, because they lack the important alarm system we were talking about above. Pain is a lifesaver.
Acute vs chronic pain
Pain can be very simply divided into two types, acute and chronic. Acute pain is the pain felt when we fall or cut ourselves, strain a muscle or sprain a ligament. When injury occurs, special sensors in the vicinity of the injury detect that something is wrong, send a message along nerves to the spinal cord and up into the brain. Your brain will process this information (very quickly) and will send a message back as a pain signal. You say “ouch”. Over the coming days and weeks, the injury heals and the pain disappears. During this process, your brain will have formed a memory of the event, and this helps you to steer clear of similar dangerous situations in the future. Protection at its best! For purposes of time, acute pain is pain that is felt for any time up to six weeks. Sub-acute pain (a sub-set of acute pain) is pain felt anywhere between six weeks and three months.
Chronic pain
Chronic pain, also known as persistent pain, is essentially pain that has lasted longer than three months and is a very different kettle of fish to acute pain. In many instances, it is pain that is felt way beyond tissue healing times and is extremely complex in nature due to the involvement of different body systems. And, most importantly, the persons belief about what pain is. The initial cause may be from a fall or car accident, just like with any acute injury. It may also be caused by diseases such as arthritis, cancer or migraines (as well as many others).
Why chronic pain develops is a complicated process. In a nutshell, generally tissues have healed, yet the brain is still perceiving a threat. This is due to changes in the nerves carrying signals to the spinal cord (the peripheral nerves) and changes in the spinal cord itself. Essentially, these nerve tissues become highly sensitised and end up sending faulty or misleading information to the brain. The brain perceives this information as still threatening, and the result is ongoing pain. It is much more complicated than that, but this gives you the gist of what is going on.
It is important to understand that when someone is in pain for long periods of time, they can start to become affected in other ways. Depression and anxiety regarding pain is commonplace. A person’s beliefs about pain will also begin to affect their behaviour. For example, they will start to avoid certain movements due to fear of injuring themselves further (which can cause other musculoskeletal issues). In psychological terms, this is known as exhibiting fear avoidance behaviours.
Treating chronic pain
The longer the cycle of chronic pain persists, the harder it is to treat. Unfortunately, treatment is not as simple as applying first aid principles like rest, ice and compression, followed by massage, mobilisation and rehabilitative exercise programs. It is still important to treat the person’s movement dysfunctions of course, but treating the depression and anxiety whilst educating the person on what is actually happening is just as important, if not more so. Until all facets of a person’s pain experience are dealt with in some way, it is unlikely the cycle will be broken. Therefore, treating chronic pain rarely comes down to just one profession. It requires what we call a multi-disciplinary approach to treatment. So yes, an Osteopath may well be part of the team, but it is likely a person will also require the services of a Psychologist and their GP too. It may be that pain medication will need to be prescribed (although the debate is still out on how effective strong pain medications are in the instances of chronic pain).
Your Osteopath will help to treat you by ensuring your body is moving in the best way possible, and that your tissues are at their optimum health. They may also advise you on how to improve your sleep patterns and diet, to ensure your body is getting the rest and nourishment it requires. They will advise you on the forms of exercise which may be beneficial and may even be able to give advice on relaxation and breathing techniques. Most importantly, they will spend time with you, educating you on what exactly is going on with your body so that you can begin to understand it yourself— and begin breaking the cycle of chronic pain. It will be a team effort, and they will be with you every step of the way!
We hope you found this blog interesting and educational. If you would like to know more about National Pain Week and further information on chronic pain, please visit http://www.nationalpainweek.org.au
References:
1. Pain Australia. 2019. The cost of pain in Australia. [Online]. [Accessed 09 June 2019]. Available from: https://www.painaustralia.org.au/static/uploads/files/the-cost-of-pain-in-australia-launch-20190404-wfrsaslpzsnh.pdf
2. National Pain Week. 2018. National Pain Week. [Online]. [Accessed 09 June 2019]. Available from: http://www.nationalpainweek.org.au
3. Butler, D. and Moseley, L. 2003. Explain Pain. Australia: Noigroup Publications
4. Zhang, S. et al. 2016. Clinical features for diagnosis and management of patients with PRDM12 congenital insensitivity to pain. Journal of Medical Genetics. 53. 533-535. https://jmg.bmj.com/content/53/8/533.citation-tools
5. Chronic Pain Australia Association. 2018. What is pain? [Online]. [Accessed 08 June 2019]. Available from: http://www.nationalpainweek.org.au/index.php?option=com_content&view=article&id=367
Pergolizzi, J. et al. 2013. The development of chronic pain: physiological CHANGE necessitates a multidisciplinary approach to treatment. Current Medical Research and Opinion. 29 (9). 1127-1135. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3793283/