September is International Pain Awareness Month. Strive Clinic's MSK specialist physiotherapist, Christina O'Connor, describes the nature of chronic pain and what help and support is available for you.
In 2001, the month of September was declared as the “International Pain Awareness Month” by the American Chronic Pain Association. This was done as part of their ongoing campaign with the intention of raising public awareness on the need for “increased understanding, communication, education and access to care” for those suffering from chronic pain (Chronic Pain Ireland, 2017). The results of a survey conducted in 2016, highlighted the difficulties people in Ireland face when trying to communicate their pain to health professionals. As seen in the image below, as many as 1.65 million people suffer from chronic pain in Ireland, a figure that is likely to have increased since this survey was completed.
Understanding Chronic Pain
What is Chronic Pain?
Chronic pain has been defined as “pain without apparent biological value that has persisted beyond normal tissue healing” (Chronic Pain Ireland, 2014). Most injuries that we sustain will typically settle and resolve within 6-12 weeks (acute pain). However, for a variety of reasons, sometimes pain can persist beyond these normal healing times with individuals developing chronic pain (>3 months).
What can cause pain to persist?
Typically, when we sustain a neuromusculoskeletal injury (i.e. injury to a nerve, muscle, bone) we will experience one of two types of pain:
(i) Nociceptive pain – results from activation of sensory nerves in response to tissue damage. This type of pain will often feel like a dull ache of varying intensity in a localised location which is aggravated by specific movements and responds well to painkiller medication. This type of pain can result from injury to soft tissue structures like bone, muscle, joints (somatic pain) or internal organs (visceral pain).
(ii) Neuropathic pain – this is caused by an injury or malfunction of the peripheral or central nervous system which will often feel like a stabbing, tingling or shooting pain of varying intensity along a specific nerve path. This type of pain tends to be more associated with chronic pain and is often resistant to painkiller medication.
Under normal circumstances, pain should resolve once the injured structure has healed. However, sometimes the pain persists due to a malfunction within the pain processing pathway or continued injury of the structure leading to a heightened pain response. Allodynia (pain response to stimulus that ordinarily is pain-free e.g. light touch) and/or hyperalgesia (heightened pain in response to a normally painful stimulus) are often characteristic of chronic pain suggestive of heightened sensitivity within the peripheral and central nervous system. Psychosocial factors can also contribute to the persistence of pain, such as the attitudes and beliefs about our pain, mood, support at home or work and finance (Innes, 2005). Over time, as a consequence of maintaining a continued state of ‘heightened’ sensitivity within the central nervous system, changes begin to occur within the brain making it even more efficient at making you feel pain. This can sometimes result in irreversible changes within the brain or account for such phenomena like ‘phantom limb pain’ where pain is felt in a body part that no longer exists.
Some of the conditions that may lead to chronic pain include:
Headache and/or Migraine: e.g. Trigeminal Neuralgia, Drug or Substance Abuse, Smoking
Musculoskeletal: e.g. Osteoarthritis, Osteoporosis, Fractures, Mechanical Low Back Pain
Neurological: e.g. Complex Regional Pain Syndrome, Multiple Sclerosis, Spinal Stenosis
Psychological: Anxiety, Depression, Personality Disorder, Sleep Disturbances
Medical or Generalised Disease Processes: e.g. Peripheral Vascular Disease, Irritable Bowel Syndrome, Diabetes, Hepatitis C, Malignancy (Cancer and post-treatment pain), Fibromyalgia
Chronic Pain Ireland (2014)
Being able to explain your symptoms is a key factor when seeking help and treatment for chronic pain. As evident from the survey discussed previously, having difficulties communicating your pain can result in individuals delaying discussing symptoms with their doctors (26%) and feeling frustrated when trying to describe their pain (52%). In part, having a better understanding of pain and utilizing educational resources, like those provided above, will allow you to be able to describe and communicate your symptoms with your doctor or other health care professionals. In addition to this, some useful strategies to help you communicate your symptoms are suggested below:
One of the reasons it can sometimes be difficult for people to describe pain is because it can be sporadic and if you suffer from pain all the time it can often be hard to identify what could be potentially aggravating your symptoms. Often when you arrive to your Doctor or health professional and are asked to describe your symptoms it is no wonder there is an element of frustration at having to answer questions relating to your pain. For this reason, writing down key points in a diary in advance of your consultation can make the ordeal less frustrating for you while also helping your clinician find ways to help you manage your symptoms!
