Chronic pain has hit the headlines recently with the news of Ant McPartlin's struggle with painkiller addiction due to chronic knee pain. There has been a surge in articles being published explaining his case and stating his condition, but not many people really know exactly what chronic pain is.
So what is it?
Chronic pain, as the name suggests, is used to describe any condition that gives pain over any period longer than 12 weeks. This is what is taught in most medical institutions, meaning that patients with pain lasting for 3 months or more are pigeon-holed into the chronic pain category. Some patients may well have a condition that may mean that painful symptoms are present for this duration, however some may develop these symptoms after minor injuries, low back pain or even after surgery as was the case with Ant McPartlin. Usually painful symptoms persist despite investigation, intervention, treatments and generally last longer than is anticipated.
It's hard to say exactly the cause of chronic pain, but it is thought that due to neuroplasticity (the ability for the brain to form and reorganise itself), signals that indicate actual or potential damage or danger continue to be produced. If cells at nerve endings in the brain or spinal cord constantly receive painful inputs, they can be over-sensitised to it leading to a sensation of constant pain.
It is thought that up to half of the British population and 20% of Europeans suffer from chronic pain. In fact back pain is actually the second highest cause for time to be taken from work.
So what can we do about it?
There is a huge amount of risk factors associated with chronic pain! For example there is an increased risk in old age, and based on the fact that over the next 40 years the population aged over 65 is due to double then the number of chronic pain cases is likely to substantially increase. Another risk factor, unsurprisingly, is if you have a higher level of pain initially over a larger number of sites then you're at higher risk of developing chronic pain. Other risk factors include anxiety, depression and catastrophising beliefs as well as other types of factors including adverse socio-economic status.
Now that sounds really bad I'm sure, especially when coupled with the research that females have a higher tendency to develop chronic pain, that pretty much most of us will fit into a risk category. But I would say you don't have to worry. There are things that can be done to prevent or lower the risk of chronic pain from developing. Some are in the hands of the medical professionals you may see, others can maybe be managed by yourselves.
There is an interesting article that was published on the Independent's website about it's authors experiences of chronic pain, and I would highly recommend you give it a read. In the article it's stated that the NHS and other professions tackle chronic pain in the wrong way by telling people that they need to learn to cope with the pain, or putting them on Cognitive Behavioural Therapy courses that teach them how to think about their pain in a positive way. Now I'm not going to bash any profession or any modality of care, as for me I feel that chronic pain is an area of medicine that is slowly being understood more, and health professionals are being educated in the correct ways to tackle it more and more.
NHS trusts are starting to put different programmes in place for patients, using current guidelines for best practice and are achieving great results. There is also a growing research base providing health professionals with the information they need to really start helping reduce the number of chronic pain cases, and to start treating patients effectively.
I feel that maybe not every case of chronic pain is avoidable, but I do feel that probably a significant number of cases could maybe be prevented or at least have improved prognoses. This purely could be done by health care professionals be it a GP, consultant, Osteopath, Physiotherapist, Chiropractor or Sports Massage Therapist. By training new generations with the latest knowledge, will hopefully mean that patients will not fall into a cycle of chronic pain. This could be done by having professionals;
Who understand the importance of identifying risk factors in patients that may suffer from chronic pain and addressing them properly
Who know the importance of communication between practitioner and patient and how saying certain things in certain ways to certain patients may increase the risk of chronic pain from starting
That know the limitations of their care and understand when it is appropriate to refer or include other modalities of care into a patients management plan
Who can effectively assess patients and identify various factors in patients and how they may effect the outcome of a certain intervention
There are a whole host of things that could be improved by health care professionals to improve outcomes of chronic pain patients. This doesn't apply to all professionals, as I know there is a good number that are up-to-date and effective at reducing the risk of chronic pain in their patients and helping treat those already suffering.
Treatment of chronic pain comes down to helping the factors that cause it. Some could be modifiable, for example helping treat any potential causes of painful stimuli, but some will be non-modifiable such as gender, age and to large extent your socio-economic status. Effective treatment comes down to finding what factors can be modified, and who will be most effective at doing that.
What can you do to help?
There are a few things that can be done by patients as well to prevent or lower the risk of chronic pain.
Don't worry about imaging (X-Ray's, MRI's etc). Getting an image without a report is unlikely, but please don't look at this image and try and interpret it without a medical professional looking at it first. This will probably stop you worrying about things that you think you've identified...
Don't worry about the reports of MRI's, X-ray's etc. Reading the reports from imaging can be scary, especially if there is a whole host of things written down with long scary names. Let the health professional in charge of your care read it with you and explain the relevant bits to you. In most cases of neck and low back imaging there is a high percentage of the healthy population who would have positive findings for disc bulges and joint degeneration even though they are pain free. Reading this without proper interpretation isn't really a good idea.
Seek appropriate medical advice in good time. If you seek out proper advice from a medical professional, they will be able to help and probably put you at ease about whatever is happening in your case. They will also help provide an effective management plan for you.
Other pieces of general advice I would give you are;
If you have any questions at all, please don't hesitate to contact Alpha Health.