Acute pain lasts for a short time, and when the cause is treated the pain goes away.
Pain is called chronic when it does not go away and you have experienced pain on most days of the week for at least 3 months. Tests and investigations may not find an explanation for the pain. This does not mean that chronic pain is not real. The nervous system, which sends pain signals, may have become oversensitised. The pain itself, however it began, has become an ongoing problem.
About 1 in 5 Australian adults experiences chronic pain. It is reported to affect more adults than diabetes, hypertension or asthma.
Injury is the leading trigger of chronic pain, with the most common injuries resulting from playing sport, car accidents, and accidents at home or work.
The most frequent areas of pain cited by people with chronic pain are the back, leg, shoulder, arm and neck. Chronic pain is slightly more common among women than men, and is more common with increasing age.
Living with pain is difficult. Chronic pain can cause physical problems, but it can also cause emotional distress such as depression, frustration or feelings of helplessness. It can leave you feeling tired, worried, angry, or just generally in a bad mood. This can make the pain seem worse.
You don’t have to put up with pain. Ask for, and accept, help and advice from others. People who take active responsibility for the management of their pain can lead a very productive life.
There are a number of things you can do to help yourself, that can make an enormous difference:
The NSW Agency for Clinical Innovation Chronic Pain website provides a good introduction to chronic pain and strategies for dealing with it.
Chronic pain not only affects the individual who is suffering, but also family members. Family members are naturally distressed by their loved ones being in pain, but over time this can develop into feelings of frustration, anger and resentment, and emotional exhaustion.
The roles played by family members can change as a result of chronic pain. The person who has chronic pain may not be able to carry out everyday activities leading to other family members, usually the spouse, taking on more domestic duties. Child-rearing tasks may fall more heavily to one parent. Grandparents, aunts and uncles may be called upon more often to provide practical help. The family may suffer a loss in income, and leisure activities may become less frequent or even abandoned.
There are many things that family members can do to help their loved one who has chronic pain:
In a pain diary you record information about your pain, such as:
The diary helps you to gain better control over your pain. The diary is particularly helpful for discussing how to manage your pain with your doctor or other health professionals. Sharing the information in your diary with family members may help them to understand what you are experiencing.
You can design a diary for yourself, or use one that has already been developed such as by the National Prescribing Service. There are also apps available such as from the painaustralia website.
Talk to your doctor. Get information on your condition and discuss any concerns you may have. Remember you have a right to ask questions and expect answers that you can understand. Doctors sometimes don’t provide information or address concerns as they may assume you already know the information. The US Agency for Healthcare Research and Quality has useful tips for talking with your doctor about any health matter. You may require help from other health professionals, and information on how to choose the right pain management team for you is available online from Chronic Pain Australia.
Help is available from pain clinics. They have specialist doctors, nurses, psychologists, physiotherapists and occupational therapists to help people manage their pain and regain a worthwhile lifestyle. Speak to your doctor about whether a referral to one of these clinics or a specialist pain management doctor would be beneficial.
Set up a support network. This may include family members, friends or fellow sufferers.
Find out what community resources are available to you.
Check out other reliable forms of information such as books, the internet, and your local pharmacist.
Pain medicine specialists are doctors who have a highly specialised understanding of the diagnosis and management of chronic pain. They often work in a clinic with other health professionals such as psychiatrists, psychologists, nurses, physiotherapists, and occupational therapists. Using a ‘whole person’ approach to treatment, the pain specialist will call upon a wide range of treatments to ensure that a patient’s individual problems with pain are addressed. Pain clinics often have a strong emphasis on patients learning skills and strategies to self-manage their pain.
Pain specialists usually see patients whose pain has not responded to normal and standard medical treatments offered by general practitioners (GPs). If you feel that you might like to see a pain specialist or attend a pain clinic, you will need a referral from your GP or a specialist (you may already be seeing one, such as a rheumatologist). The waiting list for pain specialists and clinics may be lengthy.
Chronic pain is not easy to treat but with appropriate treatment, most chronic pain can become manageable.
The type of treatment a person needs may vary according to his or her individual circumstances, but generally the best treatment is a combination of therapies. A list of potential therapies are listed below that have varying degrees of effectiveness.
You will probably need to consult a variety of health professionals other than your doctor, such as a psychologist, occupational therapist or physiotherapist, to get the most benefit out of these therapies. When consulting different health professionals, it is beneficial to tell them about the various treatments you are undergoing or considering.
Medications that are used to relieve pain are collectively known as analgesics or, more commonly, as painkillers.
A range of pain relief medicines can be bought without prescription as over-the-counter pain relievers. These include paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and aspirin. You should speak to your doctor or pharmacist about the best options for you before buying any over-the-counter medicines.
Combination pain relievers contain more than one active ingredient, such as ibuprofen and codeine; aspirin and codeine; and paracetamol and codeine.
Opioids, such as buprenorphine, codeine, oxycodone and morphine, may be addictive and may have side effects such as nausea and vomiting. They are only available on prescription.
For more information on pain relief medicines, visit the pain website of the National Prescribing Service (NPS).
Together with your doctor or other health professional, it is worthwhile drawing up a plan to manage your pain. A pain management plan typically includes the goals of treatment, a timetable for achieving your goals, and details about the therapies to be used (e.g. specific exercises, relaxation techniques, medication) and when they should be used. If medication is prescribed, notes on the best times to take medication should be included, as well as details about what to do if a flare-up occurs, particularly if it happens after hours.
A pain management plan should be tailored to meet your needs. This means that a plan developed for you may be quite different to another person being treated for chronic pain.
Your plan should be reviewed on a regular basis.
The law imposes restrictions on who can supply medicines and how they can be supplied. These restrictions are intended to prevent or reduce unsafe or harmful use of medicines, and to ensure that appropriate health professional advice is available to people before they use them.
