MANAGING CHRONIC PAIN

Transcription

1 George Hardas

2 MANAGING CHRONIC PAIN The guide to understanding chronic pain and how to manage it. George Hardas MMed (UNSW) MScMed (Syd) MChiro (Macq) BSc (Syd) Grad Cert Pain Management (Syd) Cognitive Behavioural Therapy Cert (Syd)

3 What is chronic pain? Pain is one of the common reasons most people decide to see a doctor in the first place. But still, most people are unfamiliar with the idea of chronic pain because they have been taught that pain usually disappears when body tissues heal from an illness or injury. However, there are millions of people around the world suffering from chronic pain. Indeed, according to Australian Pain Management Association, one in every five people in Australia continues to experience pain even after the healing process is complete. Thus, chronic pain is one of the most common health problems in Australia. Although pain is unpleasant, it is not necessarily a bad thing. Its importance is that it alerts the body to some underlying problems. For example, chest pain can alert a person about an impending cardiac arrest. However, chronic pain can negatively affect the quality of your life. The problem with chronic pain is that there is no a straightforward way of treating it. Chronic pain lasts longer, beyond the time you would expect an injury to heal. Chronic pain often does not indicate ongoing damage in our body it s like the alarm has been left on and someone s turned the volume up. The pain is less to do with an injury to body tissue and more to do with what s happening in our nervous system. Our nervous system can MANAGING CHRONIC PAIN 1

4 become sensitised and overactive, so that we continue to feel pain, even without any ongoing tissue damage. In fact, there is not a definitive cure for chronic pain in the existing medical literature. Consequently, the goal of treatment is not to alleviate it but rather to help patients to manage it so that their emotional and physical functioning can be restored. Common types of chronic pain Chronic Pain usually fails into two main categories: Nociceptive pain and Neuropathic pain. Nociceptive Pain is caused by damage to body tissue and is usually a throbbing, or sharp pain. It can often be due to tumours or cancer cells that are crowding or growing near other body parts near the cancer site or from the cancer spreading to joints, muscles and bones. Neuropathic Pain occurs when there is nerve damage. As the nerves connect the spinal cord to the rest of the body to communicate with the rest of the body via the brain, when there is nerve damage it can trigger the pain receptors in certain points of your body. People that suffer from this type of chronic pain often describe the pain as a burning sensation or numbness along the area of the affected nerve. MANAGING CHRONIC PAIN 2

5 The Causes There are a number of possible causes for chronic pain depending on where they are. For example, Complex Regional Pain Syndrome (CRPS) often develops as a result of surgery or trauma such as a broken bone or nerve damage and usually occurs in the upper or lower limbs. Symptoms include swelling, weakness, skin changes and sensitivity to touch. Leg and back pain are also a common chronic pain areas, and can be associated with many factors, including degenerative disc disease epidural fibrosis, failed back surgery syndrome, lumbar disc herniation osteoporosis and spinal stenosis. While chronic back pain is usually in the lower back area, it can extend to the thighs and even feet. MANAGING CHRONIC PAIN 3

6 Treatment & Management Chiropractic therapy The biological response to a noxious stimulus is not pain. The biological sensory/discriminative awareness of noxious stimuli is called nociception. In a clinical environment it is important to differentiate this principal from the patients expression of what they feel, which is pain and to therefore determine the pathological cause of their pain and to deliver the correct treatment. In addition there are events in the brain associated with changes such as respiration and blood pressure, which follow a noxious stimulus, not related to pain. The transfer of synaptic input from nociceptors to specific laminae in the dorsal horn is highly topographically organized and activates particular subsets of second order projection neurons leading to activation of specific brain centres to the sensitisation of acute pain as well as emotional cognitive and autonomic responses. Primary afferent neurons by virtue of their peripheral transduction specialisation, central termination site, or termination site or temporal characteristics, encode stimulus modality intensity, location and duration. Electrophysiological behavioural and clinical studies have confirmed that nociceptive activity in the dorsal horn is modulated in the substantia gelatinosa by input from joint mechanoreceptors, and A-beta afferents. Impulses travelling in larger myelinated mechanoreceptive fibres take precedence over smaller diameter nociceptive fibres and act to inhibit the transmission of nociceptive activity. A lack of mechanoreceptive input (due to joint dysfunction) allows increased nociceptive transmission, which is responsible for pain syndromes, and MANAGING CHRONIC PAIN 4

