What is chronic pain?
Pain is an unpleasant or uncomfortable body experience caused by activation of the nervous system. It is typically caused by a known injury or illness, but sometimes the cause of pain can be unknown.
Most of us experience will acute pain from time to time. It often occurs following surgery, trauma or short term illness and usually lasts for a short time before the body heals and the pain goes away.
Chronic or persistent pain is pain that lasts for more than three months, or in many cases, beyond normal healing time. Although chronic pain can be a symptom or a known illness or injury it can also exist without a clear reason at all. Sometimes the long term nature of the pain is not indicating ongoing disease or damage.
What causes chronic pain?
The nervous system is made up of basic units called neurones.
Neurones form networks and this video will show you how signals – which are chemical and electrical in nature – create pathways in the brain. There is a nervous system pathway for every experience, including pain and understanding that it is a complex with many components is helpful. If you have had a traumatic experience in relation to your pain, that trauma experience will become a part of your pain pathway (see section on Trauma)
If you live in chronic pain it is important to know that your nervous system changes in response to pain, and can become somewhat unpredictable when viewed traditionally. The process is called “Central nervous system sensitisation” and it causes the pain experience to become a highly distressing, misunderstood, little explained “snake eating its tail” situation where things can progressively deteriorate.
Your thoughts, feelings, and movements are all players in exciting or inhibiting Central nervous system sensitisation. There are chemicals that are associated with thoughts, feelings and emotions, and some of these calm down the system, some of them excite the system.
The pain experience is related to activity in ascending, central and descending processes of the central nervous system (spinal cord and brain).
Ascending fibres from the body to the brain
They transmit messages to the brain about damage or threat in the tissues
Signals can also come to the brain about the health of the nerves themselves. This is called neuropathic or neurogenic pain
Central processing
In the spinal cord the central nervous system can become highly sensitive to stimuli from both within and outside the body. This process is referred to as Central Nervous System Sensitisation.
In this situation, the ongoing pain has a lot to do with the process of nervous system adaptation. It is like the nervous system becoming a very sensitive and high quality amplifier.
Descending fibres from the brain to the body via the spinal cord
This involves the sympathetic nervous system (fight or flight),
Also involves the parasympathetic (rest and digest), endocrine (hormone production), immune (defence) and motor (movement) systems. All of these nerve fibres will make a contribution to the pain experience.
Lorimer Moseley explains the nervous system and pain.
Chronic pain depends on the context
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Chronic pain can be influenced by what is happening in a person’s life at any particular time. Many people have shared stories about how extreme the pain is when dealing with negative life situations such as money stress, relationship breakdown or grief. On the other hand, many people in chronic pain share stories about finding some temporary respite when with good friends, having a laugh, feeling loved and cared about.
Dr Chris Hayes speaks about the medical system and shares his thought on how it needs to change.
Learn more about the context around pain here
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It is well known that stressful events in life make pain worse. Fighting for your rights in compo systems is chronically stressful and chronic stress can make you sick.
Chronic pain is very poorly understood in workers comp systems. This is because the tradition for such claims is that there must be a medical diagnosis for the claim to be seen as ‘legitimate’. Persistent pain, no matter what causes it, is not considered to be a diagnosis.
The following video is an interview with Wendy Berkeley who has navigated her way through workers compensation.
However, if you are in such a situation, it is important to know what you can do to facilitate your own healing process. Firstly, you may be referred to a rehabilitation provider who is given the task of managing your rehabilitation needs. This person will likely be an allied health professional such as an Occupational Therapist, Physiotherapist, Rehabilitation Counsellor or Psychologist.
Their role is to assess your needs and then recommend to the insurer what treatment you need to recover from your pain. You may be referred for an exercise program, but before commencing it is best to discuss what exercise is appropriate for your condition.
There are well-informed exercise providers around Australia. Identifying them is the important part. There are physiotherapists who help teach their clients to set meaningful goals and then share some of the strategies necessary to gradually build up over time so that they can successfully and sustainably get back to their goals.
Ruth White is one such physio. This video might help you make good choices that work for you in the compensation environment.
Relationships
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Chronic Pain affects your relationships. Learning what you can about how to manage your relationships with family and friends is important in the pain journey. Hayley produced a series of videos for National Pain Week 2011 called “Communicating Beyond Chronic Pain” We share them here and hope you find them helpful.
Communicating Beyond
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Communicating Beyond
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Communicating Beyond
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The pain journey
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Many people live with chronic pain 24/7. It is debilitating, exhausting and has an impact on all parts of a person’s life. Living like this takes courage and strength and could be referred to as “putting up with” the pain. The pain is in control and unpredictable.
Some people however have described learning new techniques for “managing” their pain. These folk share stories about gradually taking control of their pain and being able to return to meaningful, pleasurable and enjoyable activities in life with a pain reduction.
We asked people in pain to help us develop a big picture overview of what is involved in the pain journey. It is not simple, as pain is a highly complex and individual experience.
This is a summary of their experiences, and we thank all the members who contributed to this.
Understand as much as you can about the causes and the processes of your pain.
Start with understanding the science of chronic pain. Whatever your diagnosis or advice received, you can learn as much as you can about how the nervous system works, how the immune system works, what is known to make pain worse, or better.
Pain is complex and very individual. There are many health conditions that lead to chronic pain including (but not limited to) cancer, autoimmune diseases, osteoarthritis and endometriosis. There are also a large number of people whose pain starts after trauma – both physical and mental. There are some instances where clinicians can’t pinpoint the cause of the pain, and these people are never given a diagnosis. How your pain is acknowledged or understood by doctors and others is likely to impact your journey.
Your particular circumstances, as well as how your pain is acknowledged or understood by doctors and others will influence the type of pain you experience and the journey towards making that pain more manageable.
Acknowledge that chronic pain is not always understood by healthcare providers.
Many people tell us how frustrating it is when you go to a consultation and leave feeling that you have been blamed for your pain. This is the beginning of stigma, and it is important to see it for what it is. This is about the rest of the world not yet understanding the reality and the neuroscience of chronic pain.
It is important to recognise when you are seeking help in the wrong places. Actively search for healthcare providers who understand pain and build the specialist health team that is right for you. You might like to read the “Choosing your team” fact sheet.
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See the potential in yourself to be different to what you were before pain
Some people talk about learning how to accept that you are living with pain but for many this is a hard thing to deal with. Other people talk about learning to see themselves differently, not in the same way as they did before they had chronic pain. Were you someone who before the pain was a “super” man or woman who did lots of things at the same time – juggled work, kids, sport etc. It is difficult to reconcile who you were with your current abilities.
Learn strategies for dealing with pain, isolation, fatigue and with the depression that often follows pain
Pain is complex and subjective – everyone will experience pain differently, even when they have similar injuries, such as a sprained ankle. This is because how we perceive pain is a complex interaction between mind and body. This interaction involves the nervous system and other factors, such as genetics, culture, thoughts, emotions, previous pain experiences, stress, and what was happening in our lives when the pain started.
Because pain is complex, there is no ‘one-size-fits-all’ way of treating it. This can be very frustrating and distressing when you’re in pain. However, to be successful pain managers, we may have to use a combination of things such as medications, diet, relaxation, thinking strategies, and more. The good news is that, over time and with support from others, it is possible to ‘turn down the volume’ of your pain, and enjoy life.
