“Pain is Australia’s third most costly health problem and arguably the developed world’s largest ‘undiscovered’ health priority.”
~ Professor Michael Cousins AM, Chair National Pain Strategy
Chronic pain is a complex biopsychosocial phenomenon that can have a profound impact on people’s lives.1 One in five Australians lives with chronic pain, including adolescents and children. This prevalence rises to one in three people over the age of 65. The prevalence of chronic pain is projected to increase as Australia’s population ages – from around 3.2 million Australians in 2007 to 5.0 million by 2050. Of these, females bear a greater share of chronic pain.2
Everyone’s experience of pain is different. Two people with the same injury can have a very different physiological response and pain experience. When pain persists beyond the expected time of tissue healing it can become very distressing and often has a negative effect on overall physical and mental health. Like depression, chronic pain can become a serious and debilitating disease in its own right and significantly diminish the quality of life of patients and their families. Research shows that women are more likely to be depressed related to their level of pain, whereas for men depression is more strongly related to how pain interferes with activity.3
There are many underlying causes of chronic pain, although it is not always possible to determine the precise cause, especially with chronic spinal pain. Chronic pain persists long after the tissue damage that initially triggered its onset has resolved, and in some individuals, chronic pain can continue without ongoing tissue damage or preceding injury. Common chronic pain syndromes include: chronic low back pain, headache, myofascial pain syndrome, fibromyalgia, neuropathic pain, phantom limb pain, central pain syndromes, arthritis, post-herpetic neuralgia, and chronic post-surgical pain.
There is a stigma associated with chronic pain that can be one of the most difficult aspects of living with this condition. This stigma can lead patients to emphasising or insisting on the nature of their condition as solely a local tissue condition, and as such it is beyond their control. While understandable, this may impede acceptance and engagement in positive health management behaviors.
Managing chronic pain
Because chronic pain is complex, developing effective treatment and management strategies can be frustrating. There is no ‘one size fits all’ way of treating people with chronic pain. Successful pain management may require a combination of things such as medications, physical therapies, exercise, diet, relaxation, education, thinking strategies and more.
Persistent pain usually follows on from an acute injury and research indicates that early effective treatment of acute injuries is important in preventing chronic pain conditions. Efforts to prevent progression from acute to chronic pain with a focus on active treatment strategies are most likely to reduce the disability associated with chronic pain.
Considerations in providing optimal care and management:
• Assessment is critical as soon as someone is not back to normal functioning as expected after initial treatment.
• Most patients with chronic pain should be managed at the local community care level, by different health care providers working collaboratively as required.
• Pain relief must not be the only goal. Treatments need to address functional goals and physical and psychosocial obstacles to progress. Simply addressing pain severity alone is unlikely to be sufficient in promoting functional goals.
• Chronic pain following injury often cannot currently be cured in substantial numbers of people. Treatments in such cases are typically aimed at minimising the symptoms and enabling the patient to regain (and maintain) as much normal activity as possible.
One of the main personal costs of chronic pain is the loss of wellbeing and quality of life. As much of persistent pain is currently intractable to curative interventions, effectiveness should be gauged not from complete pain relief, but rather minimising the impact of persisting pain on a person’s quality of life and restoration of functional activities of daily life.
Osteopathy intervention for chronic pain has a focus on educating and empowering people to manage their condition. One to one education sessions about the neurophysiology of chronic pain (and not structure specific education) results in significant changes in pain cognitions, beliefs and attitudes as well as improvements physical performance.5,6 Neurophysiology education can improve the outcome of other therapeutic approaches, such as various exercise strategies.7,8
Osteopaths are primary contact professionals who are well trained in the biopsychosocial management of neuromusculoskeletal conditions. Osteopaths are therefore well placed to work with patients whose features of acute and sub-acute conditions put them at risk of developing a chronic pain condition, and to manage chronic pain conditions.
If you ever wish to discuss chronic pain and treatment, please do not hesitate to contact me.
1. National Pain Strategy (2010)
2. MBF Foundation (2007) The high price of pain: the economic impact of persistent pain in Australia – Pain Management Research Institute, University of Sydney.
3. Australian Bureau of Statistics (2011) 4841.0 Facts at your fingertips: Health: Characteristics of bodily pain in Australia.
4. Carnes D, Parsons S, Ashby D, Breen A, Foster NE, Pincus T, Vogel S, Underwood M. Chronic musculoskeletal pain rarely presents at a single body site: results from a UK population study. Rheumatology. 2007;46:1168-70.
5. Moseley, G. L. (2002). Combined physiotherapy and education is effective for chronic low back pain. A randomised controlled trial. Australian Journal of Physiotherapy, 48, 297-302.
6. Moseley, G. L. (2004). Evidence for a direct relationship between cognitive and physical change during an education intervention in people with chronic low back pain. European Journal of Pain, 39-45.
7. Moseley, G. L. (2003). Unravelling the barriers to reconceptualisation of the problem in chronic pain: The actual and perceived ability of patients and health professionals to understand the neurophysiology. J Pain, 4(4), 184-189.
8. Moseley, G. L. (2003a). Joining forces – combining cognition-targeted motor control training with group or individual pain physiology education: A successful treatment for chronic low back pain.