Managing Chronic Pain

What is chronic pain?Chronic pain is pain that lasts longer than 3 months

What causes chronic pain?

Medical problems such as arthritis, diabetic nerve damage and cancer

Post traumatic pain

Pain caused by damage to the nervous system

How is chronic pain treated?

It is widely accepted that chronic pain is very difficult to treat. Effective chronic pain management involves a long term, multidisciplinary team approach. Rather than aiming for elimination or cure for the pain, the focus is on improving activity, achieving pain reduction periods and ensuring overall patient wellbeing. Medications are only one part of this treatment approach.

Medications:

  • Simple pain killers: Paracetamol, non steroidal medications (Neurofen, Voltaren)
  • Other medications: anti-seizure medications (Pregabalin, Gabapentin), anti-depressants (Duloxetine)
  • Nerve Blocks: Injections (shots) of numbing or pain-relieving medicines into the spine or area with pain

Non-Medication Therapies

  • Use a heating pad or a cold pack on the painful area
  • Staying as active as possible. Walking, swimming, tai chi (a kind of martial art), or biking can all help ease muscle and joint pain. If you are not active, your pain might get worse.
  • Therapies to improve sleep or mood
  • Physical therapy to learn exercises and stretches
  • Relaxation, massage, acupuncture
  • Working with a psychologist
  • Devices that affect nerve signals (TENS)
  • If you feel depressed, talk to your doctor or nurse about it. Chronic pain and depression often go together.

How can the team at Grand Pacific Heath Centre help me?

Your GP is best placed to manage the services you require to treat your chronic pain.

Other health professionals such as an exercise physiologist, physiotherapist or clinical psychologist pay a role. These allied health professions may be accessed through something called a ‘care plan’ which may allow for some of your consultations to be covered by Medicare. Your doctor will advise if you are eligible for a care plan and can coordinate this for you.

What are opioids and do they work to treat my pain?

Opioid drugs work acting on the pleasure centres in the brain. They do not treat the cause of your pain and do they work at the site of your pain.

Opioids have a role in treating acute pain (< 3 months) and cancer related pain.

Research shows that opioids are generally non effective in treating chronic non-cancer pain, and in some cases can actually make the pain worse. Opioids can be addictive and with regular use, patients can become dependent on it, leading to misuse and in extreme cases, death.

Examples of Opioids:

Codeine – Panadeine, Panadeine Forte, Mersyndol, Neurofen Plus

Oxycodone -Endone, Oxycontin, Targin

Morphine – MS Contin

Fentanyl - Durogesic

Tramadol

Hydromorphone - Jurnista

Tapentadol - Palexia

Buprenorphine - Norspan

Methadone

Heroin

Why all the fuss?

Oxycodone, morphine and codeine were present in over 30% of deaths due to drugs in 2016.

It is important that both patients and doctors are aware of the reasons medications are being prescribed and that patient safety is always being considered. Long term opioid therapy may cause adverse effects on the breathing, digestive, musculoskeletal, cardiovascular, immune and central nervous systems. Constipation, nausea, dizziness and excessive sleepiness are common complaints. They can also cause to sleep apnoeas which can result in death.

Well known Australian actor Heath Ledger tragically died of a drug overdose. Heath suffered from anxiety and insomnia and yet some of the prescription medications that were responsible for this tragic event were medications that are prescribed for chronic pain.

As of February 1st 2018 all codeine based products require a prescription, which brings Australia in line with the rest of the world. If this change is affecting you it is important that you discuss this with your GP.

Helpful Resources:

Support Groups

www.painmanagement.org.au/what-we-do/support/pain-support-groups.html.

Further information on chronic pain

Pain made worse by opioids (Opioid Induced Hyperalgesia)

Videos

References:

racgp.org.au PM16 pain management contextual unit

AFP Volume 42, No 3 March 2013 98-102

RACGP Upscheduling of codeine

Updated February 2018