Persistent/ Chronic Pain
Understanding Persistent/Chronic Pain
Persistent (or chronic) pain usually refers to pain which lasts longer than 3 months. Sometimes, it started as an injury which has now healed, but often we don't know what has caused it. We have learnt a lot about pain in the last few years. Some of this knowledge is very new and is not yet widely known.
All pain, no matter where or how it is felt, is produced by the brain. Imagine you just stubbed your toe. Before your brain tells you, "Here is pain," it must first combine a lot of information, and then try and make sense of it all. Your nerves just say to your brain, "Danger"; they cannot tell you how serious the danger is. It's your brain that works this out, by weighing up things like what is going on at the moment, the experiences you have had in the past, and other life factors. Only after sorting through these will your brain tell you whether your toe hurts or not. It does this incredibly quickly - before you have even realised.
The problem is that the brain gets these signals through the nervous system. All of the nerves in our body, including the spinal cord and brain, change how sensitive they are in response to what we do, how we are feeling and how we see the world around us - a bit like turning the volume up or down on a radio. Sometimes, this can lead to big changes in pain levels without immediately obvious reasons. Persistent pain has more to do with these changes in the nervous system, than it does damage to your body. It's like the volume knob on your pain system has been left turned up, like a radio stuck on "loud". Persistent pain does not always indicate ongoing damage even though it may feel like it.
It's really important to understand that you can re-train your brain and nervous system to turn the volume down again, but this takes time, effort, and knowledge. PPSS may be able to work with you to give you tools and skills which can help you re-train your brain.
Even though you may not feel like it, the best way to relieve pain and to re-balance your life is to keep moving. This doesn't need to be a lot all at once. Small steps at a time, paced around what you are able to do, will help you start to gain your life back and prevent it being ruled by pain. Your mood, thoughts, stress levels, diet and sleep patterns can also all contribute to making your pain better or worse.
If you need to take pain relief to help keep you moving, you can take simple over-the-counter NSAID painkillers (such as Ibuprofen). If you have health issues that mean you can't take these types of medications (gastrointestinal, liver and cardio-renal toxicity), then speak to your GP or pharmacist first.
In the past, you may have been prescribed medications for your pain. These may be Opioids (such as Codeine, Fentanyl, Morphine, Methadone, or Zomorph) or Gabapentinoids (such as Gabapentin or Pregabalin). New research has shown that these aren't very effective at treating long-term pain. It has also shown they can be dangerous. It shows that:
- Many patients find that opioid painkillers don't help with their persistent pain. Research hasn't found any conclusive evidence that opioids are effective in the long-term treatment of persistent pain.
- Many patients also find that opioids can cause unpleasant side effects, including nausea, vomiting, dizziness, and constipation.
- Opioids can be addictive. The more of them you take, the less effective they become, and so you can very easily end up taking more than is good for you - numbers of overdoses are going up.
- Very few patients find Gabapentinoids effective in treating persistent pain. Large numbers of patients also experience side effects including dizziness, confusion, light-headedness, constipation and problems with vision.
If you have had these painkillers prescribed to you, PPSS may be able to support you to review your medications and work with you to see what is best for you in the longer term.
Tame The Beast — It's time to rethink persistent pain
Viewed 254375 times
Published on 26 Jul 2017
Pain scientists starting to think differently about persistent (chronic) pain and its causes, are they're making exciting discoveries - like how you think about your pain can change the way it feels.
Here Professor Lorimer Moseley explains how pain works and explains new approaches to help reduce your pain.
Why Things Hurt
Viewed 949772 times
Published on 22 Nov 2011
A TEDx Adelaide talk. Pain expert Professor Lorimer Moseley talks about the neurobiology of pain - a little more in depth, if you want to know the details, but still entertaining and thought provoking.
Understanding pain and what to do about it in less than 5 minutes
Viewed 615097 times
Published on 16 Jan 2013
This video explains what we know about pain, how it is recognised by the brain, and what we can do to help reduce its effects. Although it is from America, it is still relevant to patients in the UK.
The Drug Cabinet in the Brain
Viewed 60223 times
Published on 26 Mar 2013
David Butler makes comparisons between your brains natural pain relieving chemical production and their pharmaceutical counterparts.
Back pain - separating fact from fiction - Prof Peter O'Sullivan
Viewed 199017 times
Published on 13 Sep 2015
Prof Peter O'Sullivan discusses some of the myths about back pain which are widely held and negatively impact on the perception and treatment of back pain.
The Pain Toolkit is designed for people living with persistent pain, featuring twelve tools to help you manage your pain. There is a free version which gives a brief overview of the tools; the paid version is around £3.50 and contains more tips and information to help you to manage your pain. The Pain Toolkit also looks at the pain cycle, which explains a little bit about how pain becomes a long-term problem for people.
Living with Chronic Pain Recording/CD
The Pain CD was developed by an NHS Consultant Clinical Psychologist. It is designed to help people who suffer from persistent pain which interferes with their mood, activities and relationships. You can listen to it or download it for free, or buy a CD - it is £3 including postage within the UK.
This is the website for the Scottish charity Pain Concern, which has lots of up-to-date information about pain management. Pain Concern is a charity working to support and inform people with pain and those who care for them, whether family, friends or healthcare professionals. They produce information on pain using a variety of media platforms, provide support to people with pain and those who care for them, raise awareness about pain, and campaign to improve the provision of pain management services.
British Pain Society
The British Pain Society is the oldest and largest multidisciplinary professional organisation in the field of pain within the UK. Today the British Pain Society has a membership of over 1,200 and is a representative body on all matters relating to pain. The British Pain Society aims to promote education, training, research and development in all fields of pain. It endeavours to increase both professional and public awareness of the prevalence of pain and the facilities that are available for its management.
Action on Pain
Action on Pain is a national UK charity established in 1998, providing support and advice for people affected by persistent pain
Live Plan Be
This is a free online self-management tool for people living with persistent pain. The name is a play on the concept of "Plan B" — the alternative we turn to when life doesn't turn out as planned. It was created by Pain BC in partnership with people living with pain and healthcare providers. Live Plan Be is funded by the British Columbia Ministry of Health. It has an online Pain Tool Box which helps provide support and information about pain.
A pain research website developed by leading pain researchers Peter O'Sullivan and Wim Dankaerts, Professors of Musculoskeletal Physiotherapy; Kjartan Vibe Fersum, postdoctoral researcher, and Kieran O'Sullivan, lecturer and Specialist Musculoskeletal Physiotherapist. They aim to inform both the public and healthcare practitioners about the latest pain research, to dispel common myths about pain, to provide hope for change and to bridge the gap between the science and clinical practice in musculoskeletal pain.
This site is targeted towards treatment, information and support for people affected by Arthritis. However, it also has some useful exercises and information to help manage pain in different parts of your body.
Tame the Beast Website
CSP Website - Chronic Pain
NHS Website - Back Pain
NHS Website - Neck Pain and Stiff Neck
NHS Website - Shoulder Pain
'Understanding Persistent Pain' Booklet (Tasmanian Health Organisation)