Pain, Pain, Go Away: Treating Chronic Pain

By Joe Parsons

Edited by Will Stanley

The World Health Organisation defines chronic pain as incessant pain lasting more than 3-6 months. For some this can be the recovery from a severe bone break, for others arthritis but sadly for many there is no evident route of their pain. Many pain management teams across the UK and abroad are trying to spread the message that damage and pain are not necessarily related. This message begins with a statement which at first may seem controversial but is entirely sensible: The pain is all in your head.

As a chronic pain sufferer, if someone says this to me without context it is likely to make me unspeakably angry.  However, these pain clinicians are simply saying that painful stimuli are processed by the brain, which tell you it is a threat and give you pain to warn you that something is wrong.

Sometimes your brain can keep on telling you something is wrong long after the initial issue has been resolved. There have been cases of individuals spraining their wrist and despite it healing, the area became hypersensitive so that whenever it was touched, no matter how gently, it felt like agony. The body does not always respond rationally.

So pain is all in your head. There’s still a lot of misunderstanding about this, which can place a lot of professional and social hurdles for chronic pain sufferers.  While there may be a physical or medical resolution to be found, very commonly it is a case of learning to cope with your pain.

In this article, I’ll give you a whistle-stop tour through some of the issues surrounding misunderstanding of chronic pain and then outline some currently used medical approaches to treatment in the next few paragraphs.

The Misunderstanding of Chronic Pain

Having interviewed dozens of people with chronic pain, understanding has been described as a great therapy. When people truly empathise with a chronic pain sufferer, and respect them and their pain, it is incredibly refreshing and can help prevent the fatigue which comes with explaining the pain over and over again. This is particularly true in the medical setting and the workplace; chronic pain sufferers often “doctor hop” as they try to find the route of the pain and this can result in the negative side of “it’s all in your head” coming from clinicians or just being palmed off with new painkillers. This invisibility and the negative attitudes towards it translate to the workplaces as well, with very little lenience from employers for time off for chronic issues, based on sufferers I have interviewed. The idea effectively is, if you need time off relatively frequently then you’re not fit enough for the job. This leaves individuals in a position where they either work through some pretty unbearable pain, they lose their job or they’re even forced to medically retire.

So, as an individual reading this article, please do your best to try and empathise with chronic pain sufferers and respect them. If you struggle to imagine what it’s like, there are groups out there producing tools to help those not in pain, understand those who are. For example, nurses for multiple sclerosis often run workshops for loved ones of sufferers where they do activities like asking loved ones to do simple tasks with large gloves on which can mimic the numbness felt by patient. These are only small steps to understanding, but with workshops like these becoming more prevalent they are a great avenue to help chronic pain sufferers get the respect they deserve.

Physiotherapy

For certain conditions, like Ankylosing spondylitis, physical therapy is essential for maintaining health. With this condition, physiotherapy helps to maintain flexibility in the spine and surrounding joints, preventing the discs in your spine from turning to bone.

With more mechanical injuries without a genetic component, such as ligament tears, physiotherapy is key to stabilising the muscles around the injured area to reduce the strain on the injury and allow it to heal.

The treatment of these mechanical injuries is similar to the way chronic pain is often treated. Strengthening the muscles around a painful area can be beneficial in two ways: sometimes it can improve the support around the area and help restore normal function without pain but also it can provide confidence. Physiotherapy can remove uncertainty in a patient, where they would have been afraid to do certain movements or activities due to their pain, they are now confident enough to do them. This prevents sedentary lifestyle choices which often trigger other health complications which compound to make the pain worse.  

One of my physio moves.

Transcutaneous Electrical Nerve Stimulation (TENS)

TENS is a system delivered by small machines which are attached to electrodes that you place on your skin in the painful area. These electrodes deliver what are effectively small electric shocks to the affected area which feels like a buzzing sensation. This sends signals to the brain which appear to inhibit firing through nerves in the midbrain and spinal cord that are associated with sensing pain. They even appear to increase endorphin concentrations in your blood and cerebrospinal fluid, the same chemicals associated with “runner’s high”, that almost elated feeling that some people get after intense exercise (not myself sadly).

This treatment method does not work for everyone, but it has proven particularly useful in conditions like fibromyalgia where there are currently no other effective treatments.

Me wired up for TENS.

