Living with persistent pain

What is pain?

Pain is our built-in alarm system. It makes us aware that something might be going wrong in our body.

Pain is essential for our survival as it makes us do something to protect our body. For example, if you put your hand too close to a hot stove, you feel the sensation of heat. If you touch the hot surface, your body feels pain and instinctively pulls away. The pain, and your body’s reaction, prevents you from hurting yourself any further.

We have danger detectors – called nociceptors – spread throughout most of our body. Pain is usually triggered when the brain receives messages from these nociceptors when they detect something potentially harmful. This message is sent to the brain as a signal that there may be danger. The brain then evaluates this message and decides whether the body needs protecting by producing pain. This is a normal reaction that protects us from any further harm.

Acute and persistent pain

Pain may be described as acute or persistent.

Acute pain usually begins quickly and lasts for a short period of time. It is the pain associated with things like a stubbed toe, a broken bone, a burn or having a tooth removed. Acute pain usually goes away after the underlying problem – the inflammation, injury or infection – has been treated or has healed.

Persistent pain, sometimes called chronic pain, is pain that lasts for more than three months.

What causes persistent pain?

Persistent pain is very complex and may be caused by a number of factors. It may occur alongside conditions such as arthritis, diabetes or fibromyalgia. It may occur after an injury or trauma to the body has healed. And in some cases the cause is not known.

Persistent pain is associated with changes to the nervous system (the nerves, spinal cord and brain). Throughout our lives our nervous system changes and adapts to help us learn from and deal with different experiences. This is called neuroplasticity. However, sometimes this normal process of adapting and changing becomes abnormal. It is no longer helpful. Persistent pain is an example of this.

Some changes to the nervous system affect the way the brain understands the information it receives about pain, and things such as touch or movement. In such circumstances, everyday activities that should not cause pain may cause pain. Pain may be worsened by staying in one position for short periods. The affected area may be tender to light pressure, and at times to very light touch. Often this pain can spread to nearby areas or to the opposite part of the body. This is often referred to as ‘central sensitisation’.

The impact of pain

Although everyone’s experience of living with persistent pain is different, there are many common factors. Pain impacts us physically, emotionally, psychologically and socially. It can affect:

• our strength and fitness
• the ability to complete our usual activities at home or work
• our mental health
• social connections
• intimacy
• sleep
• concentration
• our relationships with family, friends and workmates.

Fear of pain and further injury can affect the way we normally do things. Concerns about making things worse can affect the way we move and can make us less active. This can lead to you becoming ‘deconditioned’ or ‘out of shape’. It can also increase the chance that pain will continue to persist.

Diagnosing persistent pain

Your doctor or healthcare clinician will discuss your pain with you and will:

• ask about your history of pain, including:
  • if you have noticed any patterns
  • potential triggers
  • things that make your pain worse
  • things that make your pain better
• discuss any other health problems that you may have
• conduct a physical exam.

Sometimes your doctor may order a scan or other investigation to confirm or rule out a condition. It is important to note that for some conditions, such as back pain, scans are not recommended at all.

Scans have a high rate of ‘false positive’ findings. For example, this can mean that a scan can indicate that something is wrong or ‘abnormal’ in people who have no pain at all. Or it can highlight such a perceived ‘abnormality’ as the source of your pain, when it is not.

A thorough examination by your doctor will decide whether scans or further investigations are appropriate or helpful in developing a treatment plan that is right for you.

For more information about questions to ask your doctor before you get any test, treatment or procedure, visit the Choosing Wisely Australia website.

Treating persistent pain

A team approach, with you at the centre, is the best way to manage your pain and help you continue to do the things that are important to you. Your healthcare team (for example, your doctor, physiotherapist and pharmacist), family, friends and support groups all play a role in this team. But at the heart of the team is you. Read the BHC factsheet ‘Treating persistent pain’ for more detailed information.

Sometimes pain can get on top of you

It’s not easy dealing with persistent pain. Facing ongoing uncertainty about how you’ll feel each day can be very frustrating. It makes planning your everyday activities, work, social life and family commitments challenging.

So it’s not surprising that sometimes the pain and your emotions can get on top of you. But there are many things you can do and many resources available to help you get back on track. Read the BHC factsheet ‘When do I need to see my doctor about persistent pain?’ for more information.

Persistent pain – moving forward

Many factors can influence your recovery and it’s difficult to know how quickly different people with different painful conditions will respond to treatments, or even to the passage of time.

Most acute painful conditions resolve gradually over a few days to a few weeks. A smaller proportion can continue beyond three months and sometimes for much longer.

Despite the ongoing presence of pain, you can improve what you can do and how you feel.

When starting any new treatment, discuss with your doctor or healthcare clinician how long it may take to achieve your specific goals. If you are not progressing in the time you have discussed, it may be of benefit to seek another opinion to determine if a different approach can help you achieve your goals.

Where to get help

• Your GP
• Physiotherapist
• Exercise physiologist
• Psychologist
• Occupational therapist
• Musculoskeletal Australia. National Help Line Tel. (03) 8531 8000 or 1800 263 265
• Medicine Line Tel. 1300 633 424
• Choosing Wisely Australia
• Lifeline – Crisis Support13 11 14
• beyondblue – Support Service 1300 224 636
• painHEALTH
• Pain Australia
• Chronic Pain Australia
• Job in Jeopardy Assistance
• Employment Assistance Fund
• Transport Accident Commission (TAC)
• Worksafe

Contributors

Thanks to the following organisations whose pain experts helped create and review this content.