Chronic Pain

Physiotherapy is an important component of pain management for a wide range of conditions. Many pain management strategies, such as medication, simple massage and heat packs will provide only temporary relief of symptoms. Physiotherapy is used to treat both acute and chronic pain conditions using a wide modality of treatments including manual therapy, electrophysical agents and exercise therapy via tailored exercise prescription.

PAIN

The terms chronic pain and persistent pain are often used interchangeably. Pain is said to be chronic if it persists beyond the normal healing time of about three months. As physiotherapists, we are trained to assess the warning signs or red flags indicating that a patient may be headed for a downward spiral.  Examples include; patients reluctant to move after surgery due to pain, fear avoidance, patients not seeking treatment early post-MVA and low back pain sufferers avoiding activity. This is without considering family history and co-existing medical pathologies.

Effective pain therapy requires a biopsychosocial model of care. This takes into account the physiology of pain alongside the cognitive impacts and drivers and the multiple variables of lifestyle and community living which can generate increased anxiety and distress.

Chronic pain occurs because of changes to the nerves or nervous system which keeps the nerves firing and signalling pain.  This can lead to allodynia and generalised sensitivity.

Depression and Chronic Pain

Chronic pain is a term used to describe pain that lasts beyond the typical time it takes for an illness or injury to heal. Sometimes chronic pain is also described as pain that lasts longer than 8-12 weeks (three months). Research suggests that anywhere from 30 to 50% of people with chronic pain also struggle with depression and anxiety.

Major depression in patients with chronic pain is associated with decreased function, poorer treatment response and increased healthcare costs.  Hence the need for accurate diagnosis, early intervention and pain relief.

The lifetime prevalence of major depression in Australia is 11.6%, but is 1.6 times higher in those reporting arthritis and anecdotally, I would suggest it may be higher in neck and back pain sufferers.

Biopsychosocial model

It is widely accepted in the medical/ health professions that management should be holistic, involving all aspects of the client’s life. A model of assessment and management is now used call the biopsychosocial model. This sounds very complex, but basically means that 3 aspects of the client should be considered:

1. a) Bio – biological: the physical body should be assessed for changes or injury,
2. b) Psycho – psychological: the aspects of anxiety and stress should be addressed,
3. c) Social – aspects of the social situation and home/ work environment should be considered.

These 3 aspects will have a bearing upon your pain experience. However, it is not possible to decide how much each contributes to the pain. The exact mixture of the biological processes that are in action in any pain situation can only be a hypothesised (meaning an informed guess can be given).

Methods a Physiotherapist can use to alleviate the acute pain before you begin to exercise.

1. Manual therapy and soft tissue techniques.
2. Neural Mobilisation
3. Heat and/or cold therapy and self-treatment including exercise
4. Professional tailored Exercise Prescription
5. Timetabling/ Scheduling /Pacing to assist with daily demands
6. Therapeutic Ultrasound.
7. Electrical stimulation (e.g. TENS units)

This involves a range of therapies, both passive and active, designed to rehabilitate and improve movement. Australian Physiotherapists are highly skilled practitioners who use scientific evidence-based research to manage and improve pain. They are the musculoskeletal experts, however, they also treat neuropathic pain and neurological conditions.

In general terms, an active exercise program is needed for people living with persistent (chronic) pain. This helps with remodelling of neural tissue, stimulating muscle tissue with new input, rebuilding strength and helping with sleep patterns.  This program is individually designed for you by your Physiotherapist which entails specific exercises which must be realistic to compliment the patient’s lifestyle.

Depression and Chronic Pain

Alex Holmes, Nicholas Christelis, Carolyn Arnold

Medical Journal of Australia (2013)