7 nociceptive reflexes that can alter musculoskeletal tone and affect the sympathetic nervous system. Chiropractic therapy initiates passive joint movements, which result in mechanoreceptive stimulation, creating pre-synaptic inhibition of nociceptive afferent activity thus diminishing or abolishing pain. Normal joint function can help normalise mechanoreceptive and nociceptive input. Exercise Regularly While it sounds obvious, keeping active can help someone suffering with osteoarthritis to no end. Not only does exercise boost your energy it can also help with strengthening your muscles and bones, and keeping your joints flexible. Both resistance based training and aerobic exercise can benefit an individual who is plagued by pain. The resistance training will help to build stronger muscles, the strengthened muscles will then provide more protection and support for the joints that are affected by osteoarthritis. Whereas aerobic workouts can help you lose weight which in turn may help to relieve the stress on painful joints. If there is a history of osteoarthritis in your family it can be a good idea to make sure that you exercise regularly. It is of course sensible to only exercise in moderation as excessive workouts can sometimes aggravate the injured joints, and it is good practice to avoid exercising at all when in pain as it is more than likely just to cause more pain. MANAGING CHRONIC PAIN 5

8 Eat Healthily Eating a diet that is rich in nutrients can be beneficial to the treatment of arthritis, vitamin D and omega-3 fatty acids are particularly helpful. Experts advise that it is best to focus on eating health foods as opposed to loading up on supplements, diets including whole grains, low-fat dairy fish, and lean meats are most beneficial to those suffering from osteoarthritis. Regular Sleeping Pattern A good night's sleep can be beneficial to the symptoms of osteoarthritis in the sense that it can help you cope with the stress. Removing all distractions from the bedroom such as televisions and computers, can help make the process easier. If you are struggling because of osteoarthritis related pain the use of additional pillows to take pressure of your afflicted joints is something that could be beneficial. If you are in the Sydney area and require specialised treatment for osteoarthritis, sports injuries, or chronic pain that is causing you discomfort then do not hesitate to arrange an appointment with George Hardas today and see how he can help you. MANAGING CHRONIC PAIN 6

9 Psychological Treatment The truism that chronic pain has a psychological dimension cannot be overemphasized. Thus, Cognitive Behavioral Therapy can go a long way in helping a patient to manage chronic pain. This is a type of psychological treatment which helps you think and respond to certain problem situations in your life. Then the treatment focuses on helping you to learn more helpful ways of thinking and responding to these situations and others that you may face. Biomedical Treatment This mainly involves medication, nerve blocks, and even surgery. In some cases, doctors may use more invasive medical procedures such peripheral nerve and spinal cord stimulation. Other doctors go as far as using implantable intrathecal drug delivery systems. Some of the commonly used medications include paracetamol anticonvulsants, anti-inflammatory analgesics, and Opioids. Pharmacological treatment for anxiety and depression may also be applied in some cases. Home Based Solutions Even as you undergo physical therapy, biomedical treatment, and psychological treatment; you will also have your own part to play when it comes to managing chronic pain. MANAGING CHRONIC PAIN 7

10 For instance, you have to stay active and also acknowledge and respect your physical limitations. You also have to find interesting things to do in order to distract yourself from focusing on your pain. For instance, you can take a walk or engage in a hobby. It is also advisable to make social connections in order to have people you can talk to regularly. Most importantly, you have to listen to your doctor and follow prescriptions carefully. Summary Overall, it is apparent that Chronic Pain is a major health issue. Dr George Hardas of Sydney in association with the Orthopaedic Research Institute, St George Hospital Clinical School, Faculty of Medicine UNSW. As well as the Pain Management Research Institute, Sydney Medical School, Royal North Shore Hospital, for specialized assistance in chronic pain management. MANAGING CHRONIC PAIN 8