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Chronic pain explained

If you have chronic pain, you are not alone. One in five Australians, including children and adolescents, lives with chronic pain, but this number rises to one in three for those over the age of 65. Chronic pain is usually defined as constant daily pain that is present for at least 3 of the preceding 6 months. Chronic pain can have many causes but it can also have no diagnosable cause. The following information concerns chronic pain that is not the result of cancer. 

6 min read

What is chronic pain?

Chronic pain, also called persistent pain, is pain that continues beyond the time expected for a painful condition or injury to heal, usually about 3 months.

Chronic pain occurs because the nerves and spinal cord become over-sensitive and magnify messages when there is no active damaging stimulus. When the nerve messages reach the brain, the brain thinks there is harm and reacts by feeling pain – even when there is no injury.

When chronic pain continues for some time, the brain may start to react to messages from other parts of the body near the site of the now-healed damage and you feel pain in those areas too, making the situation worse.

Neuropathic pain is a type of chronic pain that occurs following damage to the nervous system itself. It is also called nerve pain or nerve-damage pain. The sensations associated with this type of pain are described as burning or shooting pains. The skin can be numb, tingling or extremely sensitive.

Managing chronic pain

The focus of treatment needs to be on managing your pain and improving your day-to-day function, rather than completely stopping the pain.

Chronic pain is best managed through a multidisciplinary pain management plan with your healthcare professional, covering aspects such as:

  • physical fitness and activities
  • medication
  • mood
  • sleep
  • relaxation and overall health.

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 your pain. Don’t wait for your pain to be completely gone before starting normal activities, including work.

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 medicines.

Opioid medicines for chronic pain

Opioids (eg, morphine, codeine, endone, etc) are commonly used to treat severe acute pain or cancer pain.1 However opioids are not universal painkillers,2 and they are often not very effective in chronic pain that is not caused by cancer.3

Long-term use of opioids is associated with potentially serious harms, which includes both opioid-related side effects, and an increased risk of accidental fatal overdose, dependence or addiction.4

Before considering using opioids, you should discuss your full medical history with your healthcare professional, and together you should develop a pain management plan that takes a biopsychosocial approach; that is a multimodal plan incorporating non-medicine strategies and non-opioid medicines.5

Opioids key points

  • There is no clear evidence to show that long-term opioid therapy can greatly improve chronic pain and restore physical function.3
  • Opioids are associated with side effects in around 20–30% of people; such as constipation, nausea, dizziness, sleepiness and sleep apnoea.6
  • Long-term opioid therapy is also associated with a greatly increased risk of fractures in older people.6
  • Increasing doses of opioids in chronic pain has been repeatedly linked to harm, including death from overdose.6

References

  1. McNicol ED, Midbari A and Eisenberg E. Opioids for neuropathic pain. Cochrane Database Syst Rev 2013;29.
  2. McDonough M. Safe prescribing of opioids for persistent non-cancer pain. Aust Prescr 2012;35:20–4. [Full text]
  3. Turk DC, Wilson HD and A. C. Treatmnent of chronic non-cancer pain. Lancet 2011;377:2226–35. [Pubmed]
  4. Franklin GM. Opioids for chronic noncancer pain: a position paper of the American Academy of Neurology. Neurology 2014;83:1277–84.
  5. Holliday S, Hayes C and Dunlop A. Opioid use in chronic non-cancer pain--part 2: prescribing issues and alternatives. Aust Fam Physician 2013;42:104–11.
  6. Holliday S, Hayes C and Dunlop A. Opioid use in chronic non-cancer pain--part 1: known knowns and known unknowns. Aust Fam Physician 2013;42:98-102.

Non-opioid medicines for chronic pain

The goal of treating chronic pain with medicines is to reduce pain to a level that allows you to improve your functioning and quality of life.1,2 Medicines to treat pain are generally divided into opioids and non-opioid medicines.3 Opioids (eg, morphine, codeine, endone, etc) are used to treat severe acute pain or cancer pain,4 but are often not very effective in chronic pain that is not caused by cancer.5

Non-opioid pain medicines can be effective at relieving pain,3 but should generally be used only for a short period and only for as long as they are helping to manage your pain so that you can maintain physical and social function.2

  • It is unlikely that any pain relievers will be able to completely stop chronic pain.6,7 A multidisciplinary approach to management has been shown to be more effective for chronic pain than relying on pain relievers alone.8
  • Medication is best used alongside other non-drug approaches as part of multimodal management of pain.1
  • Pain medicines do not work for all patients, and often don't remove pain completely when they do work.5
  • All medicines have side effects and before prescribing a medicine for chronic pain, your doctor will discuss its potential benefits and harms, to help decide whether the medicine may be useful for you.2

