Understanding and managing chronic pain

Chronic pain can have numerous causes, but commonly it can result from an initial injury, such as a back sprain. Whilst injuries can heal, pain can persist, affecting quality of life and the ability to carry out necessary and enjoyable activities. Dr John Tanner, a top sports medicine specialist, gives us some insight into what defines chronic pain and how it can be managed.

How do we define chronic pain?

Chronic pain, broadly speaking, is pain persisting for more than three months. However, this may be an acute injury which has failed to heal or a problem that has defied diagnosis. It can mean that the underlying tissues have healed, but the pain pathways in the nervous system have altered in a way that pain signals continue to transmit, often using non-pain pathways. This is then termed a chronic pain disorder.

Can pain be measured?

Pain is a subjective experience and cannot be measured objectively. One can measure pain thresholds, and observe pain tolerance which varies amongst individuals. One can also use MRI functional imaging to observe the activity in the known pain centres in the brain.

How do we determine what level of pain is debilitating?

The level of pain that affects ability varies enormously and is affected by an individual’s response. It is affected by beliefs, attitudes, behaviour, emotions, as well as social and occupational issues.

How can chronic pain be managed?

The following methods can help patients to manage their chronic pain:

• Self-help
• Developing coping strategies
• Changing mental approach (cognition)
• Meditation
• Medication (over-the-counter painkillers)
• Some active medical interventions, depending on the root of the pain
• Social support

Is the answer always medication?

No, medication benefits are limited and may come with unwanted side effects. Physiotherapy, exercise and mindfulness approaches can be much more helpful and sustainable.

What advice do you give to your patients who suffer from chronic pain?

Each person is a unique individual, their pain experience coloured by all of the above, including previous experience of pain, medical care and understanding of their condition and so on. Helping and supporting a person with chronic pain means exploring all of these aspects; prioritising, pacing, goal-setting, motivating, looking into aspects which require more investigative diagnosis or other treatment methods which may not have been tried, and working out together a personalised and orchestrated plan, maintaining empathy at all times.

If you suffer from chronic pain, make an appointment with an expert.