Persistent pain, or chronic pain, is pain that lasts for more than three months. It’s a common problem that affects one in five Australians, so if you live with pain, you’re not alone.
The good news is that there are many things that you and your healthcare team can do to help you manage your pain so you can get on with the things that are important to you.
An important note: Treatment that only focuses on reducing your pain for a short time is not the most effective treatment for persistent pain. A change in focus to slowly reclaim your functioning, without making your pain worse, is often more appropriate and more achievable.
Things you can do to manage persistent pain
Working as a team is the best way to manage persistent pain. Your health professionals (such as your doctor, physiotherapist and pharmacist), family, friends and support groups all play a role in this team. And you’re at the centre.
As the central player in your pain management team, it’s important that you take control. Here are some practical things you can do.
Find out more about your condition and treatments
Access good quality, up-to-date information, and stay informed. Quality information can be a powerful tool to help you take control of your pain.
Check out the list of websites and contacts at the end of this information sheet for more information. A quick tip – when looking online, always be wary of sites that push a particular type or brand of treatment. And take celebrity endorsements with a grain of salt!
The most important component of any treatment is whether it helps you to achieve your goals. Setting goals to accomplish specific activities that are important to you, in a given timeframe, can ensure that treatment is meeting your needs, or is being modified to ensure that you keep recovering.
For example, your pain may impact on your ability to walk your dog for long periods. Your goal may be that after six months you’re able to walk your dog around the local park for 30 minutes. By having a goal, something that’s important to you specifically, you’re able to work with your healthcare team to ensure that your treatment plan is helping you achieve this goal.
Learn how you can use self-management strategies
Self-management strategies help manage pain effectively by minimising and managing pain flare-ups. There are many things you can do to manage your pain – and different strategies will work for different situations. For example, heat packs can help ease muscle pain, cold packs can help with inflammation and gentle exercise can help relieve muscle tension. Try different techniques until you find the things that work best for you. This is an important way in which you can gain control in managing your health.
Identify and record your pain triggers
Write down and keep track of the things you notice trigger your pain, and the things you notice help you manage your pain.
Pace your activity levels to avoid flare-ups in pain
Prioritise and plan your activities so that you stop yourself from overdoing things. Alternate activity and rest periods, consider delegating some tasks to others, and do your most demanding tasks when you’re feeling your best – but don’t overdo it.
It’s easy to push yourself too far, which can result in a flare-up of pain. Pacing is an effective way to keep pain at lower levels and allows you to function at a higher level more consistently. Your doctor, occupational therapist, physiotherapist or psychologist can help you with tips and advice on pacing.
Try relaxation and other techniques to manage stress
Performed on a regular basis, this may help you cope better with your pain. Strategies such as stretches, massage, heat and gentle activity may help you recover from a flare-up in pain and help you get back to your usual activity levels more quickly.
Reduce, don’t stop
When you’re in pain, it’s usually better to reduce the level of activity you would normally do, rather than stopping altogether. For example, walk the dog around the block for 5 or 10 minutes rather than half an hour. Gradually returning to your normal activities is a very effective treatment for pain soon after an injury, as well as for persistent pain.
Make a plan to gradually increase your activity levels
Get advice from your doctor or physiotherapist about how to increase your activity levels safely. Soon you’ll be walking the dog for 15 minutes, a month or so later 20 minutes and by six months you’ll reach your goal of 30 minutes, with a few ups and downs on the way.
Involve family and friends
Keep your family and friends involved by discussing your plan with them. They can be a great source of support and encouragement.
Try to stay involved in your usual home activities, as well as your work, leisure and social activities. Social connections are extremely important.
Aim to stay at work, on restricted duties if required, and develop a plan with your employer to return to your full work duties.
Staying off work for prolonged periods can have harmful effects on your ongoing physical and psychological health and decrease the likelihood of ever returning to work.
Your doctor, physiotherapist and occupational therapist can help you with information about how to stay at work.
Take small steps
Don’t wait until you feel 100 per cent before returning to activities or to work. Small, gradual steps allow you to stay connected and mean that you can continue to do the things that are important to you, sooner rather than later.
Your healthcare team for managing pain
There is a range of different health professionals who can work with you to manage your persistent pain. You may see them on an ongoing basis, or you may visit them from time to time as needed.
- Your general practitioner (GP) is central to your care and will help you access other health professionals and services. Make sure you have a doctor who knows you, at a practice that can see you when you need to be seen. Having the same doctor, rather than moving from one doctor to another, means that your care will be consistent and organised. This will lead to the best possible outcomes for you.
- Physiotherapists use a variety of techniques to reduce pain to allow you to gradually increase your activity levels. They can show you how to increase mobility or strength of an affected body part by developing an exercise program for you.
- Exercise physiologists can help you improve your health and fitness, and support you to live a healthy lifestyle, through clinical exercise programs tailored to your specific needs.
- Occupational therapists help you learn better ways to do everyday activities such as bathing, dressing, working or driving. They can also provide information on aids and equipment to make everyday activities easier.
- Psychologists can help you to work through your feelings, particularly if you’re feeling anxious or depressed. They can also help you with goal setting and prioritising activities.
Pain management programs
If pain continues to persist after three months, despite treatment, a useful approach can be to participate in a pain management program. These rehabilitation programs are designed to specifically address the range of factors affecting your recovery including:
- physical factors
- any psychological issues, including your mood, stress or poor sleep
- social factors, such as how you manage your home and social activities, as well as your safe return to work.
At pain management programs you’ll learn from health professionals (such as doctors, physiotherapists, psychologists, occupational therapists and nurses) about how you can manage your pain more effectively with the least side effects.
Talk with your doctor about whether a pain management program would be helpful for you.
Medical treatments for persistent pain
Medical treatments for persistent pain may include:
- injections of a local anaesthetic, steroids or strong anti-inflammatory
Medication to reduce pain can play a useful part in your recovery in the early days following injury, but the effects are often limited.
Sometimes reducing your pain with medication can help you to start working towards your physical activity goals. It’s best to discuss with your doctor both the potential benefits and risks associated with pain medication.
It’s also important that you talk with your doctor before you stop taking a regular medication for pain. You may need to gradually reduce your dosage, rather than simply stop taking it, to avoid potential side effects of withdrawing from a medication. This isn’t a sign of addiction, but a common side effect of these medications. Your doctor will advise you on this.
Guidelines recommend that strong pain medications, such as opioids (for example morphine, codeine and Endone), shouldn’t be taken for longer than three months, if possible.
Injections of a local anaesthetic, steroids or strong anti-inflammatory into a painful area may be recommended with some conditions. Injections of strong analgesics such as pethidine and morphine are used in the management of cancer-related persistent pain.
Surgery is rarely recommended to manage persistent pain conditions unless all other non-surgical options have been exhausted and it is considered medically necessary.
Note: Injections and surgery are only effective with a small proportion of painful conditions. The degree of benefit, the risks of harm and the cost of surgery all need to be weighed up against each other. If surgery has been suggested, it may be beneficial to seek a second opinion before proceeding. Remember treatment is only worthwhile if it helps you reach your goals.
Where to get help