Types of non-opioid medicines for chronic pain

Non-opioid pain relievers that are commonly used as part of a pain management plan are paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs).3

Paracetamol

Paracetamol can be effective for mild chronic pain or to supplement other medicines. It is important not to take more than the recommended dose.2,3

Non-steroidal anti-inflammatory drugs (NSAIDS)

In many cases of chronic pain, inflammation is not the cause, so anti-inflammatory medicines may not be helpful. NSAIDS may be able to give short-term relief during a pain flare-up, but generally they should not be used for long-term pain relief because of the risks associated with them. In cases where long-term NSAIDs may be the best option, you will be treated under the ongoing supervision of your doctor. NSAIDS can interact with other medications and you should discuss your medicines with your doctor or pharmacist.1,3

Antidepressants

Low doses of medicines normally used to treat depression (antidepressants) called tricyclic antidepressants can have a pain relieving effect for several types of chronic pain, including neuropathic (nerve) pain. However, these medicines can have side effects (eg, a persistently dry mouth) which can be hard to tolerate.1,9

Another type of antidepressant called a serotonin and noradrenaline reuptake inhibitor (SNRI), can be also effective in some types of neuropathic pain.1

The doses of antidepressant medications used to treat pain are usually lower than those used to treat depression.10

Anticonvulsants/antiepileptics

A detailed review of clinical research trials shows that some medicines originally developed to treat epilepsy, known as antiepileptic medicines, may provide pain relief in some, but not all, people with specific neuropathic pain conditions such as painful diabetic neuropathy, postherpetic neuralgia and central neuropathic pain.11

Antidepressants and anticonvulsants/ antiepileptics are prescription medicines. Do not take them unless they have been prescribed for you. Always follow the instructions provided by your prescriber or pharmacists.  

For more information, see the Consumer Medicine Information (CMI) for your brand of medicine, available on our Medicine Finder page or from your pharmacist or doctor. 

References

  1. Cohen ML. Principles of prescribing for persistent non-cancer pain. Aust Prescr 2013;36:113–5. [Online]
  2. Pain Australia. Fact sheet 7: Managing chronic pain. Waverly, NSW: 2014. 
  3. Hooten WM, Timming R, Belgrade M, et al. Assessment and management of chronic pain. Institute for Clinical Systems Improvement, November 2013.
  4. McNicol ED, Midbari A and Eisenberg E. Opioids for neuropathic pain. Cochrane Database Syst Rev 2013;29.
  5. Turk DC, Wilson HD and Cahara A. Treatmnent of chronic non-cancer pain. Lancet 2011;377:2226–35. [Pubmed]
  6. Siddall PJ, McCabe R and Murray R. The pain book: finding hope when it hurts. Sydney, Australia: Hammond Press, 2013.
  7. Therapeutic Guidelines. Key points for patients about chronic pain. Melbourne, Victoria: Therapeutic Guidelines Limited, 2011.
  8. Australian and New Zealand College of Anaesthetists. National pain strategy: pain management for all Australians. Melbourne: ANZCA, Faculty of Pain Medicine, Australian Pain Society, Chronic Pain Australia, 2010. [Full text] (accessed 11 May 2015)
  9. Fishbain D. Evidence-based data on pain relief with antidepressants. Ann Med 2000;32:305–16.
  10. Holliday S, Hayes C and Dunlop A. Opioid use in chronic non-cancer pain-part 2: prescribing issues and alternatives. Aust Fam Physician 2013;42:104–11.
  11. Wiffen PJ, Derry S, Moore RA, et al. Antiepileptic drugs for neuropathic pain and fibromyalgia - an overview of Cochrane reviews. Cochrane Database Syst Rev 2013;11:CD010567.

Talk to your health professional about chronic pain

Working with your doctor and other healthcare providers to develop a strategy that works best for you will improve your experience of living with chronic pain.

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 will help them tailor a pain management plan to suit your individual needs.

Consider your answers to some questions your health professional may ask to help understand and manage your pain:

  • What is your pain like? What brings it on?
  • What other symptoms do you get when you have pain?
  • What medications and treatments have you tried?
  • How does your pain affect your activities of daily living?
  • How does your pain affect your relationships and role in your family?
  • How does your pain make you feel?
  • How well do you sleep?
  • What would you like to be able to do?

Develop a personal pain management plan

Your plan could include setting achievable goals to give you something to aim for. Topics that could be covered in the plan include:

  • activity management (eg, pacing of tasks)
  • behavioural management (eg, relaxation)
  • cognitive therapy to help you think more positively about your ability to manage your pain
  • exercise
  • medicines management, as needed.

Take a copy of your plan with you each time you visit your health professional. Be proactive and highlight the goals you have reached, or any problems you have faced.

6 min read

Date published: 20 April 2017
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