Chronic pain affects around 20% of Australian adults.
Chronic pain is usually defined, in medical terms, as constant daily pain that is present for at least three of the preceding six months. Chronic pain can have many causes, sometimes it's the result of a severe injury or a disease (eg, arthritis) but it can also have no diagnosable cause.
Prevalence of chronic or persistent pain rises as people age.
Most patients with chronic pain use at least one medicine – and many rely solely on medicine to manage their pain. However, chronic pain is complex and good management requires a mix of physical, psychological and medical treatment. Often opioid narcotics are prescribed as 'pain killers', but their use is limited. Medicines should only be seen as part of a comprehensive pain management plan, rather than an end in themselves.
Chronic pain is not the same as Acute pain,while acute pain usually develops in damaged tissues, chronic pain often results from neuroplastic changes that occur in the central nervous system.
1. Mental health issues including major depression are also more common in patients with chronic pain.
2. Social and psychological factors contribute to the perception, tolerance and experience of pain.
3. Analgesic medicines modify chronic pain to a modest extent rather than eliminate it.
4. Medicines such as antidepressants and anti-convulsant can be considered for pain that responds poorly to analgesics, such as neuropathic pain.
5. Opioids are indicated for use in acute pain, cancer pain, palliative care and for treating opioid dependency and addiction. However, there is limited evidence of the efficacy of opioid/narcotic analgesics for treating chronic non-cancer pain
6. There is insufficient evidence to demonstrate efficacy of opioids in the long term. Tolerance commonly occurs within four weeks. Opioids are also addictive and can lead to significant harm.
Central sensitization occurs over time when neuroplastic changes cause the central nervous system to become sensitized and respond excessively to both noxious and innocuous stimuli, such as touch and light pressure. Central sensitization can manifest as a hypersensitivity to pain.
Tolerance is distinct from central sensitization. It is a progressive lack of a response to a drug. The two phenomena are still being investigated to determine the underlying mechanisms and possible bio-markers of each condition. Chronic pain can have an enormous impact on people. It may interfere with a person’s sleep patterns, their sexual activity, their ability to work and conduct daily activities, and it can cause emotional distress and lead to serious mental health problems, including depression.
The goals of pain treatment are to enhance functioning and reduce suffering and distress, while minimizing the risk of adverse effects. While it is rare to eliminate chronic pain completely, it should be possible to control pain to a tolerable level and allow people to function at an acceptable level.
Many people are given unrealistic expectations of Pain relievers.
Educate yourself about chronic pain and its treatment, and address any unrealistic expectations you may have formed.
While acute pain can usually be attributed to an identifiable disease or damage process, finding an identifiable process for chronic pain can be very difficult. Sometimes the cause of the pain cannot be determined. This does not make the pain any less real to you. Trying to achieve a 100% pain relief will never happen, but you can try for 70% relief by not just relying on pain relievers but use other therapies as well. For More information see NPS Chronic Pain and NSW Health Chronic Pain management.