We have all experienced pain at one time or another, but for those with chronic pain the experience is never-ending and it changes everything. Chronic pain affects more than two-fifths of the UK population, meaning that around 28 million adults are living in a constant state of discomfort and agony. It is more common in women and without proper care, it gets worse as you get older.
Opioids are commonly prescribed for chronic pain but they are addictive and come with serious side-effects – so what can be done?
What is “chronic” pain?
First, it helps to understand more about chronic pain and why it happens. “Chronic” just means “long-term” in medical jargon and that usually means more than three months. It is sometimes referred to as “persistent pain” or “disabling pain”. It can last for years and it’s usually ongoing and pretty constant.
Pain can of course affect all aspects of living. It makes work very difficult or even impossible. Family life and relationships can also be very difficult. It can mean that people are house-bound and lose their independence as well as any hope of a normal life. It stops people doing the things they used to enjoy. Chronic pain sufferers often have difficulty sleeping because of the discomfort they are in 24 hours a day.
If pain goes on for a long time, life closes in and treatment after treatment fails to make much of an improvement it can lead to anxiety disorders or depression, which in turn will make pain even worse. It can be really frustrating when you’re very aware that there are treatments – but nothing seems to work for you.
In my work as a trustee of the Arthritis and Musculoskeletal Alliance, we have highlighted the problems with chronic pain management in a new report. We found that patients often face delays and setbacks when trying to gain access to appropriate NHS treatments and healthcare support services. Access to NHS specialist pain services is difficult and is inconsistent across the UK and satisfaction is low.
Treating chronic pain
To effectively treat pain it’s important to understand its complexities and the various aspects of this issue that are influenced by different factors such as biological or psychological implications for instance. Pain management solutions should not be limited to one specific strategy but instead consider all potential means necessary in order to ensure effective treatment.
Cognitive behavioural therapy has also shown some promising results in treating back pain and it can help people who are struggling with depression, anxiety or insomnia.
Mental techniques such as mindfulness meditation and positive thinking may sound like new age mumbo jumbo but they work too. Modern research is showing that when these approaches are combined that they are more effective than any single approach.
It’s important to remember though that pain is always personal and what helps one person may not help another. There is no miracle cure for chronic pain – but there are a lot of things we can do to work out our own solutions, so it doesn’t control us.
Manual therapy is effective treatment for chronic back pain
When it comes to chronic back pain however, some approaches have been shown to be effective. Exercises and movement-based therapies such as physiotherapy and chiropractic have been found to be really valuable. That’s because they help the muscles and joints in your back to function better which eases pain.
It is thought that manual therapies like manipulation and exercise work with chronic pain because they not only improve function but activate signals to the spinal cord and brain which modify the pain signals and their perception.
There are other approaches that can help too. There is evidence for the effectiveness of acupuncture in treating chronic pain and it has been shown to be as effective as conventional treatment such as analgesics like morphine or tramadol which have severe side-effects. Here at Sundial, we use acupuncture needles to improve muscle spasm and pain too. We find it a useful tool in our armoury.
What causes mild pain to turn into chronic pain?
The short answer is that no one knows exactly why some of us get ongoing pain and others recover from an injury in a week or two.
We know now that pain does not mean damage. It’s often the result of a signal being sent to your brain, but that signal can be wrong. They are signals from nerves in tissues that mean there is the potential for tissue damage and perhaps you might want to do something about it.
Sometimes it gets mixed up with other signals or memories – like when you get back pain and start imagining how terrible things will become if it doesn’t go away. It is also thought there may be chemicals in our brains that distort the message.
There are other outside influences too. Stress is a big factor and the more stressed you get, the worse your pain will be. Our genes may also play an important role in some cases of chronic pain – but this doesn’t mean that it’s written in stone. In fact, there have been many cases where people who were told they would just have to “live with it” but went on to make a full recovery.
Are pain alert mechanisms to blame for chronic pain?
If you get an injury, naturally enough, it hurts. It is supposed to stop you from moving the injured area and causing more damage. As the injury heals the need to avoid certain movements goes away and so does the pain. But sometimes the pain persists even though the original injury has gone. It is called central sensitisation. Why this happens is explained by what is going on in the brain and spinal cord.
Sometimes our pain surveillance system is set on high alert and this leads to a heightened perception of pain. The pain stimulus might be small but the experience of pain can be big a bit like turning a whisper into a scream.
When a pain nerve gets activated the signal goes up the nerve to the spinal cord. where we process this signal. The spinal cord can act like an amplifier where it turns the signal up and then sends it on to the brain or the signal can be turned down and less signal gets sent to the brain.
The brain will also act to amplify or turn down the pain signal. Expectations, past experiences, beliefs, attitudes and emotions can all influence how much or whether you have pain.
The brain is a very powerful organ and it’s not surprising that the mind can affect pain. If you have an injury or illness, your body might experience some inflammation too – which can make things feel worse and cause even more problems. The problem with chronic pain is that this cycle of inflammation and increased sensitivity to pain signals means there are all sorts of ways that pain can get worse and you might end up in a state where nothing helps.
People with sensitisation are often in pain. It can move around and can be sensitive to foods or light. They also have more flare-ups than other people. Some people feel better after very aggressive exercise or foam rolling because these activities activate a process that modulates pain and creates pain relief.
Those with central sensitisation have a much smaller or no positive response to these approaches and can even flare up with more pain. They lose the ability to modulate the irritation. Exercise is still important but we just have to do it differently. We don’t do as much in one sitting, we slowly progress the intensity and we accept that some flare-ups and discomfort will occur.
The key to breaking this cycle is understanding how your brain processes signals, what may be influencing the way it does so and then finding ways to work around these factors.
Mindfulness Meditation helps chronic pain
Research has found that when people are taught mindfulness meditation they report less pain and improved quality of life.
When people with chronic pain are taught mindfulness meditation they were also more able to handle the unpleasantness that comes along with it – like not caring so much if things don’t get done, being less bothered by thoughts or just having a different view about what’s going on in their lives. They also started showing changes in the brain – so they have more activity in areas which are involved with pain processing and less of a response to painful stimuli.
The benefits were seen after people had been taught these skills for only 12 weeks, but it’s important to remember that mindfulness meditation is not a miracle cure. It doesn’t work for everyone and some people might find it harder than others – but with time and effort it can offer a tool that helps you cope better.
We have a free Mindfulness Meditation Programme that you can follow along to. To access it – click here.
So the good news is that there are now many treatments to help manage chronic pain.
Opioids, for example, were once the go-to answer but they’re addictive and have serious side effects so it’s best not to rely on them too much. A combined approach, such as the one we use here at Sundial, with chiropractors, physio’s using manual techniques and working alongside GP’s and specialists is the best approach.
Call us or book online to see how we can help you live a life without pain.
Royal College of Chiropractors Quality Standard on Chronic Pain, 2016
The Silent Epidemic, British Pain Society www.britishpainsociety.org
Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain. NICE guideline [NG193]Published: 07 April 2021
Low back pain and sciatica in over 16s: assessment and management
NICE guideline [NG59]Published: 30 November 2016 Last updated: 11 December 2020
Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials. BMJ 2019;364:l689
Chronic Pain – This is how it feels, Arthritis and Musculoskeletal Alliance, 2019
Recovery Strategies – Pain Guidebook, Dr Greg Lehman