Frequently asked questions (FAQ) about chronic pain

What causes chronic pain?

It is thought that chronic pain occurs because the messaging system in the nerves and spinal cord becomes over sensitive and magnifies messages when there is no active damaging stimulus. This means that when the nerve messages reach the brain it thinks there is still harm and reacts by feeling pain – even when there is no injury.1,2

Why haven't I been given a diagnosis?

Traditionally, pain was seen as a symptom of a disease or condition,3 and although chronic pain can be associated with conditions such as arthritis, sciatica or low back pain, in many cases no specific ongoing injury or disease can be found as a cause.4,5

The intensity of chronic pain often reflects a problem with the body's pain system itself rather than damage in a particular part of the body.1 It can help chronic pain management if it is approached as a chronic medical condition, not just a symptom of something else.6-8

Don't I need more tests, isn't pain a signal of damage to the body?

Not necessarily. The intensity of chronic pain often reflects a problem with the pain system itself rather than damage in a particular part of the body.1

Pain used to be seen as only a symptom of underlying disease or condition,3 and although chronic  pain can be associated with chronic conditions such as arthritis, sciatica or low back pain, in many cases no specific ongoing injury or disease can be found as a cause.4,5

Even when there is an underlying painful condition, the level of pain you feel may be out of proportion to any damage or continuing harm to the body.6,9 This is what can make living with chronic pain so difficult. It can be a challenge to understand why there is so much ongoing pain and discomfort, which isn't serving a useful purpose and yet doesn't seem to be able to be relieved.1

What can I do about my pain?

Most people with chronic pain are likely to experience some pain over the long-term.7 This means that for most people with chronic pain the focus of treatment needs to be on managing the pain and improving their ability to do day-to-day tasks, rather than completely stopping the pain.1,7,10

There are a number of healthcare professionals who can provide help and support, but like any long-term complex condition chronic pain requires self-management. Learning pain management skills and incorporating them into your daily life is important.11

While it is unlikely that any pain relievers will be able to completely stop the pain,1 a multimodal or multidisciplinary approach has been shown to be more effective for chronic pain as medicines may have a limited role in chronic pain management.5,12

How do I talk to my doctor about my pain?

For many people with chronic pain, having a sense of collaboration and trust with their healthcare providers is important. An open dialogue can create the basis for common understanding of treatment goals and challenges.13,14

The more you tell your healthcare providers about your pain, your personal situation and what strategies you have tried to manage your pain, the better. This can help them tailor a management plan with you to suit your individual needs.14

Who can help me deal with my pain?

There are a number of healthcare professionals who can provide help and support. Chronic pain management needs to cover a number of different aspects of life and these can be covered in a multimodal or multidisciplinary plan. Talk to your healthcare provider about developing a multidisciplinary plan that suits your needs.15

However, like any long-term complex condition, chronic pain requires self-management. Learning pain management skills and incorporating them into your daily life is important.11 People who are actively engaged in self-management techniques report lower levels of pain-related disability, improvements in mood, better general health and reduced use of health services and medicines.16

What is a biopsychosocial approach?

Because there are many factors that affect chronic pain, management needs to cover a number of different aspects of life too. This is called multimodal or multidisciplinary pain management and it looks at:1,3,10

  • Biological aspects – such as your physical fitness, activity and medical issues.
  • Psychological aspects – including your understanding of pain and how you think about it, as well as mood and emotional factors which may be related to anxiety or depression.
  • Social or environmental aspects – such as work, social activities, relationships and family issues.

Because it incorporates these three areas it is called a bio-psycho-social approach.7 There is a lot of research evidence to show that people with chronic pain who are actively involved in this type of approach to manage their pain have less disability than those who rely just on more passive therapies, such as taking medication or surgery.17

Why has a psychologist been recommended to help me manage my pain?

Your doctor may refer you to a psychologist to try techniques such as cognitive behaviour therapy to help retrain your brain.1

It is thought that in people experiencing chronic pain the messaging system in the nerves and spinal cord becomes overly sensitive. This magnifies the messages from the nerves even when there is no active damaging stimulus. When these nerve messages reach the brain it thinks there is harm and reacts by feeling pain – even when there is no injury.1,2

Although the brain and the mind are very closely connected, the brain is a physical organ made up of billions of nerves. The brain has billions of connections in very complex networks that control your whole body.18 Most of the processes are automatic and can't be controlled by direct thought. However, what you think and feel can have a big influence on all this complex activity without you even being aware of it.2

It can be hard to have control over our feelings and emotions. You can't just decide you are not going to let pain make you angry or depressed. However, psychological techniques can be used to help train you to counter unhelpful thoughts and change your behaviours. This can have a positive influence on the pain we feel and how we are able to function.1

Will my pain get worse if I am very active?

