Active Self-Management: Living Well with Pain
What is pain?
Acute pain is a normal protective warning signal. It often occurs directly after injury, lasts a short duration (hours to a couple of months), and dissipates within 3 months of onset. Where as chronic pain lasts longer than 3 months, beyond and despite the expected healing period and often the pain felt is no longer a sign of harm or injury to oneself.
In some situations the problem that caused the acute pain, such as arthritis, continues and this explains the ongoing nature of the pain. However, there are also times when pain continues despite resolution of the initiating event. Scientific research into how pain occurs within the body has led to recent advances in our understanding of why this happens. We know that pain has persisted for more than three months is no longer a straightforward warning system of physical harm, but involves complex changes in the nervous system and brain. Unfortunately, this condition is not uncommon, with 1 in 5 Australians experiencing chronic pain.
Although pain is often described in terms of its duration, acute pain lasting less than three months, and chronic or persistent pain having lasted longer. These definitions don’t explain why a person has pain, and doctors will attempt to further define an individual’s pain by describing its source.
- Musculoskeletal pain has originated in the joints (eg. hip or spine arthritis), bones (eg. fractures), ligaments / tendons (eg. ankle sprains, tendonitis) or muscles of your body.
- Visceral pain refers to pain perceived from organs in the body, eg. chronic angina or abdominal/pelvic pain.
- Neuropathic pain occurs when the problem itself is within the nervous system, either because of nerve damage in the periphery, or due to problems in the spinal cord or brain. This is a particularly difficult problem because the mind may perceive pain in a part of the body that has no injury at all, or only a minor injury, because nerves are sending the wrong message to the brain. Sometimes people have severe pain in their foot, despite having had that foot removed at the time of a leg amputation. This is due to neuropathic pain.
(Video courtesy of Brainman)
People who live with pain know that it challenges many aspects of your life and can affect your whole person. Click here to read more.
The challenge of chronic pain
Although the root cause of chronic pain may not be able to be “fixed” or “cured” there is an ever-growing body of research that shows how addressing the contributing factors that lead to the suffering associated with chronic pain, can improve your quality of life and assist you with managing your pain more effectively.
The brick wall of suffering when living with chronic pain
What is active self-management?
Chronic pain has an enormous impact on all aspects of your life, including:
- Physical health
- Emotional and mental health, including isolation, depression, stress, anger and anxiety
- Changes to relationships, work, lifestyle, sleep, weight, general health, activity and function
- On-going reliance on your healthcare team, medications and treatments
The goal of active self-management is to empower you with the knowledge, skills and tools to navigate and interact effectively with your healthcare team and the world around you. With an improved understanding of what chronic pain is and how to actively self-manage it, you will feel more in control of your life and your pain.
(Video courtesy of Pain Management Network)
If you would like to learn more about active self-management, visit:
- PainAustralia: self-managing chronic pain fact sheet
- Pain Management Network Australia
- The Pain Toolkit
Active self-management essentials
- Understanding the pain cycle: understanding what the cycle of chronic pain is, can help you get off the merry-go-round and start moving forward with your goals for the future.
(Video courtesy of The Pain Toolkit)
- Understanding fear-avoidance patterns in chronic pain: this is where the fear of pain leads you to avoid activities. This gradual decline in activity results in deconditioning and worsening of pain over time. If you would like to learn more click here.
(Video courtesy of Geelong Chiropractor)
- Understanding the boom-bust cycle in chronic pain: this is a situation where despite pain levels increasing, you persevere and ignore its warning (boom) until the pain becomes unbearable (bust) causing a flare that leaves you wiped out for days. This all or nothing behaviour leads to inability to maintain consist levels of activity. If you would like to learn more click here.
(Video courtesy of The Pain Toolkit)
- Understanding the concept “Hurt does not always equal harm” in chronic pain: the changes to your body that occur with chronic pain, mean the warning felt (your chronic pain) is not necessarily reflective of damage at a tissue level. If you would like to learn more click here.
(Video courtesy of Tame the Beast)
- Understanding the principles of pacing strategies in chronic pain: movement is essential for maintaining general health but also managing your chronic pain. Often after prolonged periods of inactivity due to pain movement becomes an enormous challenge. Pacing is a method of returning to activity in a smart, achievable and sustainable way. If you would like to learn more click here.
