Managing Acute & Chronic Pain

April 14, 2015

What Is Pain?

Pain, although unpleasant, is normal. And it is perfectly normal, once you have it, to want to get rid of it. Even though pain is unpleasant it is your body’s way of protecting you in times of injury or disease. Pain helps you make decisions about what you should and should not do. When you are in pain you move, think and behave differently. Think back to when you have cut a finger; you probably kept your finger still. By holding it straight, your pain reduced. This sort of pain is important as it allows you to protect your body whilst it heals.

Pain generally occurs when your body’s alarm system alerts your brain to actual or potential danger of injury by issuing a “warning.” For example, if your hand touches a hot surface your body reacts by pulling your hand away to prevent you from getting burned.

Acute Pain

This pain is usually linked to a problem that can be fixed. If you break a bone, cut a finger, or suffer from a tooth abscess, you have acute pain. This pain will resolve when the bone is fixed, the wound healed or the abscess drained. Acute pain is a sign that something is wrong and something should be done. The pain only lasts while the problem is there. Pain killing medication will generally help relieve acute pain.

Chronic Pain

So what about Chronic (or persistent) pain? This is pain that has lasted for longer than 3 months. It affects approximately 20% of people. It impacts people’s lives, from causing minor restrictions to complete loss of independence. It is different to acute pain. In chronic pain, the most up-to-date research tells us that something different is going on: the pain is no longer serving a useful function. This pain is a real sensation, but no longer helpful.

No physical cause of pain

Often, no obvious physical cause can be found for chronic pain. This can be frustrating and confusing – after all, you know you have pain. In many cases even the best scans are not able to identify the part that is hurting from parts of you that are not hurting. Even when doctors can pinpoint physical changes on the scans or X-rays (for example, arthritis, a disc problem) it is still impossible to say whether these are the actual source of your pain or not.

Chronic pain conditions

Most chronic pain conditions are not life threatening e.g. low back pain, arthritis and recurrent headache. They may start as acute pain associated with a problem such as a slipped disc, operation or injury. The pain may be continuous or occasional, you may feel more sensitive to pain and it may sometimes be prone to flaring up or getting worse very quickly. However, when the problem has been sorted the pain doesn’t seem to switch off. The pain system is no longer working normally. It has become “wound up”, sensitive and flares up easily.

Is there a cure for chronic pain?

Even though there may not be a specific diagnosis it does not mean the pain is not real but just that there’s nothing nasty to worry about. However, there is no cure for chronic pain. This pain generally does not go away with rest; warm baths or massage and some types of medication are not very effective. However, these things may give temporary relief.

Things that would usually settle or treat an acute pain are often not successful in treating chronic pain. This is because the problem is within the pain system, rather than being located in any specific part of your body. The pain system does not appear to be functioning normally.

Living with pain that won’t go away can be discouraging at best and unbearable at worst. But it is important to remember that there are treatment options that can reduce your pain and improve your quality of life. Your doctor may recommend the use of over-the-counter or prescription medications, in addition to other therapies like physiotherapy or exercise, to manage your physical pain.

However, if you are living with chronic pain, overcoming the emotional challenges can be the hardest step in the coping process. The following list can help you cope with your chronic pain.

However the first step is to change your attitude towards your pain- this is the first and most vital step. A change from “being a patient” to “being a person who has a chronic condition” is vital. Being/starting to feel in control and knowing how to manage your pain is the next step.

How To Manage Chronic Pain

1. Accept the Pain

Chronic pain should not be ignored or taken lightly. If you have been living with chronic pain, it is important to recognize it as a problem, learn about your condition, and see your Doctor/Physiotherapist to talk through treatment options.

2. Get involved

Take ownership of your pain relief. Understand your treatment plan, engage with your Doctor/Physiotherapist and be an active partner in your own health care. The accountability will help you overcome emotional challenges and keep you motivated to continue improving your overall health and quality of life.

3. Learn to set priorities/goals

Living with chronic pain can put the rest of your life on the back burner, as relieving pain becomes your top priority. Make a list of things in your life that you would like to do, whether it is exercising more frequently, visiting with family and friends, or traveling. Setting priorities and goals other than pain relief can help you enjoy life a little more, while also keeping you determined to relieve pain in order to achieve those goals.

