I Am a Health Professional

Living With Chronic Pain

I am a health professional helping people live better with pain.

By Dr Lynette Guy - Board Member Chronic Pain Switzerland

The first step in treating acute and chronic pain is seeking medical care to diagnose the cause of the pain. Some cases require the help of an expert medical practitioner or a doctor who has specialist expertise in pain (Pain Specialist) to work with each individual to determine the best course of therapy to manage pain. Please see the "Community resources" section for information on Specialist Pain services nationally.

Acute pain is most commonly a 'normal phenomenon' that acts as a warning signal. In chronic pain, however, sometimes the signals to and from the brain are modified and can exacerbate the pain experience. A number of other reactions in the body may take place, and how we as health professionals think and react to the pain can further influence how the client responds to that pain.

Often the nerves and brain respond and change under the influence of chronic pain. For instance the nerves in the body that sense danger become more sensitized. The brain can also release chemicals that further sensitize the nervous system and spinal cord.

The nature and management of chronic pain differs from acute pain. In acute pain, inflammatory responses, such as bruising and swelling may be apparent. In cases of chronic pain, even when a physical cause is removed, however, the pain may remain.

In chronic pain, the obvious bruising and swelling may have resolved, but there may be an underlying level of inflammation that is difficult to see, but also it is likely that other firing of signals within the nervous system are ongoing. These are not able to be seen on normal X rays or CT scans.

Consequently it is not possible with most modern imaging techniques to identify activity that might be taking place in pain pathways in the nerves and spinal cord or the brain. This makes it virtually an 'invisible' form of pathology, making diagnosis very difficult.

Not having a 'visible' injury may in some observers' eyes diminish a person's experience of pain. Stigma, anxiety and depression add to the issues of chronic pain experienced by an individual. Equally, for the family of a chronic pain sufferer the experience can be all-consuming.

Pain Management involves a team approach. Management of chronic pain ideally means being assessed and assisted by a team of professionals whose aim is to minimise an individual's pain and maximise their level of activity. Effective management of chronic pain requires a comprehensive assessment by each member of the team, and communication between these practitioners and the individual to ensure a successful management program is developed according to the needs of each individual client/patient.

Assessing the individual's needs can include:

  • Defining the pain (e.g. nature, frequency, duration, distribution of the pain and exacerbating factors)
  • Determining the cause
  • Review of the effectiveness or otherwise of past and current therapies,
  • Review of medications, past and present
  • Review of the individual's whole situation including their home functioning, work functioning, social functioning, their understanding of their pain, their outlook about the future, evidence of coping skills, approaches to activity etc.

This type of information is essential in order to outline a plan of action that meets the needs of each individual who is suffering from chronic pain. This could include:

  • Education about pain
  • Adjustment of medicines
  • A physical exercise program
  • Psychological support
  • Social and vocational case management of vocational and/or quality of life issues.

Helpful Links for Health Professionals:

  • New Zealand Acute Low Back Pain Guide
  • Swiss Pain Society
  • International Association for the Study of Pain
  • NSW Therapeutic Advisory Group
  • Whiplash evidence based information centre
  • WorkSafe Victoria Outcome Measurement Tools for allied health professionals