Chronic (persistent) pain
If pain lasts for more than 3 months or longer than the expected healing time, it is called chronic or persistent pain. In medicine, the word chronic means long-lasting.
What chronic (persistent) pain is
Pain can either be acute or chronic.
Acute pain is pain that comes on suddenly and ends quickly, for example, when stubbing your toe. The term acute does not have anything to do with how bad the pain is or how serious the problem is.
Chronic pain is pain that carries on after you were expected to recover from an injury or illness.
The difference between these 2 types of pain is important. Different approaches are needed for treating and managing them.
Chronic pain is common. At least 1 in 5 people in Aotearoa New Zealand experience it. For some people, this means they experience pain all the time. For others, the pain may come and go.
You may get chronic pain without any known cause. Or you could get it following a medical condition or injury, even if the injury has healed.
Chronic pain can affect people of all ages, including tamariki and rangatahi.
Chronic or persistent pain in children and young people — KidsHealth
Chronic pain can affect your ability to function day to day. It can be draining and frustrating. It can also affect your relationships with whānau, friends and work colleagues.
There are many things you can do to live well with chronic pain.
Diagnosing chronic (persistent) pain
Your healthcare provider will take a detailed record of your pain and how it affects your everyday life. They may ask you to keep a pain diary.
This information can help them tailor your treatment to your needs. It can also be helpful for you to think about what your triggers are and how your pain affects you. Asking your whānau or other support people to be involved in this process also helps.
Your healthcare provider may organise tests to investigate further.
It is important to know that results found in x-rays and scans may not correspond with pain levels. For example, one person could have a knee x-ray showing mild arthritis and be in lots of pain. Someone else could have a knee x-ray with lots of bony changes but have no pain.
Self care for chronic (persistent) pain
Self care techniques are often the most effective way of treating chronic pain. It can take time and effort to practise them, and you may not notice them working immediately. But they are likely to gradually lessen your pain over time.
Treating chronic (persistent) pain focuses on understanding and managing your pain. It also focuses on improving your quality of life. The causes and triggers of chronic pain are complex, and treating it needs several approaches.
You are the only person who can ever know what it is like to live with your pain. So, self care is the most important part of managing your pain.
Make healthy lifestyle choices
Healthy lifestyle changes can be very helpful. These include:
- being smokefree and limiting alcohol
- being physically activeexternal link
- eating well
- reducing or managing stress.
See your healthcare provider if you have depression or anxiety. This is very common in people who have chronic pain. Treating your depression or anxiety through counselling, online courses or medication can help pain management.
Alcohol and drug support courses — Just a Thoughtexternal link
Pain management plan
Develop a pain management plan with your healthcare provider.
Setbacks or flare-ups are a normal part of chronic pain. Develop a pain setback plan for how you will deal with them.
Make sure you have enough support. Talk to your whānau and friends so they can understand what you are going through. If they understand, they can provide support where you need it.
RetrainPain is a free course that teaches you techniques for overcoming chronic pain. Through a series of 1-minute videos, it uses a science-based approach to reducing symptoms.
Self care for good sleep
Poor sleep can make pain worse, and pain can disrupt sleep, creating a cycle that can be difficult to break.
Relaxation techniques activities such as tai chi and meditation can help improve sleep and manage chronic pain. Regular physical activity and making changes to your sleep environment and habits can also improve your sleep.
Understanding your pain
You can continue to experience chronic pain long after your initial injury has healed or when your initial problem has been removed or repaired.
It is not a simple problem. There is no dividing line between skin, muscles, nerves, the spinal cord, the brain and thoughts, beliefs and emotions. It is the nervous system as a whole that produces your pain experience.
The fact that environmental and emotional factors can influence pain does not make it any less real.
Chronic pain often reflects a problem with your pain system itself rather than damage in a particular part of your body.
It is not always possible to pinpoint what causes the pain or where it starts. What is happening with the nerve may only be a small part of the whole pain picture.
There is also a risk of serious complications such as loss of function. A good example of this is phantom pain after a limb is removed. There is no limb, but the pain problem continues.
Most people with chronic (persistent) pain do not get relief from medications. Stronger medication is not necessarily more effective and can result in unpleasant side effects. You might even become dependent on the medication.
People can develop a tolerance to medication they use regularly. This can mean they need stronger and larger doses to get the same pain relief.
There are many recognised pain management techniques you can learn to manage chronic pain when no cure or fix has been found. These techniques can help you manage your pain, so it does not have as big an impact on your life.
They can also calm down the sensitive nervous system that contributes to your pain experience.
Pain does not necessarily mean you have to give up all your activities. There are ways you can manage how you approach activity when you have pain.
If you avoid activities, you are likely to become less physically capable. This will harm your confidence and probably increase your pain over time.
Overdoing activities can also lead to problems. Learning to change your approach to activities can be difficult. Ask for help if you are not sure how to do this.
It is common for people with chronic pain to feel that others doubt their pain is real. Chronic pain may not be visible on a scan or to others around you. But it is a recognised condition that is based in the central nervous system (brain and spinal cord).
A pain management approach shows you how to stop the pain from interfering with your life as much. It also shows you how to increase your confidence in coping despite pain. As many factors contribute to your chronic pain problem, your management plan needs to consider all these things.
By using pain management strategies, you can learn to be more in control of your pain rather than it controlling you. But what is essential is your willingness to try and your belief that change is possible.
You may have developed helpful ways to deal with your pain problems. If you think there may be room for improvement, it may be worth taking another look at your pain management plan with a healthcare professional.
This is understandable and a common concern. It is usually related to the idea that you would not be able to cope with more pain. But as people become better at using their pain management skills and more confident in managing fluctuations in pain, their worries and fears usually lessen. Setting down a plan for dealing with problems can help you feel more in control of the situation.
It is very frustrating for people to see someone they care about in pain, especially if it seems that there is little they can do to help. Most people do want to help.
It is important to let people know what you need to strike a balance between doing things for yourself and having good support from others.
Treating chronic (persistent) pain
It is understandable that you expect pain to be relieved with medicine or procedures such as surgery. But chronic pain is a long-term condition caused by changes to your body. This means other approaches are needed to manage it.
Managing pain involves education and guidance in pain self-management. It also requires lifestyle changes and emotional and social support.
Medicines only have a small role to play in managing chronic pain. This is because they only help a few people, and it is normal not to find them useful. They also have side effects that you have to consider.
If you are taking a medicine, consider whether it is significantly reducing your pain and improving your quality of life. If not, you should stop taking it. But talk to your healthcare provider first. Some medications need to be reduced gradually.
Before starting any medication, it is important to ask your healthcare provider a few key questions.
- How will we know if it is working?
- What improvements should I expect, and in what timeframe?
- Is this just a short-term trial, and can it be safely stopped if it does not help?
- Long-term, what are the chances this medication will help me compared to the chances it could harm me?
Asking these questions helps make sure that any treatment is both effective and safe — and that you stay in control of your care.
Getting help for chronic (persistent) pain
If you have chronic pain and it is affecting your quality of life, see your healthcare provider.
If your pain is complex, your healthcare provider may refer you to pain management services.
Many different types of professionals are involved in helping people to manage chronic pain, including:
- doctors
- nurses
- occupational therapists
- physiotherapists
- psychologists
- social workers.