PAIN MANAGEMENT

The main causes of pain include medical conditions (such as cancer, arthritis and back problems), injuries and surgery. Sometimes, the cause of the pain can't be found or there are no available treatments for it. In other cases, the cause may be remedied, but the associated pain lingers on. Chronic pain is defined as pain that persists for longer than three months. At any given time, around one third of Australians are in pain. Management strategies include pain-killing medications, and complementary therapies (such as acupuncture and massage). Studies suggest that a person's outlook and the way they emotionally cope with chronic pain influence their quality of life. It has been shown that people who learn self-management skills lower their levels of felt pain. It is important to learn these skills, and to deal with the associated stress and depression in constructive ways.

The epidemiology of pain
A Brisbane study in 1986 found that certain groups are more likely to suffer chronic pain than others. The findings of this study were similar to research findings from other countries. Selected statistics include:

The incidence of pain rises with advancing age.
Women are more likely to be in pain than men.
The most commonly reported pain is back pain.
The most severe pains include those of the back, head, neck and leg.
The pain is constant for around one fifth of people.
The cause is unknown in around one third of cases.
One fifth of cases were caused by work-related accidents.
Most people surveyed had suffered chronic pain for longer than three years.
Seven out of 10 people sought professional help.
The most common source of professional help was the family doctor (80 per cent).
Pain-killing medications
The type of medication you are prescribed depends on your pain. The issues you need to discuss with your health care professional include: the location, intensity and type of pain; which activities ease or exacerbate it; the impact your pain has on lifestyle factors, such as appetite and quality of sleep. Medications for chronic pain are best taken regularly. If your pain is well managed, you are less likely to take large doses of painkillers, and the risk of side effects is reduced.

The medications available for the management of chronic pain include:

Aspirin and aspirin-like drugs
Paracetamol
Opioid drugs, such as codeine and morphine
Local anaesthetics.
Long term use of some medications can have side effects which affect a person's quality of life. They may also lose their ability to reduce pain. Some studies have shown that medication can undermine the value of developing self-management skills. This occurs because the person believes they are coping better with pain due to the medication, not because they may have learnt effective coping skills.

Complementary therapies
Numerous studies have found that certain complementary therapies are effective in pain management. Some of these therapies include:
Acupuncture - a component of traditional Chinese medicine. Acupuncture involves the insertion of slender needles into specific points on the skin.
Massage - better suited to soft tissue injuries and should be avoided if the pain originates in the joints.
Relaxation techniques - including meditation and yoga.
Transcutaneous electrical nerve stimulation (TENS) therapy - a minute electrical current is passed through the skin via electrodes, prompting a pain-killing response from the body.
Cognitive-behavioural therapy - this is a process of learning to change how you think and, in turn, how you feel and behave about pain. It is part of a process of self-management of chronic pain.
Coming to terms with chronic pain
Sometimes, chronic pain cannot be relieved. Suggestions on how to emotionally handle this difficult and distressing situation include the following:
If all medical avenues have been exhausted, don't raise false hopes by searching fruitlessly for a cure.
Accept that your pain may not go away and that flare-ups may occur. Talk yourself through these times.
Find out as much as you can about your condition so that you don't fret or worry unnecessarily about the pain. Fear makes cowards of us all!
Take steps to prevent or ease depression by any means that work for you, including talking to friends or professionals.
If painkillers can't ease the pain, don't increase the dose - take fewer or none at all, in consultation with your doctor.
Improve your physical fitness, eat healthy foods and ensure you get all the rest you need.
Don't allow the pain to curtail your life more than necessary - if you miss activities you used to do before the pain, try reintroducing those activities in a gently paced way. You may need to cut back on these activities if pain flare-ups occur, but it will be possible to increase slowly again as you did before.
Concentrate your efforts on finding fun and rewarding activities that don't exacerbate your pain.

Seek advice on new coping strategies and skills from an occupational therapist.
Where to get help
Your doctor
Occupational therapist.
Things to remember
At any given time, around one third of Australians are in pain.
Management strategies for chronic pain include pain-killing medications, and complementary therapies (such as acupuncture and massage).
Studies suggest that a person's quality of life is influenced by their outlook, and by the way they emotionally cope with chronic pain.

Seek advice on new coping strategies and skills from an occupational therapist.
You might also be interested in:
Acupuncture.
Cancer pain management.
Fibromyalgia.
Headache - treatment options.
Headache and medications.
Massage.
Pain-killing drugs.
Physiotherapy.