A limited group of medicines are available over-the-counter from non-pharmacy outlets (e.g. paracetamol, aspirin). Although they can still lead to harm if used inappropriately, they are safe and effective when taken as instructed on the packaging.
Some medications do not require a prescription but are only available from a pharmacy. This ensures that professional advice from a pharmacist is at hand when the medication is purchased.
Some pain medications are available by doctor’s prescription only and can only be obtained from a pharmacy (e.g. diclofenac tablets). They are restricted in this way to ensure that a patient has their condition diagnosed by a doctor who can then prescribe the most appropriate treatment. The strong opioid pain medications (e.g. morphine, oxycodone) have tighter restrictions on how they can be prescribed because of their potential for abuse.
When restrictions are imposed on pain medications, the following things are taken into consideration:
More information about the regulation of medicines in Australia is available from the Therapeutic Goods Administration.
There are a variety of medicines for which doctors need approval or authorisation to prescribe or to continue prescribing. Authorisation is commonly required for various pain medicines listed on the Pharmaceutical Benefits Scheme (PBS).
The PBS is a Commonwealth-funded system that subsidises the cost of many prescription medicines. When you obtain a medicine under the PBS, you are required to make a contribution towards the cost, which in 2013 is $36.10 (or $5.90 for concessional patients) for each item. An additional cost may be involved if you or your doctor chooses a more expensive brand of medicine. In order for a medicine to be subsidised on the PBS, certain requirements must be met. Your doctor may need to apply to the Commonwealth Government for an authority as part of these requirements.
In some cases your doctor may also need to apply to a State or Territory health authority (e.g. NSW Ministry of Health) to obtain approval before prescribing your medication, or to continue prescribing your medication.
The possible side effects of medications can affect individual people in different ways. Some people may experience none of them, while others may experience some or all of them. In many cases, side effects either wear off over a short time or can be reduced by changing the dose and the timing of the dose.
Before taking medication, speak with your pharmacist and/or doctor who can provide you with information about the side effects produced by particular drugs.
Note: The side effects produced by pain medications are not limited to those mentioned below.
Most people who take paracetamol do so without any problems. In rare cases a person may develop a rash or another allergic reaction, or possibly a blood disorder. High doses of paracetamol can lead to liver damage.
The most common side effect reported by people taking oral NSAIDs is stomach upset (e.g. indigestion, heartburn, stomach pain, nausea). Other possible side effects include headache, dizziness, fluid retention (e.g. swelling around the ankles, feet, lower legs, hands and possibly around the eyes), and tinnitus (ringing in the ears). Some people notice that they bruise or bleed more easily. NSAIDs can also cause allergic reactions such as skin rashes and wheezing. NSAIDs that are applied to the skin can cause reddening, stinging, itching and skin rashes. People with asthma have a higher risk for experiencing serious allergic reaction to NSAIDs.
Because the side effects of NSAIDs are potentially serious, not all patients can use them. Patients who should not use them include those with an allergy to aspirin or any NSAID, those with a blood disorder or who are taking blood thinning agents, or those with an active peptic ulcer. Aspirin should not be given to infants or young children who have a viral illness, particularly chicken pox, because of the risk of a serious brain disorder (Reye’s Syndrome).
Common side effects of anticonvulsants are drowsiness, and unsteadiness or poor balance. If you have been prescribed an anticonvulsant, you should only stop taking it after consulting your doctor as stopping it suddenly can be hazardous.
There are several types of antidepressants. Different antidepressants have different side effects. The most common side effects are drowsiness, constipation, dry mouth and blurred vision. Some people experience nightmares or an increased heart rate. Some antidepressants cause more sleepiness and some less; some lower blood pressure, while others raise it; some increase appetite while others do not.
Constipation is very common during opioid treatment. Drowsiness and nausea are also fairly common side effects, particularly at the start of treatment or when the dose is increased. Other side effects include urinary retention, itching, headaches, decrease in sexual interest, occasional feelings of disorientation, and dizziness. Although rare, seizures have been reported with tramadol. Individuals who have epilepsy should avoid tramadol.
Pain medications that contain opioids are potentially addictive.
When a person takes opioid medication for some time their body adapts to the drug. If they suddenly stop taking the drug, withdrawal can occur – symptoms of withdrawal may include muscle aches, watery nose and eyes, irritability, sweating and diarrhoea. A withdrawal reaction indicates a person has become physically dependent on the drug. This is a normal response to repeated use of opioids. It does not mean a person is addicted. There are many drugs that cause physical dependence. One such substance familiar to a lot of people is caffeine. Some people accustomed to drinking coffee (a cup of which contains around 100mg of caffeine) experience a headache when they suddenly stop drinking coffee – this is a withdrawal reaction.
Another common effect of taking opioids on a long-term basis is ‘tolerance’. Individuals who become ‘tolerant’ to a drug need a larger dose over time to get pain relief.
People who are ‘addicted’ are usually physically dependent and tolerant, but they also have intense cravings and a compulsion to take it again and again. They find it very difficult to stop or reduce their use of the drug, and are determined to obtain it despite the physical, psychological or social harm it may cause.
If opioids are prescribed for your pain, you are not abusing them if you are taking them as prescribed by your doctor.
People who are addicted have an overwhelming desire to use their medication (typically for reasons other than pain control), and will compulsively seek it out and continually use it regardless of any harm.
If you think you may be addicted to your medication, talk to your doctor. Your doctor may:
The opioid doses prescribed to give you pain relief are unlikely to turn you into a ‘zombie’ when used correctly. When you start treatment, the opioid medication can make you feel drowsy. It is important at this time to take extreme care when operating machinery or driving. The drowsiness may last a few days before you return to feeling alert.