Managing persistent pain Information for patients This leaflet has been produced to help you understand pain and why it persists. It also explores ways that may help you manage persistent pain. 1
What is persistent pain? There is no set definition of persistent, or long-term pain, but it may include some of the following features: pain for more than three months good days and bad days pain which is affected by how you feel pain which is made worse by other things such as the weather pain that is not helped, or only partly helped, by various treatments pain that does not fit a set pattern Living with pain can make it difficult for you to cope with life, it can leave you feeling down and affect your relationships with others. It can be frustrating if you have seen lots of different health professionals, have had many tests and investigations and still feel no better. This leaflet explains: why some people have this type of pain what causes this type of pain how to manage your pain Where does pain come from? Nerves carry messages about all of your senses (such as smell, touch, sight and temperature) to your spinal cord and brain. They also carry messages about pain. If you have a new injury your nerves send messages to your brain and you feel acute pain. This type of pain is useful because it tells you to rest and move carefully while your body is healing. Acute pain usually lasts only a short while before going away. For example, 2
if you burn or cut yourself, you feel pain for a short while and then it disappears as you heal. Sometimes pain can continue however, even after your body has healed. This is persistent pain. This type of pain is not useful because it can make it hard for you to do physical activity. But being able to move is an essential component of managing persistent pain. Why does pain persist? There are many reasons why pain does not go away after your body has healed. These include: the nerves in your body becoming more sensitive to pain over time pain messages becoming confused so that even touch, such as someone giving you a hug, can be painful pain messages being stored in your brain, a bit like getting a song stuck in your head after hearing it on the radio. These changes in your nervous system help to explain why you feel pain when you are doing daily activities that are normally pain free. 3
The vicious cycle of pain If you have persistent pain you probably find that you have good and bad days. On good days you might do lots to try to catch up on things you need to do but this might result in you overdoing it. On bad days you might do very little. Are you in control? No: your pain is! A vicious cycle can develop where physical activity causes more pain, as shown in the diagram below. Overactivity On a good day, you tend to do too much Pain Decreases You feel better Increased Pain You link pain with activity Underactivity You rest until the pain has settled Do you recognise this cycle? If so, read on... 4
Managing your pain It is important to try and break this cycle. The following pages offer some ideas about things that you can do to help yourself. You can talk to your healthcare professional about them first before trying them. 1. Pacing Pacing means that you do the same amount of activity, such as walking or standing, each day. Start by just doing the amount of activity you can do on a bad day without making the pain worse. This is your baseline and the amount you should do each day, whether it is a good or a bad day. Now you are in control, not the pain. Discuss your activity and baseline with your healthcare professional. Stick to it and slowly do more. Seek guidance from a healthcare professional if you are not sure how to progress. Example You can walk three minutes on a bad day before your pain increases. This is your baseline, so walk three minutes every day but not more. Once you are happy with your baseline, start increasing the time you walk by 30 seconds to one minute each week, or walk twice a day Pacing also means you do things little and often and change position regularly before the pain gets worse. 5
2. Movement and exercise Your body needs and expects normal movement. You were made to move and it is safe to do so. Nerves are happy with normal movement because it reminds them of the messages that they should send to your brain. But if it is painful to move a part of your body, your natural reaction is to stop moving. This causes your joints to become stiff and muscles to tighten and weaken, which makes movement more difficult. This can lead to you not being able to do certain things. This may also make you feel down. It is important to remember that when you first start exercising things may hurt a bit more because you are using muscles that you are not used to working. This is not a sign of damage. Hurt does not mean harm Movement can make your muscles stronger and help you: become less stiff, so making moving easier and less painful improve your circulation, which keeps your body tissues healthy release your body s natural painkillers become more fit release hormones (chemicals) that can make you feel happier. So, the good news is that regular, gentle movement can help you: control the pain feel better On the following pages are some activities you can do to help 6
