Who of us, when confronted with the onset of a new pain experience, would think, “this is going to turn into persistent pain defining my life in years to come?” In my experience, not many. Persistent pain catches us all by surprise.

One of the most common complaints raised by those impacted by persistent pain is that their journey to gaining a diagnosis of persistent pain therefore being directed to the appropriate treatment providers is long, arduous, and convoluted. Many people struggle to find a clear pathway. One of the reasons for this is because our understanding of persistent pain as a disease in its own right (and not just a symptom of something else) is reasonably recent, only coming to the fore in the early 2000s.

Not long afterwards, The National Strategic Action Plan for Pain Management was introduced with persistent pain as a disease, a central tenant. This National Strategic Action Plan is aimed at not just increasing consumer education but training and educating health professionals to better understand persistent pain and consequently participate more effectively in pain management care. Despite this progress, this understanding is still trickling down to the medical and allied professionals on the ground.

As a result, what often occurs is consumers find themselves stuck on a long journey of trying to find the source of the pain, all the while there is a distinct lack of focus on appropriate management of the pain itself and its impacts on an individual’s life. Some people find that they feel like they are on a merry-go-round of passing from doctor to doctor to investigate yet another explanation for the pain and or treatment of various suspected sources. This can often last for months to years, during which time the pain passes from acute pain, less than 3 months, to persistent pain. Left untreated or inappropriately treated, this begins to impact various parts of an individual’s life, and as it does, it grows into a larger and larger problem with associated knock-on effects on the nervous system and body. Perhaps you may relate to the frustration of this experience.

What makes the situation more complicated is that the line between acute pain and persistent pain is blurry. Consumers often present to their GP or Allied Health Professional in the acute phases of their pain journey and so prescription of short term, Band-Aid medications is entirely reasonable. The problem is acute pain and persistent pain require starkly different treatment strategies. Acute pain management is characterised by the rest and wait approach. We stop our activities, enter survival mode, and passively wait for healing to ensue. Once pain has lasted for longer than 3 months however, changes in the nervous system and body occur requiring active, self-management treatment. The passive-rest approach becomes counterproductive and perpetuates the problem.

Unfortunately, there is no flashing alarm that is triggered once the pain has lasted more than 3 months, blasting a “Change Your Approach” signal. Wouldn’t that be nice?

If you find yourself being passed from one health professional to another, it can be easy for the whole picture to be missed: the chronic aspect of the condition. Each professional inspecting your pain from their particular perspective is important to rule out causes and treatments, but all too commonly the developing persistent pain problem is untreated during this time.

As someone who has sadly heard this story many times in treating people with persistent pain, I would like to offer a few key tips for navigating your persistent pain journey.

1.Get a good Pain Specialist.

A good pain specialist is worth their weight in gold. As early as 3 to 6 months into your pain journey, I recommend getting a referral to a pain specialist. A good pain specialist will help to oversee your pain treatment options; pharmacological, interventional, and conservative treatment and maintain a cohesive, big picture perspective and plan. They will often look at improving your medication regime for greater effectiveness and reduced side effects. Incorrect pain medication prescription is not uncommon and can, in the long term, increase your baseline pain levels. That is why it is important to seek input from a pain specialist for your medication management.

Where appropriate your pain specialist will introduce you to the world of Allied Health professionals and the like who specialise in persistent pain and can offer you tailored pain management strategies as an adjunct to your pharmaceutical control. Your pain specialist may offer you a range of interventions such as radiofrequency neurotomies, steroid injections, lignocaine infusions, ketamine infusions and spinal cord stimulators. Whilst more invasive interventions can be effective, conservative treatments are usually exhausted before invasive options are considered. Conservative options have been proven to be effective in managing persistent pain and introduce little to no risk of worsening your pain. Invasive interventions and surgeries always carry a risk. It is important to understand the extent of these risks before moving forward with any invasive treatment. A good Pain Specialist will always address this with you. If you are not sure, do not be shy to seek a second opinion.

