Understanding Persistent (Chronic) Pain

Persistent (or chronic) pain usually refers to pain which lasts longer than 3 months. Sometimes, it started as a injury which has now healed, but often we don't know what has caused it. We have learnt a lot about pain in the last few years. Some of this knowledge is very new and is not yet widely known.

All pain, no matter where or how it is felt, is produced by the brain. Imagine you just stubbed your toe. Before your brain tells you, "Here is pain," it must first combine a lot of information, and then try and make sense of it all. Your nerves just say to your brain, "Danger"; they cannot tell you how serious the danger is. It's your brain that works this out, by weighing up things like what is going on at the moment, the experiences you have had in the past, and other life factors. Only after sorting through these will your brain tell you whether your toe hurts or not. It does this incredibly quickly - before you have even realised.

The problem is that the brain gets these signals through the nervous system. All of the nerves in our body, including the spinal cord and brain, change how sensitive they are in response to what we do, how we are feeling and how we see the world around us - a bit like turning the volume up or down on a radio. Sometimes, this can lead to big changes in pain levels without immediately obvious reasons. Persistent pain has more to do with these changes in the nervous system, than it does damage to your body. It's like the volume knob on your pain system has been left turned up, like a radio stuck on "loud". Persistent pain does not always indicate ongoing damage even though it may feel like it.

Understanding Pain in less than 5 minutes, and what to do about it!

It's really important to understand that you can re-train your brain and nervous system to turn the volume down again, but this takes time, effort, and knowledge. The PPSS can work with you to give you tools and skills which can help you re-train your brain. This video can help you understand more about pain and what can help relieve it. There is also a very useful booklet available produced by the Tasmanian Health Organisation which explains this in more detail, which is listed to the right.

Painkillers

Even though you may not feel like it, the best way to relieve pain and to re-balance your life is to keep moving. This doesn't need to be a lot all at once. Small steps at a time, paced around what you are able to do, will help you start to gain your life back and prevent it being ruled by pain. Your mood, thoughts, stress levels, diet and sleep patterns can also all contribute to making your pain better or worse.

If you need to take pain relief to help keep you moving, you can take simple over-the-counter NSAID painkillers (such as Ibuprofen). If you have health issues that mean you can't take these types of medications (gastrointestinal, liver and cardio-renal toxicity), then speak to your GP or pharmacist first.

In the past, you may have been prescribed medications for your pain. These may be Opioids (such as Codeine, Fentanyl, Morphine, Methadone, or Zomorph)  or Gabapentinoids (such as Gabapentin or Pregabalin). New research has shown that these aren't very effective at treating long-term pain. It has also shown they can be dangerous. It shows that:

  • Many patients find that opioid painkillers don't help with their persistent pain. Research hasn't found any conclusive evidence that opioids are effective in the long-term treatment of persistent pain.
  • Many patients also find that opioids can cause unpleasant side effects, including nausea, vomiting, dizziness, and constipation.
  • Opioids can be addictive. The more of them you take, the less effective they become, and so you can very easily end up taking more than is good for you - numbers of overdoses are going up.
  • Very few patients find Gabapentinoids effective in treating persistent pain. Large numbers of patients also experience side effects including dizziness, confusion, light-headedness, constipation and problems with vision.

If you have had these painkillers prescribed to you, the PPSS can support you to review your medications and work with you to see what is best for you in the longer term. Watch the video below to learn more about the body's natural pain killer processes.

The Drug Cabinet in the Brain

Pain Management

See our other pages on pain and pain management to see if they can help you understand more about this subject, and find ways of helping with your symptoms.

Neuropathic Pain Patient Pain Management Resources