Pain, a small word used by people around the world to describe a range of unpleasant feelings, affects all of us at some point in our lives. Pain is a normal and necessary part of life. When a person has pain, it affects them in many ways including physically, emotionally and socially. Pain which has started recently is known as acute pain. Acute pain is usually associated with tissue damage and generally eases as we heal. [6]. Acute pain is helpful as it alerts us to look after ourselves by protecting the area of injury until it is healed.
Chronic pain is different. Chronic pain is when the pain has been present for more than three months. Chronic pain is not usually associated with ongoing tissue injury, and can be a disease in its own right. It is also possible to have acute and chronic pain at the same time. For example if you have chronic pain, it is possible to injure yourself and you may then have acute pain which heals when the injury no longer needs protection, but the chronic pain may continue. Attempts to treat chronic pain by rest and avoidance of activity are unhelpful and can perpetuate greater pain and loss of ability to take part in your life.
Chronic pain affects one in five children and adults, and is even more common among vulnerable populations including the elderly, veterans and indigenous populations [1, 2]. Approximately one in twenty people are significantly limited by chronic pain in their daily activities (like being able to go to school or work or doing their household chores). In this fact sheet, we will discuss some key messages which people living with chronic pain and researchers working on chronic pain have identified as being helpful for preventing chronic pain.
Communication Is Important
When people are in pain and consult a healthcare professional, it is critically important that they understand their diagnosis. Diagnostic uncertainty (or a perceived lack of explanation or incorrect label to explain pain symptoms) is associated with mistrust of the medical system and potentially reduced engagement and benefit from treatment [2, 4]. Clear communication between patients and their health care professionals reduces the anxiety of being ill and in pain. Reducing anxiety is important when someone is living with chronic pain, as worry about pain can lead to greater suffering and decreased functioning. Working with a healthcare professional who communicates clearly, gives the opportunity to ask questions and raise concerns makes a difference. Feeling engaged in your care can reduce pain and improve your health outcomes.
When you are going to see a healthcare professional it can be helpful to follow these steps to take PART:
Prepare: write down specific questions which are worrying you with the most important at the top of your list.
Ask questions and make sure you understand the answers.
Repeat what has been told to you in your own words so that you can check that you have understood correctly.
Take action on what you need to do next [3].
There Are Different Kinds of Pain
Not all pain is the same. Acute pain is associated with actual or potential tissue damage. This is the normal every day kind of pain which is helpful, and which motivates us to protect the painful area so that it can heal. Acute pain needs to be distinguished from chronic pain, which is generally not protective. Chronic pain occurs when the nervous system has become sensitive (the new term for this kind of pain is nociplastic pain). This pain might have started as acute pain when there was an injury or tissue damage, but this is not necessary in all cases for chronic pain to develop. Chronic pain is not helpful and protecting the area of the body which is painful does not help the body to heal, in fact it worsens chronic pain. Neuropathic pain is a type of chronic pain that occurs from disease or damage to the nerves. This pain is not helpful, and protecting the painful area does not allow it to heal. Neuropathic pain and chronic pain require different treatments than acute pain, and these treatments typically emphasize the need to increase function across areas of life.
It May Be Safe to Move Even If There Is Pain
Pain is not an accurate measure of tissue damage. When the body is injured, the healing process releases chemicals which make our nerves very sensitive. This can increase your pain, even though the injury is healing. Overall, it is important to start moving gradually after recovery from acute pain. When treating chronic pain, it is important to increase movement in a gradual way. This is done by first finding a baseline and progressing with small steps to increase how much activity you can tolerate without making pain worse. Emotional distress can make pain worse, as the areas of the brain involved in processing pain and emotions are very close to each other. If pain is not improving after an injury, or if you have chronic pain you may need to see a health professional, or even a pain expert. It is often safe, and necessary, to start moving and doing activities, and living life fully even if there is some pain.
