Part 1: Understanding your pain can help to ease your pain

Most people think of pain as a result of an injury or a disease, but pain can occur with or without either. Pain usually resolves before tissues have fully healed, but for some people pain persists even after tissues have healed - it’s called chronic or persistent pain.

An estimated one in five Australians live with persistent pain. It can make daily life a struggle. But by understanding your pain and taking an active role in strategies tailored to you, daily life can improve. Don’t give up; it might take some time to find out what works for you. The first step is to learn more about pain and how your pain is unique to you.

Five key facts in understanding pain

Research has shown that by learning about how pain works, you can reduce it and improve daily life.¹ Here are five key facts to help you understand your pain better:

1. Louw A, Zimney K, Puentedura E, Diener I. Physiotherapy theory and practice. 2016; 32: 332-355. https://www.ncbi.nlm.nih.gov/pubmed/27351541

1. Pain is always real

Pain is always real whether or not it is associated with physical damage. Pain is never ‘all in your head’. It is always a real experience that can have a big impact on day-to-day life.

2. Your pain is unique to you

Everybody’s pain is different. Your body’s tissues can send ‘danger messages’ to your brain in response to a number of threatening things such as an injury or too much heat or cold. Your brain then has to decide whether or not to make pain in order to protect you. Many things can alter this decision - see the diagram below.

Factors that might influence your pain

3. Pain can exist with or without tissue damage

Pain is not a good indicator of damage in your body. Small injuries, for example a paper cut, can hurt a lot, and some really traumatic injuries don’t hurt at all at the time of the injury. Persistent pain can continue long after the initial physical injury or damage has completely healed. For instance, some people missing a limb will feel pain in the missing bit; this is called Phantom Limb Pain. In order to understand pain, we need to understand that it is the brain and nervous system that makes pain.

4. All pain is made by the brain

Pain is a normal experience that alerts us to danger and helps us to survive by making us want to protect the painful body part. Your brain produces pain when it decides that your body tissues are in danger and require protecting. For example when you stub your toe and instantly feel pain. We know that pain is always real. When it becomes chronic it is often more associated with your nervous system and brain becoming extra, even over, protective. Over time, the nervous system can become more active at sending danger signals and the brain becomes better at making pain - this is known as sensitisation. When your system is sensitised many things that didn’t hurt before can hurt.

5. Pain can be reduced

Research has shown that persistent pain can be reduced over time by “re-training the brain and nervous system”. The most effective way to reduce pain is by taking an active role in learning about your unique pain experience and to use a healthcare team for support. Part 2 will explain the steps you can take to reduce your pain.

The healthcare team and how they can help

A number of health professionals can help you to understand your pain so that you can get back to doing the things you enjoy. Your GP will likely be your main contact and coordinator. DVA gold and white card holders might be eligible for services provided by some health professionals and require a referral from their GP.

Who might help	They can help by...
GP	Being your main point of contact Diagnosing and monitoring your condition Developing a pain management plan and referring you to other health professionals Suggesting strategies to help manage your pain and support you in making changes Prescribing and supervising medicines that might be used to help manage your pain and get you moving
Psychologist	Teaching you how to understand your pain and how it impacts on your body, thoughts, emotions and behaviours Helping you to change the way you think about pain Supporting you to realise you are not alone Teaching you strategies to cope better with the pain, how to pace yourself each day and set reachable goals Teaching you how relaxation and meditation can help lessen your pain
Physiotherapist	Giving you advice on how to start moving again in a safe manner Setting an achievable movement and exercise schedule, and showing you how to pace your activities Teaching you stretching and strengthening exercises Providing short term manual treatments where appropriate e.g. physical manipulation of muscles and joints Helping you to understand your pain and how it affects your body, thoughts, emotions and behaviours

Talk to your GP or ring the Veterans’ MATES Helpline on 1800 VETERAN (1800 838 372). Other health professionals who might help your plan for pain management include: a pain specialist, pharmacist, exercise physiologist, dietician, or occupational therapist. Some people with chronic pain could benefit from therapies such as massage and yoga, to help with muscle tightness and relaxation. However these services are not funded by DVA.

Part 2: Understanding your pain can help to ease your pain

Part 2: Understanding your pain can help to ease your pain

Understanding how your pain works is the first step in working out a treatment plan tailored for you. A number of health professionals can help you understand and treat persistent or chronic pain.

If you are living with persistent pain, you might have already tried quite a few things. Understanding your pain and having a treatment plan are likely to be the most useful ways to reduce your pain and improve day-to-day life. Finding a supportive healthcare team, and being involved in choosing your own plan of action, will help.

Your pain is personal and unique to you

We now know that pain is not as simple as it might seem. Pain is a complex protective mechanism that is always decided upon by the brain. As highlighted in Part 1, pain can exist with or without damage to the body. Because of this, many things can contribute to your experience of pain, including your general mood, your beliefs about what is causing your pain, social interactions with others and past experiences.

Working out what might trigger, increase or reduce your pain, can help guide strategies to treat your pain. You will have pain when there is a greater sense of threat to your body tissues than there is sense of safety to your body tissues, and your brain decides that you need to be protected. This will be different for every person.

Sense of threat and safety can come from many, often surprising things. Signals from injured tissues can be a sense of threat, but the things we see, say and hear can also provide a sense of threat. At a certain point when there is enough sense of threat in your life, your brain will produce pain to look after you. Finding things that reduce threat and add safety will help reduce your pain. In the examples below, Doug a veteran with chronic pain discusses what contributes to his pain, and the strategies that have helped him.

2. Based on the principles of The Explain Pain Handbook: Protectometer and adapted with permission from Noigroup Publications – www.noigroup.com

How this information can help you

Identifying the things that increase your sense of threat and safety will help guide the best pain treatment strategies for you. This information can point to things you could change in your day-to-day life. For example if going for a walk with a friend, in your favourite place, helps decrease your pain, try to do this more often.

Complete the insert to identify the things that are associated with safety for you. The goal is to add more things that increase safety and reduce threat. If you can change the balance of threat and safety in your life, you can treat and reduce your pain.

Bring the insert to your appointments with your healthcare team. They can help you work through filling this out. As outlined in Part 1, your healthcare team could include your GP, psychologist or physiotherapist. This information helps them to understand your unique pain and how to help you tailor strategies to improve your day-to-day life. They could also help you identify additional things that might affect your pain as these can hide in hard to find places.

For further information talk to your GP or ring the Veterans’ MATES Helpline on 1800 VETERAN (1800 838 372).

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