What are my options for managing chronic pain?

Chronic pain is a common condition that affects 1 in 5 Australians aged over 45. Chronic pain can be difficult to cope with on your own, so it is important that you work with your doctor to develop a tailored plan for managing your pain.

Medicines alone are not the most effective way to treat chronic pain. It is best managed using a combination of different approaches, which might include pain-relief medicines, but will most likely also include management alternatives such as physiotherapy, relaxation techniques and building stress-management skills.

People who actively manage their pain in these ways see more improvements in their mood, overall health and ability to function, compared with those who only use medicines to manage their pain.

Physical therapy

When you experience chronic pain, it might seem natural to avoid too much standing, bending or moving around. However, exercise and stretching can often decrease your pain and improve your ability to function as you normally would.

If you are less active over time, you may start to lose muscle mass, flexibility and strength. This makes it more difficult to carry out regular daily activities, particularly as you become weaker as time goes on. Your doctor may recommend physiotherapy, massage or exercise as ways of helping you to manage your pain.

Physiotherapists and exercise physiologists can help teach you how to move your body safely, and pace yourself throughout the day by doing tasks in smaller steps — rather than all at once.

Psychological therapy

Your doctor may recommend psychological therapies to help you manage your pain. These could include cognitive behavioural therapy (CBT) and mindfulness.

As mood and mindset can influence the way people experience their pain, it's helpful to include mood and social goals in your pain-management plan. Psychological techniques can help you limit or eliminate unhelpful thoughts and change the way you behave as a response to pain.

For example, one goal that a person might set as part of psychological therapy is to spend 30 minutes a day socialising with friends or family, or resuming a hobby after a month of treatment.

Mind-body therapies

Mind-body therapies include yoga, relaxation and meditation. These therapies can help you to reduce your stress levels, which may in turn reduce your experience of pain. Yoga and Tai Chi can also be a part of your physical therapy program.

Biofeedback

Biofeedback is a skill that involves learning to recognise and control body processes. Biofeedback can involve an instrument (for example, to measure muscle tension) or you can learn to do it yourself.

With biofeedback therapy, you learn relaxation and visualisation exercises designed to increase your control over bodily functions such as your heart rate and muscle activity. These techniques help induce relaxation, lower your muscle tension, and can be used, for example, to reduce the frequency of headaches and pain.

Other therapies

Because everyone's experience of pain is different, individuals need different treatment plans to help manage their own chronic pain.

As well as the above, some complementary therapies may be useful, including:

• Learning strategies to improve your sleep can help improve your ability to function well during the day and feel less pain.
• Joining a support group, where you can share your experiences and hear how others in similar situations manage their pain. (See 'Find a health service', below.)
• Seeking advice from an expert in pain management.

Watch this video from NPS MedicineWise: Australians talk about their experiences with a range of different pain management options.

Can medicines be used to manage chronic pain?

In some cases, medicines can be helpful in managing chronic pain. These could include over-the-counter (OTC) medicines, supplements and prescription medicines. OTC pain medicines, such as paracetamol and ibuprofen, can be accessed without a doctor’s prescription.

Before taking any pain medicine, talk to your doctor or pharmacist about whether the medicine is suitable for you, and whether it's likely to help you manage your specific type of pain.

Some 'combination' pain medicines can also be helpful in treating pain. These are medicines that contain more than one active ingredient, such as paracetamol with caffeine, or ibuprofen with paracetamol.

If you are using OTC pain medicines to help you manage your pain, tell your doctor so they can better understand which treatments are working well for you. Your pharmacist can also advise you on whether an OTC or complementary medicine is safe to take alongside your prescribed medicines.

Are there pain medicines that should not be used to treat chronic non-cancer pain?

Opioids (such as oxycodone, morphine and codeine) can be used to treat short-term (acute) pain, such as pain after surgery or an injury, or chronic pain in people with cancer. However, there is no clear evidence that opioids are useful in managing chronic non-cancer pain.

Prescription opioid medicines can be dangerous and may be addictive, especially when used regularly for an extended period of time.

Evidence shows that the longer a person takes an opioid, the less pain relief they will receive. This is because the body gets used to the dose of opioid that's being taken — known as ‘tolerance’. When a person has tolerance to opioid medicines, they need higher doses of the medicine to produce the same effect. But higher doses increase the risk of serious side effects.

Long-term use of opioids can also make someone more sensitive to pain — this is known as ‘opioid-induced hyperalgesia’.

What is interventional pain management?

Interventional pain treatments are usually reserved for people who haven't responded well to other pain management methods. These treatments are usually recommended after consultation with a pain specialist.

Your doctor or pain specialist can discuss with you the risks and benefits of these treatments and whether they’re suitable for you. In most cases, interventional pain treatments provide short-term pain relief, allowing you to modify your lifestyle and develop good habits. This makes it easier to cope with chronic pain if it returns.

Interventional pain treatments for chronic pain include:

• Transcutaneous electrical nerve stimulation (TENS): a battery-operated stimulator sends a pulse of energy through the skin at the site of your pain. TENS can help manage a range of pain types, including back and neck pain, arthritis, migraine headaches and post-operative pain.


• Spinal-cord stimulation: similar to TENS, this involves planting an electrical device under your skin near the spine. The device applies a current to the spinal cord, which interrupts the pain signals being sent to the brain. A hand-held control allows you to adjust the intensity of the charge.


• Radiofrequency ablation: this is a procedure performed by a doctor that targets joint- and nerve-based chronic pain. Needles are placed directly onto pain-inducing nerves, and heat is produced at the tip of the needle to interrupt the signals to the brain.


• Nerve block: this intervention is used to treat intense chronic nerve pain — for example, as in Complex Regional Pain Syndrome (CRPS). A local anaesthetic is injected to stop the nerves from transmitting pain signals.


• Epidural injections: medicines such as corticosteroids and a local anaesthetic can be administered to the epidural space (between the vertebrae and spinal cord in the spine) to reduce pain.


• Surgery: some types of chronic pain may respond to surgical treatment.

When should I see my doctor?

If you experience chronic pain, you should ask your doctor about the pain management options that could be suitable for you.

Chronic pain is best treated using a combination of physical therapies, relaxation techniques and stress-management strategies. Your doctor can help you create a chronic pain management plan that includes some or all of these methods.

Resources and support

• Call 1300 MEDICINE (1300 633 424) to talk about the medicines you are taking for your pain.
• Discuss your pain on the Pain Link telephone helpline (1300 340 357), which is staffed by volunteers with personal experience of chronic pain.
• Go to Painaustralia to find pain services and programs in your area.
• Learn more about how chronic pain can be managed on the Chronic Pain Australia website.