(Video courtesy of Geelong Chiropractor)
Some useful resources on pacing:
- Graded Exposure (link)
- Pacing Goals (link)
- Chronic Pain and Exercise (link)
- Pacing for Pain and Fatigue (link)
- Understanding the importance of movement despite levels of chronic pain: chronic pain leads to a “hyperactive alarm system”, which does mean flare ups are inevitable. When these occur, it is important to not give up or give in. Consistency and persistence are important to long-term management of pain. Click here for the Pain Management Networks flare up plan.
(Video courtesy of Pain Management Network)
- Understanding how thoughts affect chronic pain: most people living with chronic pain know that during times of stress, anger, depression, anxiety and fear, their pain is harder to manage. The effects these emotions and the associated thoughts have on exacerbating our pain is partly due to the chemicals released in our brain (neurotransmitters) and partly due to the actions we choose as a result of these thoughts and emotions. If you would like to learn more click here.
(Video courtesy of Pain Management Network)
- Understanding how chronic pain affects sleep: sleep is one of the most common issues associated with chronic pain. It is also one of the greatest sources of suffering. Improving sleep hygiene can lead to better quality and greater satisfaction with sleep. If you would like to learn more click here.
(Video courtesy of Pain Management Network)
- Understanding the role of lifestyle and nutrition in managing chronic pain: there is a growing body of evidence that suggest nutrition and lifestyle play an important role in managing chronic pain. This is thought to be due to the effects nutrition and lifestyle have on our nervous, immune and endocrine (hormonal) systems. If you would like to learn more click here.
(Video courtesy of Pain Management Network)
There is also emerging research on:
- Gut-brain connection: this is the communication link between your gut and brain. Neurons are cells found in your brain, central nervous system and gut that tell your body how to behave. Your vagus nerve is one of the largest nerves and is partially responsible for the communication between your gut and brain. The other communication channel is through chemicals knowns as neurotransmitters. Interestingly, many of our neurotransmitters are produced in our gut. 95% of our bodies serotonin (our happy and calming neurotransmitter) is produced in our gut. This gut-brain connection is also influenced by our immune system, which is why research has turned to gut-health and inflammation in the body. Chronic pain is considered an inflammatory process in the body and there is research that has recently been released to show how the microbes in the gut are different in chronic pain conditions such as fibromyalgia. Learn more about gut health and chronic pain here.
- Mind-body connection: Conventional medicine is increasingly acknowledging the role of the mind-body connection in the initiation and maintenance of chronic pain. In this age of sophisticated research methods and technology, the evidence is impossible to ignore. When the body experiences an injury, like back pain, the pain travels along two pathways from the source of the pain to the brain. One is the sensory pathway that relays the message of physical pain meanwhile; the other is the emotional pathway that transmits the message to the part of the brain that processes emotions. The interrelated connection between the mind and body exists. A simple example is the common experience of heightened pain at times of emotional distress. This “bank account” concept can be described when the overall pain experienced is the sum of…
…will be familiar to many with chronic pain. Experience, and now neuroscience, can explain why emotions and distress alter the experience of pain. Put simply, the way we think, feel and react is fundamental to managing pain. Treatment regimens that target both the mind and body are key to managing pain. If you would like to learn more click here.
(Video courtesy of Pain Management Network)
- Neuroplasticity of the brain: this is a promising area of medicine and science, showing that the brain has the ability to change its structure and function in response to learning and practising new skills. Research in this area has shown the potential of how the brain can change and even heal itself. Michael Moskowitz discovered that chronic pain can potentially been unlearnt through neuroplastic techniques, click here for more information.
(Video courtesy of Sentis)
If you would like to learn more on any of the above topics, below are some great books worth a read:
- “This Way Up” online course
- PainTRAINER online free course
- Mindspot free online course
- Psychology Tools: CBT worksheets
- Explain pain. David Butler and Lorimer Moseley.
- Manage your pain. Practical and positive ways of adapting to chronic pain. Dr Michael Nicholas, Dr Alan Molloy, Lois Tonkin and Lee Beeston.
- The pain book. Finding hope when it hurts. Philip Siddall, Rebecca Mccabe and Robin Murray.
- How to sleep well. The science of sleeping smarter, living better and being productive. Dr Neil Stanley.
- Cognitive therapy for chronic pain. A step-by-step guide. Beverly E. Thorn.
- Change your thinking. Positive and practical ways to overcome stress, negative emotions and self-defeating behaviour using CBT. Sarah Edelman PhD.
- The brain’s way of healing. Remarkable discoveries and recoveries from the frontiers of neuroplasticity. Norman Doidge MD.