Persistent Pain

What can I do to improve how I feel, move and function?

Let’s be realistic – medicines and other single strategies are unlikely to help on their own. These five things in combination are the most useful way to improve day-to-day function and stop persistent pain controlling your life.

1. Learn about your pain

The first and best thing is to learn more about why your body is producing these sensations.

Two examples of how we might understand persistent pain:

Pain as an alarm system

One way to understand pain is to think of the body as having a built-in alarm system such as outlined here: www.youtube.com/watch?v=jyHeAQbFs34

1. For example, if you step on a nail, the alarm system triggers and you feel pain until you do something about it, e.g. pull the nail out and get treatment. As the wound heals, the pain lessens and eventually goes away. Similarly, when you hurt your back, you get help from your GP and physiotherapist, and with treatment the pain should settle back down again.

2. However, for about one in four people, the alarm system ramps up, and even with help doesn’t settle all the way back down. You are left with an extra-sensitive alarm system that changes your life. Activities that previously caused no problem can suddenly cause the pain alarm to trigger.

The impact of thoughts, feelings and behaviour on our pain

Another way to understand pain, is that pain itself can affect or be affected by what we think, feel and how we behave (see figure below).

1. For example, pain can trigger forgetfulness or impaired focus. Feeling depressed and helpless can heighten the perception of pain; positive feelings can reduce the feelings of pain. Similarly the fear of pain can lead us to behave in different ways, such as limiting movement, which can actually increase the pain.

2. Blocking difficult emotions that might arise at a time of trauma can ramp up our alarm system. Becoming aware of these buried emotions and releasing them can help to reduce pain.

3. Using strategies that address our habits of thinking, feeling and behaving can help to reduce pain. For example, using mindfulness and relaxation techniques or talking to a psychologist can help to reduce the level of pain experienced.

2. Set goals for improving your day-to-day function

Think about tangible goals for your improved function. For example, you might have a goal of going for a daily walk, or a more practical goal of doing the grocery shopping without help. Write down these goals and talk to your GP about them. See ‘My Health Plan’ for an example of how you can record and work towards your goals: www.aci.health.nsw.gov.au/__data/assets/pdf_file/0003/209667/health-plan.pdf

3. Make movement part of your plan

Movement is very helpful for treating persistent pain. Learn how you should move and how often you should move. For some tips, see: www.aci.health.nsw.gov.au/chronic-pain/for-everyone/pain-and-physical-activity Your GP can refer you to a physiotherapist or exercise physiologist who can help get you moving again.

4. If you take medicines, consider whether they are helping you

Medicines might help in the short-term, but for persistent pain medicines can make you feel worse. We now understand that opioids can actually cause more pain, by making your nerves and brain more sensitive to pain. They can also cause unwanted side effects such as drowsiness. For some people, reducing the amount of pain medicines taken can be helpful. Your GP or pharmacist can answer any questions you have about your pain medicines.

5. Have a team of health professionals to help you

The best place to start is to talk to your GP. They can talk to you about a range of strategies and look at ways to improve your day-to-day function. They can also refer you to a psychologist, physiotherapist, exercise physiologist or occupational therapist who specialise in treating persistent pain. A social worker can help you find community activities and support.

Where else can I go for support?

If you are experiencing persistent pain, you are not alone. Stay connected with your healthcare team, family and friends. If you are feeling isolated, consider joining an activity group for a hobby that you enjoy. If you are finding it hard to cope with the stress of day-to-day life, talk to your GP and healthcare team, family member or a friend.

Take a look at some supports developed specifically for veterans:

1. Open Arms – Veterans’ & Families Counselling: offer free and confidential counselling and peer support to anyone who has served at least one day in the Navy, Army or Air Force, and their families. Call 1800 011 046 (available 24 hours a day, 7 days a week) or send a message through the web form at: www.openarms.gov.au/contact

2. DVA’s High Res SMART (Self-Management and Resilience Training) tools at the Open Arms website offer a range of tools to help you cope with stresses of day-to-day life: www.openarms.gov.au/get-support/self-help-tools

3. Open Arms pain resources at: www.openarms.gov.au/signs-symptoms/pain

4. Open Arms ‘Managing pain’ program can help you learn about effective pain management strategies: www.openarms.gov.au/get-support/treatment-programs-and-workshops