4. Set realistic goals

Coping with chronic pain can be daunting, particularly as you try to resume everyday activities that once were easy and normal. Managing your pain in small steps can give you a sense of accomplishment, and also help you achieve your larger goals more effectively.

5. Recognise Emotions

Living with chronic pain can be stressful and is just as much an emotional issue as a physical one. Recognizing how your emotions affect your pain, and vice versa, can help relieve your pain and make everyday living more enjoyable. It can be difficult to manage things at home, work, with friends and family as well as many other things that can be difficult. You may not feel you have any control over the pain and don’t feel able to cope with it.

How do you feel about your pain?

Experiencing pain can lead to feelings of anxiety or fear about what might be causing the pain; especially where there is no obvious cause. It may feel like damage is being done to your body and you may feel some concern about what the pain might mean- what damage could have been done and what the future might hold.

Feeling pain can also make you feel tense, especially if you expect the pain to come back or get worse. You may feel easily angered and hostile towards people who you may meet that don’t understand your situation or how your pain affects you. Some people even feel anger towards the pain itself. When things aren’t going so well it can lead to feeling bad tempered, anxious, frustrated and having troubling thoughts. You may feel hopeless and very down about feeling this pain, which can result in depression.

The pain itself or worrying about it may cause difficulties with sleeping. You may be kept awake or find it difficult to stay relaxed. Being tired and having a sleepless night can make people feel more upset and bad tempered.

How do your feelings and thoughts affect your pain?

Our experience of pain always stays with us; we have a kind of memory for it. For example, if a person comes across pain every time we carry out an activity or task, then it is unlikely that they will continue with it, or for that matter, ever return to it. The more often we associate something with pain, the more we are likely to actively avoid it.

Thinking of pain before it happens can make it feel worse. A feeling of pain may even be set-off just by thinking of a past experience of pain. Depending on the situation, a person’s threshold for feeling pain may be altered. Sometimes what would feel a little painful may become excruciating and vice versa.

For example, during a rugby match a player may be injured but not feel significant pain until after the match. This is caused by a hormone called adrenalin, which prepares our body for action during circumstances that we perceive as risky.

Similarly, during an enjoyable activity that makes us feel good, pain is often dulled by chemicals called endorphins; there is often less of a focus on any pain experience. However, on the other hand, a person who is feeling very anxious, tense and wound-up in another circumstance may not be able to tolerate even the slightest touch. In these scenarios how a person feels has affected their perception of pain- a persons thoughts and mood can make a difference to how they feel pain.

6. Learn to relax

Persistent pain is a stressful experience, but it is important to find ways to relax the mind and body. Not only can stress make the pain worse, but it also causes other physical and emotional side effects. Find ways to relax in your own way- there are many things you can try:

• a good balance between rest and exercise (Pacing)
• massage
• regular use of heat or cold packs
• stretching
• deep breathing exercises
• relaxation
• distraction
• feeling more confident and having a positive mood
• having fun and socialising all help to gradually reduce your pain

To some people it may be as simple as just going outside to play with your dog.

7. Exercise

There is no need to fear or avoid exercise, even if you live with chronic pain. In fact, moderate exercise can actually help to decrease pain by building and toning muscles, increasing endurance and strength and improving your attitude and self-esteem. Your Physiotherapist can structure a specific regime for you. We can also use a device called a TENS machine which some people find helpful in giving them some pain relief.

8. See the total picture

Following the steps above will hopefully help you to realize that your pain does not define who you are. Concentrate on what you are able to do, not what you are not able to do. Chronic pain may be part of your life, but feeling confident in your knowledge and management of the pain can help put the rest of your life back on track.

9. Reach out

Millions of people suffer from chronic pain and don’t share their experience with others out of guilt, embarrassment or pride. Sharing what you’ve learned about successfully managing your pain can help others find their path to pain relief and encourage them to seek help and much needed support.

Thanks for reading!

This post has been written by PhysioActive physiotherapist Gail Craig, Grad Dip Phys, MCSP, HPC registered - Spinal Physiotherapist, Manual Therapist, Women’s Health

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