Chronic Pain and how we can help

What is chronic pain?

‍
Chronic or persistent pain can persist for over 12 weeks, despite medical treatment or intervention. It can affect people of all ages and all parts of the body. The pain can often remain even after routine tests come back clear. Chronic pain can have negative effects on both physical and mental health. The most common conditions to be associated with chronic pain include: osteoarthritis, rheumatoid arthritis, back pain, fibromyalgia, inflammatory bowel disease, surgical trauma, and advanced cancer.

Our bodies transmit signals from one part of the body to another, including pain signals. The brain decodes these signals to determine how serious and how strong the signals are. However, the brain doesn’t always receive and process these signals accurately, and pain that would usually subside over time can linger.

It is important to remember that pain is individual and can affect one person differently to the next. Two people could suffer the same injury but describe the pain experience differently in terms of both type, length, and severity. The body’s signals can be hard to stop, are often intense, and at times seem to start for no obvious reason.

Chronic pain initially caused by an illness or injury which has been treated or repaired can change the way our nerve cells function, making them hypersensitive to pain signals. This can lead to someone continuing to experience pain associated with the treated difficulty without physical reason. Pain is typically poorly understood and can sometimes leave people feeling as if others perceive their pain to be in their ‘head’ and 'not real'.

‍

Actions that can help

1. Historically, it was commonly recommended to gain respite whilst experiencing chronic pain (particularly back pain). However, we now know that it is more effective for recovery to continue life as normal without spending too much time resting or in bed.
2. Try as far as possible to continue with day-to-day tasks. Research shows people become less active and experience increased low mood when not engaged in activity, such as work. Being at work can act as a distraction from pain, and in most cases, doesn’t usually make pain worse.
3. Try to get regular exercise that doesn’t cause strain. For example, walking, swimming, exercise bikes, yoga and pilates can make great activities for those experiencing pain.
4. If your physician has referred you for physiotherapy, this is worth engaging in as it can help.
5. Try techniques such as guided self help or meditation to help manage pain. There are resources online such as the Pain tool kit and Meditainment.
   ‍

Symptoms

In some instances, pain can be near constant. However, for others pain can come and go. There may also be periods when pain is worse or more intense than usual. This can be due to increases in stress or activity. The general symptoms associated with chronic pain include:

• joint pain
• muscle aches
• burning sensation
• fatigue
• sleep difficulties - difficulty getting to sleep, staying asleep, or both
• loss of stamina and flexibility, due to decreased activity
• difficulties with mental health, including experiences of low mood, anxiety, irritability or agitation

Specific symptoms of chronic pain can vary extensively because each person experiences pain differently. This is one reason why chronic pain can be difficult to diagnose and treat, particularly if no biological cause is found or the underlying cause has been treated successfully.

Treatment

‍The most commonly recommended way to manage chronic pain is to combine exercise, maintaining a work/activity routine where possible, physical therapy, and painkillers if necessary.

Exercising without putting too much strain is recommended little and often in order to help prevent stiffness or weakening. Staying at work and active if possible is helpful in many ways, including for managing mood. Whilst it may be difficult to get to work when in pain, in the longer term this is likely to be beneficial. It may also be helpful to discuss difficulties with pain with an employer to see what support and adaptations can be made to ensure the working day is easier to complete. A pain expert is likely to recommend some form of physical therapy to help enable people to move better and relieve pain, alongside painkillers where necessary.

Psychological therapy has also been found to be helpful for those suffering chronic pain. There are several types of therapy available including Cognitive Behavioural Therapy (CBT), Mindfulness Based Therapy (MBT), and Acceptance and Commitment Therapy (ACT). Psychological therapy for chronic pain primarily targets improvements in physical, emotional, social, and occupational functioning rather than focusing on resolution of pain itself. Treatment often involves learning relaxation techniques, changing beliefs about pain, acquiring new coping skills, and addressing any anxiety or low mood commonly accompanying pain.

Facts

1. Chronic pain is the most common cause of long-term disability.
2. Pain can be a chronic difficulty, a barrier to long term physical health treatment, and can occur alongside other illnesses and conditions (such as depression, post-traumatic stress disorder and traumatic brain injury).
3. Chronic pain can not only interfere with physical day-to-day functioning, but also cause increased irritability, frustration, and other mood changes.
4. The estimated prevalence of chronic pain in the UK population is 43% and it is associated with a variety of psychological, social, and economic consequences.
5. Psychological therapy can help people to learn new techniques to manage experiences of low mood and anxiety in the context of suffering pain.

How to get help

In order to access treatment or support for chronic pain talk to your GP, as they will be able to refer you to a specialist for further assessment. The specialist can then work with you to decide the best way forward. Some people have experienced a sense of not being taken seriously when discussing their pain. It may take persistence. If you are not seeing any improvements with your current treatment plan, it is important to highlight this to a healthcare professional and request to try alternative methods. By starting a conversation with a friend, family member or healthcare professional, you will be taking the first step towards improving your physical and mental well-being.

‍