When you have constant pain it seems natural to avoid doing things like walking, bending and moving around as they can make the feeling of pain worse.1 However our bodies are designed to move. When we decrease activity, we lose muscle strength – over time this means that even simple daily activities can become more difficult.1 Many people with pain fear exercise as they think it will cause more problems. However, regular stretching and exercise can actually decrease pain and increase your ability to function physically.11

It is important to remember that chronic pain is not necessarily associated with ongoing damage to your body.1 This means that hurt doesn't necessarily equal harm, and if no ongoing cause for the pain is found, you can slowly increase your physical activity despite a certain level of pain. This gradual approach to activity is called pacing.12

Should I wait for my pain to go away before I go back to activities I used to do?

Starting to exercise and learning new coping skills are important strategies to help improve your ability to function and reduce the impact of the pain. It is also important not to wait for the pain to be completely gone before starting normal activities, including work.3

Can chronic pain be treated without medicine?

While people with chronic pain often take some kind of medication, typically it does not provide full relief.9 Chronic pain is a complex condition and different things are needed to manage it.11

To help with self-management, it is useful to develop your own pain management plan with your doctor.11,19 This plan could include setting step-by-step achievable goals to give you something to aim for.10,11

Goals should cover different aspects of your life:10

  • Physical goals – based on duration and difficulty of a set of exercises.
  • Functional/task goals – focused on the achievement of everyday tasks such as housework, hobbies or work.
  • Social and emotional goals – covering relationships, family life and work.

What is a personal pain management plan?

Developing your own pain management plan with your doctor can help you self-manage your pain.11,19 The plan could include setting step-by-step achievable goals to give you something to aim for.10,11

Goals should cover different aspects of your life:10

  • Physical goals – based on duration and difficulty of a set of exercises.
  • Functional/task goals – focused on the achievement of everyday tasks such as housework, hobbies or work.
  • Social and emotional goals – covering, relationships, family life and work.

Examples of topics that could be covered in your personal pain management plan9

  • Exercise therapy
  • Activity management (eg, doing tasks at a steady manageable pace)
  • Cognitive therapy to help you think more positively about your ability to manage your pain
  • Behavioural management (eg, relaxation techniques)
  • Medicine management as needed

What if my medicines aren't working?

It is unlikely that any pain relievers will be able to completely take away chronic pain.1 A multidisciplinary approach has been shown to be more effective for chronic pain management than relying on analgesic medications alone.5

Medication is best used along with other non-medicine approaches as part of multimodal management of pain.7

The goal of treatment with analgesics is to reduce pain to a level that allows you to improve your physical functioning and quality of life.3,7

Will opioids help my chronic pain?

  • Opioid analgesics (eg, codeine, endone, morphine) are commonly used to treat severe acute pain or cancer pain.20 However opioids are not universal painkillers,21 and they are often not very effective in chronic pain that is not cancer related.9
  • There is no clear evidence to show that long-term opioid therapy can greatly improve chronic pain and restore physical function.9 At the same time there is growing evidence for the harms associated with long-term opioid use.21
  • If your and your doctor decide a trial of opioids  is appropriate, you may be asked to agree an opioid treatment plan. This may also be referred to as a care plan or an opioid contract.22 It is important that understand that treatment with opioids may not be helpful and may be stopped.21

Why is my doctor suggesting an opioid contract?

If opioids are being considered as an option to help with the management of your chronic pain, an initial short-term trial of opioid medication will be needed to determine whether it will benefit you. To plan and undertake such a trial, you will need to work in partnership with your doctor to set clear functional goals, and assess whether over time you reach these goals. This will help determine whether the benefits of the medication outweigh the risks.22

There is a recognised risk of abuse and misuse of opioids as they are addictive and can lead to dependence and sometimes addiction.23 For these reasons, people are often concerned about discussing opioid treatment with their doctors.24 In fact, doctors are aware that opioids don't work for everyone, and there are a number of serious risks such as sedation and worsening pain, in addition to addiction and overdose. It is important that you have a clear understanding of these risks to protect yourself from harm.13,22

Why does my doctor need approval to prescribe my medication?

Both you and your doctor are subject to strict regulations when an opioid medicine is prescribed. Your doctor will usually need to get special approval from your state Department of Health to continue prescribing an opioid medicine to you after a trial period. Your doctor will ask you to sign an opioid contract to ensure that you understand what is expected from you while you take this type of medicine, and that you consent to the requirements described in the contract.22

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References
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