Living with ball and chain of pain

For chronic pain sufferers, there are solutions – although the focus is on living with rather than curing, writes SYLVIA THOMPSON

CHRONIC PAIN is one of the most complex, confusing and frustrating conditions a person can suffer from.

In many ways, it defies logic because often the pain remains much longer than expected and a physical cause for it no longer shows up on scans. It can leave a person suffering pain feeling like a malingerer in spite of the genuine, inexplicable sen-sation that haunts them day and night.

“Good pain is a warning sign for a problem that you need to escape from, but with chronic pain there is often no escape route and it affects people physically and psychologically,” says Dr Paul Murphy, a specialist at the pain clinic in St Vincent’s University Hospital, Dublin.

“We use three months as a starting point to define chronic pain because changes to the neurobiology – in the peripheral nerves, the spinal cord and the sensory cortex – begin to occur at this point.

“Even if the issue with the joint itself has been resolved, the disease process has moved more centrally to become a problem of the central nervous system.”

Chronic pain can originate from a physical injury, arthritis or cancer, or be caused by a combination of neurological, psychological and environmental factors. It is thus often defined as a sensory emotional disorder that requires treatment to deal with the physical, mental and emotional components of the pain.

Although there are pain clinics in Cork, Limerick and Galway, St Vincent’s in Dublin is the only centre in Ireland to offer patients a three-week, pain-management programme that includes lectures, a fitness programme, an occupational therapy programme and relaxation classes.

The outpatient programme is given by a pain doctor, psychologist, occupational therapist, physiotherapist and medical social worker.

“We see this pain-management programme as the best approach to take and we get very positive feedback from those who do the programme,” says Murphy.

“We see a lot of people using hard collars on their necks, for instance, that they don’t need. There are many aids which are not suitable for chronic pain, yet people use them because they are afraid of the pain. Issues like these and encouraging people to take up exercise again to find out what they can tolerate are important.

“The focus has to be placed on managing life with pain, not being too fearful to do anything. For many people, the pain controls their lives, their relationships, their sleep, their ability to work, and they spend their time waiting for the next medication, the next injection or the next surgical treatment. But they have to learn to engage with normal life as much as possible with their pain,” says Murphy.

“The first thing we do, however, when we see a new patient, is to rationalise their medication. Often, patients come to us after seeing a number of consultants, and they accumulate medicines as they go. In chronic pain, we are trying to change how the central nervous system is functioning. It’s not like taking medication for acute pain. Often, the medication we prescribe will take between five days and five weeks before it works and needs close monitoring because of the potential side effects,” he explains.

The very nature of chronic pain can mean that it causes sleep problems, fatigue and depression. For some people, this means taking multiple medications. For others, it can mean learning how to pace themselves to deal with their pain. Others turn to “mindfulness meditation” for relief.

Vidyamala Burch, author of Living Well with Pain and Illness (Piatkus) and long-time sufferer of chronic pain, describes how she ran away from her pain for years before finally learning how to accept it and live with it. She has since developed a mindfulness-based pain management programme ( breathworks-mindfulness.org.uk) and helped thousands of sufferers to live more fulfilling lives.

“By developing a calm, mindful awareness of your body in each and every moment, it is possible to let go of frustration and suffering. By dealing with the secondary and emotional effects of chronic pain and illness, you can live more positively,” says Burch.

“Although turning your attention towards your pain may seem scary, people on our courses often say that it’s a tremendous relief . . . Being locked in a battle with your pain is exhausting but letting go of resistance and learning to stay with what’s actually happening can be a homecoming for the heart,” she writes in her book.

Pacing is another technique taught to chronic pain sufferers. Essentially, it encourages sufferers to take frequent short breaks, to gradually increase the amount they can do and to break up tasks into smaller bits. The Manage Your Pain book (see panel) has an excellent chapter explaining how to pace yourself.

A small minority of patients opt for a range of surgical interventions in the hope that their pain can be fully alleviated. These so-called advanced therapies include the insertion of spinal drug pumps (which offer pain medication directly into the spinal fluid) and spinal cord stimulators.

“For the latter, I tell patients this is the only form of surgery that you can test-drive, because once we insert the stimulator, we wake up the patient to check it covers the painful areas and provides pain relief and then put the patient back to sleep again to finish the operation,” says Murphy”

Other surgical techniques include nerve burning, which can provide pain relief for up to nine to 12 months. According to Murphy, the majority of patients will not have surgical interventions.

“Chronic pain treatments form a pyramid, with the vast majority of patients taking simple medication, physiotherapy and increased activity levels.

“Another group have nerve blocks or rhizotomies (nerve burning), a smaller number take the pain management programme and then a small number again have spinal pumps or spinal stimulators inserted.”

On Thursday, Science Today looks at the nature of pain and the scale of the issue in Ireland

ACUTE TO CHRONIC: DIFFERENT TYPES OF PAIN

Acute pain is short-term pain that lasts for anything from a few seconds or a few hours to a few days or weeks. Acute pain is a warning signal that tells us something is wrong: that we've damaged muscle or broken a bone in an injury or that we have inflammation or damage to an internal organ or tissue. It is relieved with rest, pain relief or some form of hands-on therapy, medical or surgical treatment.

Chronic pain is persistent pain that lasts for at least three months and up to several years in some cases. Chronic pain is divided into two main pain types: nociceptive pain, which is long-term pain due to tissue damage, a broken bone, a sprain or a disease such as arthritis, and neuropathic pain, due to damage in the nerves in the central nervous system. This type of pain is often described as a burning, stabbing or shooting pain, which often doesn't show up on scans. Many types of chronic pain include both nociceptive and neuropathic. Due to its enduring nature, chronic pain can also cause sleeplessness and depression.

Adapted from Manage Your Pain – Practical and Positive Ways of Adapting to Chronic Painby Dr Michael Nicholas, Dr Allan Molloy, Lois Tonkin and Lee Beeston (Souvenir Press)

There is a chronic pain sufferer in

one in

3

households in Ireland.

13%

of adults in Ireland suffer from chronic pain. This figure rises to

31%

for those in the 80-84 age group.

40%

of people with chronic pain define their pain as severe and

60%

define their pain as moderate.