yourself. You need to do them little and often during the day. Talk to your healthcare professional about them before starting so they can help you to decide how much to do. Activities Even doing small movements can help you. You may feel a stretch but your pain should not get worse with movement. Try gentle activities such as: Cycling Golf Mowing the lawn Going for a walk 7
3. Setting goals Your pain may mean that you have stopped doing some things that you enjoy. It can help to set yourself some goals that matter to you. For example, you may want to be able to cook a meal, take your dog out for a walk or meet a friend. Talk to your physiotherapist about your goals and they will be able to help you break them down into small steps that are manageable for you. 4. Other ways of managing pain Find out more about these ways of managing pain by talking to your physiotherapist. Heat/cold Some people find heat helps to reduce pain and relax their muscles. Relaxation It is important to make time to relax as this can help to control pain by making your muscles less tense. Relaxing can also help to decrease stress and enable you to cope better with daily life. Medication There are many types of painkilling medication available. Talk to your healthcare professional about which are best for you. Distraction Take you mind of pain by doing things such as listening to music, calling a friend and so on. TENS You can use a transcutaneous electrical nerve stimulation (TENS) device to help ease pain. It works by stimulating your nerves to provide a type of pain relief. You can use it for up to eight hours a day. Your healthcare professional can tell you where to buy one and show you how to use it. 8
5. Sleep Hygiene Sleep is an essential part of feeling well and feeling happy, but almost everyone experiences problems sleeping at some time of their life. Sleep disruption is common, especially during times of heightened emotions such as stress. Lack of sleep deprives you of needed rest, making management of your pain more difficult. Below are some do s and don ts which may help: Do: Go to bed at the same time each day Get up from bed at the same time each day Get regular exercise each day, preferably in the morning Use your bed only for sleep or sex Don t: Engage in stimulating activity just before bed, such as playing computer games, watching an exciting program on television or movie, or having an important discussion with a loved one Have caffeine or alcohol in the evening (coffee, tea, chocolate, etc.) Take daytime naps or doze off in front of the TV in the evening http:// www.sleepfoundation.org/article/ask-the-expert/sleep-hygiene http://www.nhs.uk/conditions/insomnia/pages/treatment.aspx Remember: Persistent pain is challenging. Be patient as you learn to manage your pain 9
Where can I get help locally? Southwark - healthy lifestyle Health activities in the borough. www.southwark.gov.uk/info/10096/physical_activity Lambeth healthy lifestyle Health activities in the borough. www.lambeth.gov.uk/services/leisureculture/ SportsClubsCentres/HealthyLifestyles/ Lewisham healthy lifestyle Group activities at leisure centres Fitness in the community www.lewisham.gov.uk Bromley healthy lifestyle Health activities in the borough www.bromley.gov.uk/info/200073/parks_and_open_spaces/733/ healthy_lifestyle_schemes_in_parks_and_open_spaces Psychological Therapies Service Information for about the local talking therapies services available for stress, low mood, depression and anxiety. www.slam-iapt.nhs.uk 10
Where can I get more information? The pain Toolkit Advice and support for people who live with persistent pain. www.paintoolkit.org The British Pain Society Advice about understanding and managing pain. www.britishpainsociety.org BackCare Information and support for people with back pain. Helpline: 0845 130 2704 www.backcare.org.uk Understanding Pain www.youtube.com/watch?v=4b8ob757dkc Sharing your information We have teamed up with Guy s and St Thomas Hospitals in a partnership known as King s Health Partners Academic Health Sciences Centre. We are working together to give our patients the best possible care, so you might find we invite you for appointments at Guy s or St Thomas. To make sure everyone you meet always has the most up-to-date information about your health, we may share information about you between the hospitals. Care provided by students We provide clinical training where our students get practical experience by treating patients. Please tell your doctor or nurse if you do not want students to be involved in your care. Your treatment will not be affected by your decision. 11
PALS The Patient Advice and Liaison Service (PALS) is a service that offers support, information and assistance to patients, relatives and visitors. They can also provide help and advice if you have a concern or complaint that staff have not been able to resolve for you. The PALS office is located on the ground floor of the Hambleden Wing, near the main entrance on Bessemer Road - staff will be happy to direct you. Tel: 020 3299 1844 Email: kch-tr.pals@nhs.net You can also contact us by using our online form at: www.kch.nhs.uk/contact/pals If you would like the information in this leaflet in a different language or format, please contact PALS on 020 3299 1844. www.kch.nhs.uk Corporate Comms: 0721 PL625.2 January 2016 Review date January 2019