It Is Important to Treat Our Emotions When We Have Pain
Pain is almost universally aversive or unpleasant. Pain experience affects, and is affected, by our emotions, thoughts, behaviours, and social environment including the people around us. High levels of worry and low mood are common in people living with chronic pain [5]. Effective management of chronic pain requires gaining an awareness and skills to manage other areas of your life that can be affected by or are impacting your pain. Are you worried, anxious, depressed, angry, irritable, stressed? All of these emotions affect how our nervous system works. If these emotions are poorly managed, they can increase the chances of developing chronic pain, and can also increase our suffering if chronic pain is already present. Treating the whole person, not just the body, is important when we treat pain.
Summary
There is a lot you can do for yourself to reduce the impact of acute pain and to prevent developing chronic pain. Having knowledge and understanding about pain, having good communication with your health care professional, keeping active and looking after your emotional health all reduce pain and reduce the risk of developing chronic pain. Actively engaging in your own health care and pain management makes a big difference to pain.
There are many resources available that can be used by people with pain to understand more about their condition. A few we recommend are:
- For kids with pain: https://www.aboutkidshealth.ca/pain
- To learn about pain – Retrain Pain Foundation: https://www.retrainpain.org/
- To learn about pain – Tame the Beast: https://www.tamethebeast.org/
- Understanding pain in five minutes: https://www.youtube.com/watch?v=C_3phB93rvI
- Understanding Pain – Elliot Krane – The Mystery of Chronic Pain: https://www.youtube.com/watch?v=J6–CMhcCfQ
- Understanding pain in kids: https://www.aci.health.nsw.gov.au/chronic-pain/painbytes
REFERENCES
[1] Health NDo, Africa SS, Council SAMR, ICF. South Africa Demographic and Health Survey 2016. Pretoria, South Africa: National Department of Health Statistics South Africa South African Medical Research Council ICF 2019.
[2] King S, Chambers CT, Huguet A, MacNevin RC, McGrath PJ, Parker L, MacDonald AJ. The epidemiology of chronic pain in children and adolescents revisited: a systematic review. Pain 2011;152(12):2729-2738.
[3] Lorig KR, Holman HR, Sobel DS, Laurent DD, Gonzalez VM, Minor M. Living a Healthy Life with Chronic Conditions: Self-Management of Heart Disease, Arthritis, Diabetes Boulder, CO: Bull Publishing Company, 2012.
[4] Neville A, Jordan A, Beveridge JK, Pincus T, Noel M. Diagnostic Uncertainty in Youth With Chronic Pain and Their Parents. The journal of pain : official journal of the American Pain Society 2019;20(9):1080-1090.
[5] Rayner L, Hotopf M, Petkova H, Matcham F, Simpson A, McCracken LM. Depression in patients with chronic pain attending a specialised pain treatment centre: prevalence and impact on health care costs. Pain 2016;157(7):1472-1479.
[6] Treede R-D, Rief W, Barke A, Aziz Q, Bennett MI, Benoliel R, Cohen M, Evers S, Finnerup NB, First MB, Giamberardino MA, Kaasa S, Korwisi B, Kosek E, Lavand’homme P, Nicholas M, Perrot S, Scholz J, Schug S, Smith BH, Svensson P, Vlaeyen JWS, Wang S-J. Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11). PAIN 2019;160(1):19-27.AUTHORS
Romy Parker, PhD
Associate Professor
Department of Anaesthesia & Perioperative Medicine
University of Cape Town
Cape Town, South Africa
Fiona Campbell, BSc, MD, FRCA
Staff, Department of Anesthesia and Pain Medicine
Director, Chronic Pain Team
Co-director, SickKids Pain Centre
The Hospital for Sick Children
Toronto, Canada
Kathryn Birnie, PhD RPsych
Assistant Professor
Department of Anesthesiology
Perioperative and Pain Medicine
University of Calgary
Psychologist, Alberta Children’s Hospital
Calgary, Canada
REVIEWERS
Mary Wing, Grad/Dip Chronic Condition Management
Patient Educator/Advocate, Adelaide Pain Support Network
Member, Global Alliance of Pain Patient Advocates (GAPPA)
Adelaide, South Australia
Saurab Sharma, MPT, PhD Candidate
Assistant Professor
Department of Physiotherapy
Kathmandu University School of Medical Sciences
Dhulikhel, Kavre, Nepal
Michael Falcon, OTD, OTR/L, MHA, BS
Occupational Therapist, Consultant
Oregon, United States