Taking control of chronic pain

When you stub your toe, pull a muscle or fall from a bike, you’ll feel pain. You hurt for a while and then it gets better. Except sometimes, it doesn’t. Pain, it turns out, is far more complex than we once believed.

Pain is there to keep you safe. Strong pain is a warning sign, telling you that something is wrong or under threat and that you need to do something about it. Acute pain is short term, lasting from a few seconds to a few days or weeks. It usually resolves by itself, or with medical treatment.

Chronic or persistent pain is different. This is pain that you’ve experienced for longer than 3 months, the time when your body should have completed the healing process after an injury. Chronic pain often begins with an injury or underlying illness like arthritis, although many people can’t identify the original cause.

One in 5 Australians over 45 live with chronic pain.¹ If you’re one of them, it can impact every aspect of your life, including your work, relationships, sleep, physical activity and mental health.

When you’re in chronic pain you feel as if there must be something physically wrong, but despite x-rays, scans and tests, your doctor may not be able to explain it.

Whether it’s caused by an obvious injury or not, pain is always produced in your brain and is there to protect you. Pain changes your behaviour so you can avoid injury and allow your tissues to heal.

But why does pain persist even after the tissues have healed?

Pain experts now believe that many cases of chronic pain are due to changes in the central nervous system (your spinal cord and brain), rather than damage to the body structures, a process called central sensitisation or pain system sensitisation.²

After being in pain for a long time, your brain can become too protective and your pain system too good at making pain. You can get warning signs (pain) that are unnecessary or out of proportion to the stimulus. This doesn’t mean the pain is ‘all in your head’. Pain is always real, and it’s always produced by your brain.

Anything that causes your central nervous system to become more sensitive, such as fear, frustration, stress or anxiety, can make all forms of pain worse, while anything that calms it down can help lower your pain. The key to reducing pain is to train your pain system to become less protective.

A multi-disciplinary pain management approach will focus on reducing your pain through:

• pain education
• meditation
• relaxation
• exercise
• psychological support
• traditional treatments including medication.

Once any physical injuries are either treated or ruled out, your doctor may offer you medication for your pain. Keep in mind that some medications, particularly opioids, can lose their effectiveness over time. Opioids also have side effects and are no longer considered first line treatment for chronic non-cancer pain, as there are better options. Your doctor can also refer you to a specialist pain management clinic if necessary, or to other allied health professionals who can help manage pain, such as a physiotherapist or psychologist.

Educating yourself on the science of chronic pain and understanding how pain sensitisation works is an essential first step to reducing your pain.³

Feeling fearful, anxious and depressed is understandable when you’re in pain, but these emotions can amplify pain through their effect on your central nervous system.

Anything that calms your nervous system will also help with pain. This includes activities such as meditation, yoga and breathwork, and connecting to friends, family or support groups. Let your loved ones know what you’re going through, and don’t be afraid to ask for help with daily tasks that become difficult.

A pain psychologist can give you tools to help you manage your pain, such as cognitive behaviour therapy (a talking therapy to help identify and manage unhelpful thoughts), and other pain management techniques. And always talk to your GP if your mood is particularly low, as it’s important to treat any underlying stress or depression.

When you’re in pain, moving your body is often the last thing you want to do. Yet being active, whether it’s biking, swimming, walking or going to the gym, is going to make you feel better, provided it’s at a level that’s comfortable for you. Exercise strengthens your muscles, bones and joints and improves your mood. Exercise is also ‘hypoalgesic’, which means it’s a natural pain reliever. Planning your day in small steps (called pacing) can help build activity. If you need help with an exercise program, talk to a physiotherapist or exercise physiologist.

Convenient comfort foods like biscuits, ice cream, savoury snacks and other highly processed foods can be just what you feel like when you’re in pain. They may feel comforting, but foods high in sugar and fat are not only short on nutrients, they’re also considered inflammatory, which may worsen your pain if you eat too many.

Stock your pantry and fridge with colourful fruit and vegetables, wholegrains, nuts, seeds and legumes, and include a source of omega-3 fats (from oily fish, walnuts, some eggs, canola oil, chia seeds and flaxseeds). These are anti-inflammatory foods and may help relieve your pain.

Pain Australia works towards improving the quality of life for those living with pain. Visit their website for resources and support, including their National Pain Services Directory.

Chronic Pain Australia provides education and support for those living with chronic pain.

Lifeline Australia is a 24/7 crisis support service available online and over the phone on 13 11 14.

Beyond Blue offers 24/7 mental health information and support online and on the phone at 1300 224 636.