With almost half of the adult population (43%) living with some type of chronic (persistent) pain, Dr Zoe helps us to understand the condition and how best to manage it .
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Pain is extremely complex and there are many different types.
Dr Zoe thinks it is helpful for people to know the difference between acute pain and chronic pain, as treatment approaches for them are often different:
“All pain is caused by the brain. Acute pain is a warning to the body that there is tissue damage, usually caused by specific injury or illness. It can usually be treated with medication, and resolves with days/wks/months. Persistent pain, or chronic pain is when the pain has continued for three months or more. At this stage the tissue damage is not the main issue, and this type of pain may not respond as well to drugs. The brain keeps producing pain, even once body tissues are ok and there is no longer any danger. The issue has become the brain and nervous system. If investigations have ruled out any ongoing issue, or if there is no suitable treatment to cure the pain, then at this stage the aim of treatment is to "Retrain The Brain”.
“Medicines can help to some extent but becomes important to “Retrain the brain”. Pain can lead to stress, depression, impact negatively on relationships, all of which can make the experience of pain worse, make the nervous system more sensitive – creating a vicious circle. So often treatment of chronic pain needs to start away from the pain
Thoughts/emotions – using methods to reduce stress and change way of thinking towards more positive, eg, focussing on what can do, rather than what can’t. Therapy can support with this.
Lifestyle – diet, smoking, alcohol. Your GP or practice nurse can support with this.
Pain/life story – Going back to when the pains started and looking at correlations between worrying period and worsening pain – therapy may help with this.
Physical activity – Gradually, and without fear, physiotherapists can support with this
Often people have been living with pain for many years and have tried lots of different methods to attempt to cure the pain and are usually experts when it comes to their own experience of pain. One approach, that I like to use with patients is to consider chronic pain as a disease state in itself and therefore support my patients to look at ways to live with and control pain, rather than cure."
TENS MACHINES: Transcutaneous electrical nerve stimulation (also known as TENS) is a method of pain relief involving the use of a mild electrical current. A TENS machine is a small, battery-operated device that has leads connected to sticky pads called electrodes: “This distracts the person from the initial pain they are feeling, dampens down the pain receptors and also increases endorphins – the body’s natural painkillers. There don’t cause any harm, so are worth a try and some people find them extremely helpful”
JOINT PAIN: Steroid injections can be used for musculoskeletal joint pain, especially knees, shoulders and the small joints of the hands and feet. “They work for the majority of people, but not everyone and 1 injection can alleviate pain for several months. One of the GP’s at your surgery may be able to do this for you, without a referral”
PAINKILLERS: Zoe identifies numerous painkillers people can take to help with pain such as; paracetamol, Ibuprofen and neuropathic painkillers: “Neuropathic painkillers, such as Gabapentin, Amitriptyline and Pregabalin calm down the nerve activity and can work really well with nerve pain especially if caused by nerve damage.”
PSYCHOLOGY THERAPY: Relaxation techniques, such as mindfulness and meditation, or with professional support from a therapist can be very helpful and often are the most important factor, when it comes to living with chronic pain “Some people find it difficult to accept that pain is a part of their life, so having psychological therapy can help them accept this and start to rebuild their life with the pain, which in itself can help control the pain.”
Self help / Support groups
There are lots of self-help advice available from a variety of organisations supporting people living with long-term pain, such as:
This 20 minute guided meditation course from Meditainment is easy-to-follow, free and proven to help people cope with chronic pain.
It's part of the Pathway through Pain online course which is provided by the NHS in some areas for people with persistent pain. Ask your GP or pain specialist how to access the course.
GPs can refer complex cases to specialist pain clinic. Dr Zoe says “Your GP can refer to a specialist pain clinic, where pain is assessed holistically. Everyone’s solutions to managing chronic pain will be different. Pain clinics offer a wide range of treatments and support in developing self-help skills to control and relieve your pain.”
Some people receiving treatment at a pain clinic may be offered a pain-management programme (PMP). The aim of a PMP is to improve your quality of life, despite your pain, rather than reducing your pain.
PMPs are usually delivered through a series of group sessions with other people with persistent pain, in a friendly environment.