Some key points of information I would suggest you note down relating to your pain;
Pay attention to where you feel the pain, if you are getting new symptoms and try to describe how it feels e.g. burning, shooting, ache, throbbing
Time of day
Is it worse in the morning/afternoon/evening/night? Is it waking you up at night? If so, do you get back to sleep easily?
Make a note of particular movements/house chores/exercises that seem to make the pain worse or better and if possible, how long you can do these without making the pain worse - e.g. you know you can walk for 5 minutes without your back getting sore but if you walk any longer you have extreme pain for the rest of the day.
If you are taking pain relief, is it giving you relief? If so, for how long? Are you remembering to take it as prescribed?
This list isn’t exhaustive but it will give you a starting point! Your doctor or health professional will be able to direct you towards more specific points depending on the symptoms you describe. There are also numerous phone apps, such as PainScale (a free phone app) that you can use to note down your pain and help you monitor your symptoms
Additional Communication Tools
The American Chronic Pain Association has a variety of online communication tools available for you to download (PDF files) that will also assist you in communicating your symptoms such as;
- Activity Charts
- Pain Maps
- Daily Activity Checklists
My pain feels like… is an online resource developed in collaboration with The Multiple Sclerosis Society of Ireland, Pain Alliance Europe, Parkinson’s Association of Ireland and Chronic Pain Ireland. It has useful educational information as well as a visual chart to assist in describing the sensation of pain.
I have compiled a list of educational resources that I have found useful over the years when trying to educate patients on chronic pain. The first link ‘Retrain pain’ is a free online educational resource that has been designed specifically for patients with chronic pain and involves a series of 8 modules – highly recommended!
Online Educational Resources – very useful!
- Learn a science-based approach to overcome chronic pain
- Understanding Pain in less than 5 minutes, and what to do about it!
- Understanding Pain: Brainman stops his opioids
- Cancer Pain
Educational books – easy to understand (no medical jargon!)
- Explain Pain (2013); Authors: Lorimer Moseley, David Butler; 2nd Edition
Useful websites for support and further information:
- Chronic Pain Ireland - http://www.chronicpain.ie/getting-help/what-is-chronic-pain
- Irish Pain Society - http://www.irishpainsociety.com/
- The American Chronic Pain Association - https://theacpa.org/
- National Cancer Institute – https://www.cancer.gov/about-cancer
- Chronic pain useful phone apps - https://paindoctor.com/pain-diary-apps/
Access to Care
Strive Clinic is an outpatient clinic offering rehabilitation, health and life-improving services for people living with chronic and complex medical conditions. The team at Strive Clinic includes General Practitioners, Physiotherapy (specialists in Pelvic Rehabilitation, Musculoskeletal, Lymphoedema Management), Occupational Therapy, Psychotherapy, Speech & Language Therapy and Specialist Nurses. We specialise in providing comprehensive, integrated and interdisciplinary care that enables a more holistic approach to combining physical and mental health interventions.
The team at Strive Clinic can help you in managing your pain using a variety of treatment techniques. Some of these might include education and advice (i.e. on lifestyle, self-management, pacing, coping strategies, work modifications), therapeutic exercise prescription, acupuncture, relaxation techniques, massage, joint manual therapy, manual lymphatic drainage, and compression bandaging/garment sizing and fitting. The focus of treatment is to equip you with the knowledge and resources to be able to manage your symptoms independently and limit the impact your pain has on your daily life.
Strive Clinic has developed a Cancer Rehabilitation & Survivorship Programme which provides a comprehensive, interdisciplinary and evidence-based programme of care for people living with or beyond cancer. Individuals participating in this programme will have access to our team of rehabilitation experts who will provide you with the best and most relevant information to empower you to improve your health. As part of this programme, you will also receive information on how to alleviate pain associated with cancer and cancer treatment as well as helpful strategies on how to manage your symptoms.
Chronic Pain Ireland (2014). What is Chronic Pain. Available at: http://www.chronicpain.ie/getting-help/what-is-chronic-pain [Accessed 14/9/17]
My Pain Feels Like…What it feels like to live with chronic pain in Ireland: It’s difficult to describe. [image] Available at: http://www.mypainfeelslike.ie/mypainfeelslike/en_IE/pain-research.html [Accessed 14/9/17]
Schatman, M.E., (2012). Interdisciplinary Chronic Pain Management: International Perspectives. 20 (7), pp. 1-5.
Innes, I.S. (2005). Psychosocial factors and their role in chronic pain: A brief review of development and current status. Chiropractic & Osteopathy, 13(6). Pp. 1-5.