2.Ensure your treatment providers understand chronic pain.

Chronic Pain often requires treatment from a range of therapists including physiotherapists, occupational therapists, psychologists, and alternative treatment providers. It’s important to understand the goals of any health professional or alternative treatment provider with whom you are working. What are the expected outcomes of the treatment? How many sessions and over what time period do they expect to see these outcomes? Persistent pain is a specialty. Make sure that any therapist you see has experience in treatment of persistent pain and self-management. Hands-on treatment has its place; however, treatment of chronic pain should always emphasise self-management rather than a long-term reliance on the treatment provider. There is nothing wrong with ongoing treatment for symptom management so long as both parties understand that this is the aim of the therapy. These treatments can be expensive, particularly if they are ongoing for months and years.

3.Gain a good understanding of your pain

Understanding pain and how it works in the body is key to controlling it and improving your quality of life. There are many pain education courses available including the one at SuperPharmacyPlus. These are worthwhile endeavours. Research shows us that the pain processes in the body are not set but are always evolving. This is called neuroplasticity. Persistent Pain is an evolved malfunction of the pain system in the body that has developed over time for a range of different reasons. With the right education, you can retrain your pain processes and dampen your experience of pain using the appropriate tools. There are many lifestyle strategies you can implement, and each person requires a different repertoire of these tools to most effectively manage their pain. That is why it is so important that those with persistent pain gain a good knowledge of their pain condition through education, as well as trial a range of lifestyle pain management strategies to ensure an effective management plan. This is always best with the support of specialising Allied Health professionals and your Pain Specialist.

4.Be ready to adapt

As you may have discovered already, persistent pain requires us to adapt. Instead of being able to vacuum and mop the entire house in one session, our pain condition may force us to break up these tasks into smaller, more manageable, bite-sized bits. If you are like me, this may go against the grain of your personality. Once I get going, I get in the zone, and I don’t want to stop until I am done. Changing is hard. Unfortunately, fighting the change usually results in failure to reach our goals, increased pain after trying to do things the way they have always been done, lower quality of life and increased distress.

In my experience, those who have the most success in managing their pain are those who are accepting of their situation. Though they might not like it, they open to new ideas and change. This is not something that is easy to come by. You may need to see a good psychologist to help with these processes of accepting the situation and improving readiness to change. Consider how you can make just one change today.

5.Right advice, good supports

It is crucial that individuals living with persistent pain seek out reputable sources for advice and positive peer influences. Whilst consumer blogs can be helpful resources, for some, they can also be a powerful influence with damaging results. Loud voices are not always helpful voices. Additionally, some bloggers may not be aware of the damage that can be done.

Connecting with others who also experience persistent pain however, can be liberating, vindicating and incredibly helpful in an individual’s pain journey. It can provide a safe space for understanding and guidance where individuals often feel misunderstood and isolated. Always ensure that peer support is sourced through reputable organisations such as The Australian Pain Management Association (APMA) who offer a peer guide service over the phone, PainLink Helpline. A phone call to this service will connect you with consumers who have been trained in basic mental health first aid and have received evidence-based pain management treatment themselves with successful results. APMA also facilitates pain support groups. For more information, visit their website.

6.Make a Pain Management Plan

Like any other chronic health condition, persistent pain needs to be managed. This requires a personalised plan with adjustment and modifications for various events. A diabetic has a plan for daily management of their disease including medication regimen, diet, exercise, stress management, and pertinent adaptations to their schedules and activities to meet their needs. Additionally, they have a separate plan for managing fluctuations in their glucose levels, and they have modified plans for sick days, holidays, and changes to activity. Likewise, Persistent Pain requires a plan for daily management including the aforementioned factors as well as considerations for managing flare ups, special events and changes to activity levels. For best results, it is recommended that this plan be developed with the support of a specialised allied health professional or as part of a pain management course.

For further information and support, visit SuperPharmacyPlus.com.au and click on the De-Amplify Pain Services link.