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  Chronic Pain Australia
  Health Consumer Organisation

  Chronic Pain Australia incorporated in 2006 to become a strong voice for Australians experiencing chronic pain. Chronic Pain Australia was a lead organisation in developing ... View profile

  There are many ways to manage pain, and people usually have to find the ways that suit them. Overall, being aware of a healthy lifestyle including diet and exercise and allowing yourself to pace up to levels rather than having high expectations of yourself is a good idea. Medicines can help, used as prescribed, but if you are not getting any benefit from medicines then it’s advisable to talk to a clinician who is trained in chronic pain about alternatives. Go to www.chronicpainaustralia.org.au and view “Understanding pain in 5 minutes” as a good starting point, then read the fact sheets http://www.chronicpainaustralia.org.au/index.php?option=com_content&view=article&id=33&Itemid=109.. Staying connected with people including friends family and healthcare professionals that understand pain and how it works is helpful too. Reply to this post  |  Report
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  Gaby Wolf (Exercise Physiologist)
  Health Professional

  As an Exercise Physiologist, I specialise in improving the balance, mobility and quality of life of older adults through specific falls prevention exercises. I am ... View profile

  A significant treatment method for chronic pain in addition to medication is exercise. Exercise helps to increase our pain threshold. It distracts us from the discomfort we experience throughout the day and provides us with a new element of life to focus on. Hydrotherapy is a great way to keep your body moving without feeling the harsh effects of chronic pain. This is because there is no gravity  in water.  Reply to this post  |  Report
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  Dr Terry Stewart (Osteopath)
  Health Professional

  I am an Osteopath and massage therapist. I am a sole practitioner in my practice and I treat neuromusculoskeletal pain and dysfunction with a combination ... View profile

  Hi Gaby,
  I have just registered and I don't know how long ago you asked your question. This is a huge question. Managing persistent pain requires a biopsychosocial approach using multidisciplinary teams or many practitioners. Each case is individual and multi faceted depending on the type of injury and pain and the multiple contributing factors; biological, psychological and social.
  
  Exercise does play a crucial role and it is very important to identify a baseline of activity that suits each individual; what level of activity can a person perform without firing up their pain? This baseline being established another crucial step is to implement correct pacing to try to prevent flare-ups of pain. This is only the active component; it is imperative that education on what pain is and psychological support be provided also. Reply to this post  |  Report
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  Dr Peter Dun (Chiropractor)
  Health Professional

  We provide strategies for chronic and more complex function problems to help restore active lifestyles. Our approach is to combine the best available research evidence ... View profile

  Adding to the previous responses, current understanding about effective pain management of patients using the biopsychosocial approach involves:
  

  • Educating them in non-jargon language about their pain experience, along with the difference between acute and chronic pain.
    
  • Education about any physical cause/s of their pain and consequences of their disorder in factual, non-emotive, empowering language.
    
  • Having treatment options explained relating to a physical cause and/or their pain.
    
  • Being taught effective, customised self-management strategies where outcome and timeframe goals are realistic.  This commonly includes posture and movement modifications to help spare particular body structures from being chronically irritated, along with fitness exercises.  A gradual, rather than quick, increase in activity levels is usually necessary – pacing.  It is often helpful to commence with water-based exercises before progressing to increasingly challenging land-based exercises.
    
  • Identifying, as early as possible, any unhelpful thoughts and behaviours about their physical problem and/or chronic pain experience.  Referral to a psychologist skilled in cognitive behavioural therapy (CBT) may be beneficial.
    
  • Stopping any unhelpful treatments – particularly those in which a patient’s role is only passive and their self-management is limited.
    
  • Educating them to expect and how to deal with progress setbacks and obstacles.
    
  • Ensuring a supportive environment among those involved in the patient’s clinical care and life.  The aim is to help minimise intentional or inadvertent progress ‘sabotage’ and maximise lasting benefits.
    

   
  Patients with simpler pain problems would likely achieve good results when managed by one skilled health care practitioner.  Multidisciplinary care – combined clinical assistance by practitioners with different skills – will be needed with increasing complexity of patient cases.  Where progress is still not satisfactory and for intractable pain, a more comprehensive multidisciplinary approach – such as with a dedicated pain management centre – has the greatest likelihood of success.
   
  Whichever setting where clinical care and advice is provided, the overall goal of pain management is to improve a patient’s knowledge of their condition and optimise their physical function in spite of continuing pain.  As physical and psychological fitness improve as part of leading an active life, the impact of any ongoing pain is likely to gradually lessen.  In some cases, the chronic pain may eventually cease, while in others, unfortunately it will persist.
   
  Lastly, many cases of chronic pain develop following episodes of acute pain.  Research studies have shown that if acute pain episodes are well managed by health care practitioners and patients, a good number of chronic pain cases can be prevented.
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  Dr Terry Stewart (Osteopath)
  Health Professional

  I am an Osteopath and massage therapist. I am a sole practitioner in my practice and I treat neuromusculoskeletal pain and dysfunction with a combination ... View profile

  Hi Peter,
  Everything you have described I totally agree with. An interesting point is that patients seem to thrive on understanding the complexity of pain; this is as you said decsribed in language that is appropriate for each individual patient. One of the most powerful statements is that pain is normal. Peripheral and central sensitisation are normal phenomena also and an understanding of these processes and how they occur can assist with persitent pain management. Once a patient understands why their nervous system is hypersensitive they will begin to understand why pacing is primary in their management.
  
  Passive treatments have  a role depending on sensitivity in the nervous system; passive treatment may be seen as a thraet to sensitive tissue by the brain if it is already alert and focussing on pain from a specific region of the body. This is where passive treatments can fail and provide the patient with another failure that can heighten negative psycohoscial influences. Patients need to have positives in their management.  As therapists we need to identify when we should not treat and refer for pain amnagement at an appropriate facility.
  
  Cheers Terry. Reply to this post  |  Report
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    Dr Peter Dun (Chiropractor)
    Health Professional

    We provide strategies for chronic and more complex function problems to help restore active lifestyles. Our approach is to combine the best available research evidence ... View profile

    G’Day Terry,
     
    Thanks for expanding on these issues.  My point about passive treatments was to highlight that whichever treatment a patient receives, they should also be taught appropriate self-management strategies.  Of course, all components of a customised package of clinical care and advice should be monitored for effectiveness, rather than a ‘set-and-forget’ approach over endless months or even years.  So, customised strategies, active/passive blend of treatment, ongoing monitoring for evidence of improvement, and change treatment/s if not helping overall to progress a patient to optimum self-management and the least reliance on others – health care practitioners, family, etc.
     
    Regards, Peter Reply to this post  |  Report
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  Dr Terry Stewart (Osteopath)
  Health Professional

  I am an Osteopath and massage therapist. I am a sole practitioner in my practice and I treat neuromusculoskeletal pain and dysfunction with a combination ... View profile

  Hi Peter,
  Pain is purely a sensory experience that is created in the brain not in the tissues of the body. In nearly all chronic pain states tissue injury is not the underlying problem, the time frame since injury is suggestive that tissues should be healed, central sensitiastion and plasticity are maintaining ongoing pain states. In these cases are passsive treatments any use in patient treatment and managment?
  
  Cheers Terry. Reply to this post  |  Report
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