Managing chronic pain

Summary

  • In chronic pain the focus of treatment often needs to be on managing the pain and improving day-to-day function, rather than completely stopping the pain.
  • Healthcare professionals can provide help and support, but self-management is important too.
  • Chronic pain is best managed through a multidisciplinary pain management plan with your healthcare providers. This can cover many aspects of your life such as physical fitness and activity pacing, social activities, medication (including complementary medicine and approaches), mood, sleep, relaxation, support and overall health.

Most people with chronic pain are likely to experience some pain over the long term.1 This means that for most people with chronic pain the focus of treatment needs to be on managing the pain and improving day-to-day function, rather than completely stopping the pain.1-3

Dr Malcolm Hogg on managing chronic pain

Watch Dr Malcolm Hogg, Head of Pain Management Services at the Royal Melbourne Hospital, as he speaks about  important aspects of managing chronic pain.

Part 1

Part 2

Learning self-management skills is key

Starting to exercise and learning coping skills are important ways 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.4

There are a number of healthcare professionals who can provide help and support, but like any long-term complex condition chronic pain also requires self-management. Learning pain management skills and incorporating them into your daily life is important.5

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.6

It is important to find ways that work for you to reduce the impact of pain on your life.5

Look at the whole picture

Chronic pain cannot be treated in the same way as acute pain. Because there are many factors that affect chronic pain,3,7,8 management needs to cover a number of different aspects of life too. This is called multimodal or multidisciplinary pain management and it looks at:2-4

  • Biological aspects – such as physical fitness, activity and medical issues.
  • Psychological aspects – which includes your understanding of pain and how you think about it, as well any anxiety or depression you may have.
  • Social or environmental aspects – such as work, social activities, relationships and family issues.
Click to expand Managing chronic pain involves many factors

Managing chronic pain3,5

Because pain management incorporates these three areas, it is called a bio-psycho-social approach.9 There is a lot of evidence to show that people with chronic pain who are actively involved in this approach to manage their pain have less disability than those who rely just on more passive therapies, such as taking medication or surgery.10

While people with chronic pain often take some kind of medicine, typically it does not provide full relief.11 Chronic pain is a complex condition and different tools are needed to manage it.5

Getting active

Many people with pain fear exercise as they think it will cause more problems. However, regular stretching and exercising generally leads to decreased pain and better function.5 Exercise helps strengthen weak muscles, benefits your overall health and will improve your sleep and mood.3

Your doctor may refer you to a physiotherapist or exercise physiologist as part of your pain management plan to help you.12

  • Unfit and under-used muscles feel more pain than toned ones and so restarting activity after long periods of inactivity may cause some discomfort (eg, muscle stiffness) but this improves in the long term with more activity.11
  • You can start with hydrotherapy or simple strengthening exercises.4
  • Remember to start slowly and build up gradually your stretching and exercising.5

Pacing your daily activities

Pacing your daily activities, either work, exercise or household tasks, is a useful way to help self-manage pain.5,11 The idea is to try to do things in small, manageable steps rather than big chunks.

  • You may have given up daily activities to avoid pain, or you may overdo things on days when you feel a bit less pain and then feel worse the next day.5
  • Planning your day in small steps, can help build activity at levels that work for you.5,11

Managing your mood, emotions and thoughts about pain

Your doctor may ask about how you are feeling (your emotions) and your thoughts about pain, and about how you feel your pain is affecting your life.

  • Living with chronic pain can cause emotional distress and lead to depression, mental exhaustion, anxiety and low self-esteem.13
  • The rate of depression is 20% higher among people with chronic pain than people who are not living with chronic pain.14
  • Depression or other mood disorders can add to the experience of pain and can make it harder to manage.4
  • Your doctor may refer you to a specially trained clinical psychologist or psychiatrist to help.4

Retraining your brain

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, there are psychological techniques that can be used to help train our minds to counter unhelpful thoughts and change our behaviours. This can have a positive influence on the pain you feel and how you are able to function.3

Your doctor may refer you to a psychologist to try techniques such as cognitive behaviour therapy to help retrain your brain.3

Sleep is important

Chronic pain often disturbs sleep, and lack of sleep decreases our tolerance of pain. There are things you can include in your plan to improve your sleep, such as avoiding alcohol and caffeine. You should also avoid daytime naps and having too much rest during the day.3, 5

Avoid relying on sleeping tablets, although these may seem helpful in the short term they are not a good long-term solution.3

Find time for relaxation

Relaxation is good for us, and it has positive effects on chronic pain.3

  • One of the reflex responses to pain is muscle tightening to 'guard' the body. In chronic pain this continuous muscle tightening adds to the pain and also changes our posture and ability to move.3
  • Stress can also cause muscle tension, and our brain's stress reactions can amplify pain.3

There are different ways to relax; try different things to see what works best for you. These include:3

  • Relaxing activities – simply doing things that you naturally enjoy and find calming such as listening to music, reading a book, taking a bath, doing yoga or Tai Chi, woodworking, playing with a pet, cooking, painting, drawing, going for a walk, watching a film.
  • Relaxation techniques – these are usually based around breathing or muscle relaxation such as progressive muscle relaxation, body awareness, breathing techniques or meditation techniques. Your healthcare professional can advise you on some of the techniques involved.