Pain Medications

First I should talk about opioids. Over-prescription of opioids is of course concerning and there are great risks of addiction associated with them.  But I’ve spoken to a number of former chronic pain sufferers who took opioid drugs for their pain and they say that once the source of pain went away they felt no desire to continue taking the drugs. Of course, this is not a rationale for giving opiates to anyone with chronic pain, but the discussion must remain open and not be entirely stigmatised as they are currently the most effective painkillers that we have currently. They act on receptors on your neurones and reduce production of a molecule called cAMP whilst increasing potassium export and decreasing calcium import. These changes combine to reduce the ability of these cells to release neurotransmitters to signal to the brain that you are in pain, so the pain is gone.  

Benzodiazepines have similar addiction issues but as with opioids the discussion should remain open. They function by increasing the effect of a neurotransmitter called GABA in your brain which stimulates muscle relaxation and sedation which can relieve severe nerve pain.

Strangely anti-depressant drugs are also common in the treatment of chronic pain. Drugs like amitriptyline have shown success in reducing chronic nerve pain and their anti-depressant effects are very useful for some patients as chronic pain can have severe implications for mental health. However, these drugs, as many depression patients will know, are also associated with potential detrimental side effects and thus they must be taken with caution.

Both painkillers and antidepressant medications may be prescribed to treat chronic pain.

Cannabinoids are also very popular at present with the rise in use of CBD oils with claims that it is very beneficial for pain patients. This is not something for which there are a great deal of studies yet but in time we will learn about their efficacy. We do however know that cannabinoids increase endogenous opioid levels and decrease inflammation so further research is important.

The psychoactive compound in cannabis, THC, is the key ingredient in sativex, a muscle relaxant and anti-spasm drug prescribed in the UK for severe multiple sclerosis patients and for many of them it has been what has allowed them to function in life. The use of cannabinoids in pain medication is currently minimal but following more studies, it may become more common as it has anecdotally had great success.

These aforementioned drugs could be described as “heavy duty” and it is definitely better to go through over-the-counter and less powerful analgesics first for the pain, but discussions on the use of these medicines must continue as for some people they are a lifeline and this has to be coupled with a greater respect for chronic pain sufferers as there is a distinct lack of empathy from the public regarding the severity of chronic pain, usually due to its invisible nature.

Mindfulness and Cognitive-Behavioural Therapy

Mindfulness involves paying more attention to your body, your feelings, your thoughts and the world around you in the present moment. In doing this we can recognise negative patterns in our thoughts and behaviours and slowly work to remove these from our lives. In a number of studies this has shown mild pain reduction for patients but significant improvement in quality of life and significant reduction in depressive symptoms.

It is this coping and positivity derived from mindfulness that is important for many to cope with their pain. Cognitive behavioural therapy can aid and supplement this mindset through helping individuals identify these negative patterns and trying to build confidence that encourages them to take a more active role in managing their pain, without feeling “beaten” by it.

So, as an individual reading this article, please do your best to try and empathise with chronic pain sufferers and respect them. If you struggle to imagine what it’s like, there are groups out there producing tools to help those not in pain, understand those who are. For example, nurses for multiple sclerosis often run workshops for loved ones of sufferers where they do activities like asking loved ones to do simple tasks with large gloves on which can mimic the numbness felt by patient. These are only small steps to understanding, but with workshops like these becoming more prevalent they are a great avenue to help chronic pain sufferers get the respect they deserve.

A few final things

I’ve mentioned just a very small number of potential mechanisms for tackling chronic pain. Music, dance, distraction, swimming, cycling and getting drunk are just a handful of other pain management methods that other chronic pain patients have told me about. I’m currently in the process of writing a book to help the public better understand chronic pain, to help show potential new therapeutic avenues for chronic pain sufferers and to give advice to their loved ones about how they can help. I hope that this sparks your interest in chronic pain so that you may want to find out more to better understand what life is like with chronic pain. If this is the case, here are a few resources for you to have a look at:

The Mystery of Chronic Pain – a TEDed talk by Elliot Krane.

Chronic Pain: A New Perspective – a TEDx talk by Georgie Oldfield

The Somerset Community Pain Management Service

My Live Well With Pain

Author bio

Joe is a PhD student researching breast cancer at the University of Manchester. Having suffered with chronic pain for 8 years now he has begun to speak openly about living with chronic pain and is currently writing a book to help the general public better understand life with constant pain

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