Managing neuropathic pain: the M3 approach

Neuropathic pain (sometimes referred to as nerve pain) is a complex condition suffered by many Australians. Living with ongoing pain is a challenge that can impact significantly on your physical, mental and social life. While it may not be able to be cured or completely eliminated, you can benefit from a positive approach and active participation in your pain management.

What is neuropathic pain and how is it different from other pain?

Neuropathic pain develops from damage or injury to the nerves that normally send messages to the brain to signal pain. It is different from the immediate pain that we feel when we damage part of our body e.g. from a cut or a burn. Neuropathic pain is often described as burning, stabbing, shooting, aching, or like an electric shock. Early treatment may prevent it from become chronic or ongoing. Common causes of neuropathic pain include shingles and complications of diabetes.

A Whole Person view of pain

The big picture looks at the whole person, not just the part of the body where you may feel the pain. Good pain management involves finding a balance between the following three areas:

Medicines

Movement

Mind

Because neuropathic pain is a complicated condition, it may involve the support of a range of health care professionals with a variety of treatment options. Your involvement in this partnership is essential to being part of the decision-making process about your pain management. With yourself and your GP at the centre, your team may include:

• doctors such as a pain specialist or neurologist
• health professionals such as a pharmacist, physiotherapist, psychologist or dietitian

Gold and white card holders may be eligible for services provided by some of these health professionals, and will require a referral by a GP.

Some may benefit from medicine-free treatment options such as yoga, relaxation or massage. These services may not be funded by DVA.

Medicines

Understanding your medicines

Neuropathic pain is often difficult to treat. It requires close monitoring and regular review of your medicines to achieve the best results. People respond to medicines in different ways; it may take time to find the best medicine for you. Talk to your doctor about whether you have a good level of pain relief, if you are experiencing any side effects and if you are able to maintain your daily activities.

To achieve good pain management outcomes, your doctor may recommend:

• staying on your current medicine(s)
• changing your medicine
• adjusting the dose of your medicine(s)
• taking a combination of medicines
• having a Home Medicines Review to better understand and manage your medicines.

Movement

Establishing a healthy lifestyle

Living with pain may mean making some adjustments which can take time. However these changes can improve the quality of your life and maintain your physical wellbeing. This can be challenging, but it is possible. It is about finding a balance.

• Stay as fit and active as possible. This will help you remain flexible and strong and keep you moving.
• Make gentle exercise part of your daily routine. Spread your exercise and activities into smaller amounts over a longer time. This is called pacing.
• Plan your tasks in small steps instead of all at once, remember to take a break before you need to.
• It is best to build activity slowly.

Pain may lead to disturbed sleep. Talk to your doctor about ways of helping you sleep better. You may also find the brochure, The myths and facts about sleep from a previous topic helpful www.veteransmates.net.au/topic-31-veterans-advice

Leading a healthy lifestyle, eating a balanced diet and exercising regularly will help you stay active and maintain your physical wellbeing.

Mind

Recognising your emotions

Acknowledging your pain is the first step towards living with it successfully. It means you are becoming involved in your own pain journey and, with the help of your health care team, better pain management can result. Pain is subjective, only you can feel your pain and many things may affect it. Understanding more about what makes it better or worse and how you react to it can help you feel less afraid, more in control and help improve the quality of your life. Acceptance is the foundation for change.

Living with a chronic condition such as neuropathic pain can contribute to feelings of fear, sadness and anxiety. Depression is common for those who live with ongoing pain. However, like other illnesses it can be treated. Treatment can help lift depression, which in turn can improve your pain. Talk to your doctor and those around you about how you are feeling.

Relaxation techniques are more than just relaxing. You may experience more pain in times of stress as muscles tighten. Relaxation calms the mind and body, which then calms the pain. Not all relaxation techniques and lifestyle approaches suit everybody, so talk to your doctor and team about what is best for you.

Thoughts and feelings can affect your response to ongoing pain. Having a positive outlook, going for a walk, doing some yoga, or catching up with family and friends can keep you in touch and involved.

Talking to your doctor is important

Visit your doctor early to talk about your pain and understand your medicines. Learn about your condition, its treatment and management so you can make informed decisions and help plan realistic outcomes. Talk with your doctor and other healthcare professionals to get the help you need to live well, in spite of your pain. It may be useful to have your partner, family member or close friend accompany you when you visit the doctor to listen and provide support.

Stay in regular contact with your doctor to talk about your pain, how you are feeling and how you are coping with your daily activities. Your conversation may include:

• The level of pain you are experiencing and how you have been feeling since your last appointment
• Your ability to carry out normal daily activities such as walking, eating, shopping, working or leisure activities
• Lifestyle strategies, which together with your medicines, may help cope with your pain
• Being aware of possible side effects from your medicines
• Keeping a pain log or diary to provide information about patterns in daily activities which may affect your pain. A Pain Diary can be accessed from NPS MedicineWise at: www.guild.org.au/__data/assets/pdf_file/0023/5945/patient-resource-my-pain-diary-nps-medicinewise.pdf
• Completing a pain assessment tool as suggested by your doctor.

Be pro-active in the partnership with your doctor and health care team so as to set realistic goals and achieve the best outcome. Your doctor can review your progress, understand your condition and recommend the best treatment.

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