Seek out social activities and support 

It is easy for people with chronic pain to become socially isolated, which does not help their condition.15

Community support networks are available to people with chronic pain. These can be helpful for information, advice, emotional support and sharing stories of pain.4

Maintain overall health

Any chronic condition will be helped by a healthy lifestyle; such as enjoying a balanced diet, maintaining a healthy weight, limiting alcohol intake and quitting smoking.12

Complementary and alternative medicine approaches

Many people use complementary (or natural) therapies as part of managing their pain. These can include herbs, homeopathic remedies, naturopathy, aromatherapy, meditation, massage, manipulation and acupuncture.3,7

There is less scientific evidence available about the safety and effectiveness of these alternatives than for conventional treatments. It is important you find out the likely benefit of a treatment, and weigh this against the cost and potential side effects before you try it.16

If you are considering complementary or alternative medicines for chronic pain:17

  • Only use proven approaches to replace conventional care.
  • Learn about the product or practice you are considering, and find out the scientific evidence on its safety and effectiveness.
  • Discuss the product or practice you are considering with your healthcare providers. They may be able to advise you on its safety, use and likely effectiveness.
  • If you are considering a practitioner-provided complementary health practice such as spinal manipulation, massage or acupuncture, ask a trusted source (such as your healthcare provider) to recommend a practitioner.
  • If you are considering dietary supplements be aware that they may cause health problems if not used correctly, and some may interact with prescription or non-prescription medicines or other supplements you take.
  • Find out about the training and experience of any practitioner you are considering.
  • Ask whether the practitioner has experience working with your type of pain.

Remember to tell all your healthcare providers about any complementary health approaches you use.

Find out more

References
  1. Cohen ML. Principles of prescribing for persistent non-cancer pain. Aust Prescr 2013;36:113–5. [Online]
  2. Harding V and Watson PJ. Increasing activity and improving function in chronic pain management. Physiotherapy 2000;86:619–30.
  3. Siddall PJ, McCabe R and Murray R. The pain book: finding hope when it hurts. Sydney, Australia: Hammond Press, 2013.
  4. Pain Australia. Fact sheet 7: Managing chronic pain. Waverly, NSW: 2014. [Full text] (accessed 11 May 2015)
  5. Moore P and Cole F. The pain toolkit.  [Full text] (accessed 24 April, 2015)
  6. University of South Australia. Chronic musculoskeletal pain (March 2014). Adelaide: Department of Veteran's Affairs, 2014. [Online] (accessed 28 April 2015)
  7. Turk DC, Wilson HD and Cahana A. Treatment of chronic non-cancer pain. Lancet 2011;377:2226–35. [Pubmed]
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  9. Gatchel RJ, Peng YB, Peters ML, et al. The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull 2007;133:581–624.
  10. Pain Australia. Fact sheet 4: Multidisciplinary pain management. Waverly, NSW: Pain Australia. [Full text] (accessed 11 May, 2015)
  11. Therapeutic Guidelines. Key points for patients about chronic pain. Melbourne, Victoria: Therapeutic Guidelines Limited, 2011.
  12. University of South Australia. Chronic musculoskeletal pain: Helping to solve the pain puzzle (March 2014). Adelaide: Department of Veteran's Affairs, 2014. [Online] (accessed 28 April 2015)
  13. West C, Usher K, Foster K, et al. Chronic pain and the family: the experience of the partners of people living with chronic pain. J Clin Nursing 2012;21:3352–60. [Pubmed]
  14. Pain Australia. Fact sheet 2: Prevalence and the human and social cost of pain. Waverly, NSW: Pain Australia. [Full text] (accessed 11 May 2015)
  15. Canterbury District Health Board. Medications and treatment. 2014.
  16. Hooten WM, Timming R, Belgrade M, et al. Assessment and management of chronic pain. Institute for Clinical Systems Improvement, November 2013.
  17. National Centre for Complementary and Integrative Health. Chronic pain and complementary health approaches: what you need to know. 2014. [Online] (accessed 11 May 2015)