Managing the complexities of chronic or persistent pain
According to the International Association for the Study of Pain, “Pain” is defined as “An unpleasant sensory and emotional experience associated with actual or potential tissue damage”. Chronic pain, otherwise referred to as persistent pain, is a phrase often used to describe conditions that have lasted a significant period, often more than 3 months, and represents a pain related problem where a significant proportion fail to resolve (Leboeuf-Yde 2013) perhaps due to the complexity of multiple contributing factors (Tracey and Bushnell 2009) which may develop.
Very basically, injured tissue causes nerves to transmit pain signals to the brain, making us realize that we have an injury. But we know thanks to significant work by the scientific community that pain is much more complex, and is in fact an experience shaped by psychological processes which function together as a cognitive system, otherwise described as “ways of thinking” which make sense of these signals (Linton, 2011). This may help to explain why pain at times might seem to be “out of proportion” to an event or injury.
Now that we are considering that cognitions may influence the pain we feel, or contribute to a pain condition becoming persistent and difficult to control, it makes sense that the management of persistent pain also addresses these cognitions, not just the physical components of an injury. Combining interventions such as physical injury rehabilitation and addressing cognitions and behaviours that may contribute to a pain condition are an example of a “multimodal” treatment approach.
In low back pain for example, clinical trials to date have largely resulted in limited evidence for treatments for persistency, probably due to their inability to account for the complexity of the condition. For example, sleep disorders and fear of activity are comorbidities commonly associated with persistent pain but often inadequately addressed during treatment. Multidisciplinary programs that address the physical, cognitive and behavioural factors associated with low back pain have been shown to provide larger effects compared to other therapies (Kamper 2014). TAC and WorkSafe currently fund intensive programs involving a number of health professions. A cost-effective alternative for those paying privately may be to see a suitably trained therapist such as a physiotherapist who undertakes functional restoration programs with a cognitive-behavioural approach, an approach which has been shown to be effective in the STOPS back pain trials. The previous Physio and back pain blog touched on this physiotherapy intervention and others. You could also discuss with your GP the appropriateness of Medicare funded physiotherapy and/or clinical psychology sessions for your persistent pain condition.
If you suffer from a persistent pain condition, there may be a suitable management option out there. Perhaps start by having a chat with your GP or local therapist.
Matt Richards is a physiotherapist at Advance Healthcare in Bundoora, with a special interest in complex back and spinal pain. Matt is a current PhD Candidate for his research with complex spinal pain. Matt provides expert physiotherapy services to Thomastown, Kingsbury, Maclead, Bundoora, and Watsonia areas.
Kamper SJ, Apeldoorn AT, Chiarotto A, Smeets RJ, Ostelo RWJG, Guzman J, van Tulder MW. Multidisciplinary biopsy- chosocial rehabilitation for chronic low back pain. Cochrane Database of Systematic Reviews 2014, Issue 9
Leboeuf-Yde C, Lemeunier N, Wedderkopp N, Kjaer P. Evidence-based classification of low back pain in the general population: one-year data collection with SMS Track. Chiropr Man Therap 2013, 21: 30
Linton SJ, Shaw WS. The impact of psychosocial factors in the experience of pain. Physical Therapy 2011, 91(5): 700-11
Tracey I, Bushnell, MC. How neuroimaging studies have challenged us to rethink: is chronic pain a disease? Journal of Pain 2009, 10 (11): 1113-20