Understanding Chronic Pain

Dr Josh Boak (Osteopath)

Starting with the Facts 

Chronic pain is a complicated topic. There are so many different factors that affect it and everyone’s experience of chronic pain is a little bit different. Let’s start start simple and look at a few stats from a 2018 survey by Pain Australia. 

  • 3.24 million Australians are currently living with chronic pain. 
  • Pain also causes huge strain on us financially costing us $139.3 billion dollars per year associated with losses in productivity, costs associated with decreased quality of life and costs to the health system. 
  • In cases of chronic pain medication is prescribed 70% of the time by GPs 
  • 1 in 100 cases employ a multidisciplinary approach. 

The first couple of points highlight just how big of an issue chronic pain is. Three million Australians counts for more than 10% of the population, and to put the cost of chronic pain into perspective, the current budget for public health in 2019-2020  is around $100 billion. 

The last couple of points highlight the issues with current management. Medication is known to be ineffective and associated with side effects in long-term management of pain where a multidisciplinary approach to pain has been shown to improve pain, function and quality of life  (Ahlbeck et al 2013). There is no magic pill and no silver bullet; chronic pain is a journey and a process that is entirely unique to you and it requires a team to best address all the different parts of what makes your pain tick.

So what is Chronic pain…

Breaking down Chronic Pain 

Pain, at its most basic level, is a perception created by the brain in response to things it thinks are dangerous to us. To put it simply, it’s a protection mechanism. If you graze your knee or break a bone, signals get sent to our brain that result in us experiencing pain and this is incredibly important to the process of healing. Almost every tissue in our body when damaged will heal within a 12 week period but pain will not necessarily subside within this time frame. This is because pain is influenced by multiple factors only one of which is tissue damage (ie: a broken bone). Chronic pain occurs when the other factors influencing our experience of pain become the main drivers rather than the tissues that originally caused the pain. As I have said there are a whole variety of unique factors that affect your experience of pain as an individual. It’s important to figure these out with your practitioner so that the treatment plan can match you specifically but I’m going to illustrate a couple of the more simple examples of how our body changes our experience of pain and how, over time, this can result in pain without the presence of tissue damage. 

Fear

I’m sure most of us remember lining up at school waiting to get our immunizations. Certainly for me, as it was for many people, this was a terrifying ordeal. You had the date etched into your brain and when it finally arrived, you’d all form an alphabetical line, walk in one at a time, and get poked in the shoulder with a sharp piece of metal. The build up to the jab creates such a strong response from the brain, that it’s already priming you for what’s to come. It’s preempting pain. So much so, that when the doctor or nurse asks you to lift up your sleeve and they wipe your shoulder with the alcohol swab, you feel a sting. Even without the tissue damage the needle would cause it elicits a feeling of pain. Concern about an experience we think is going to be painful is actually enough for us to start feeling pain or cause a far greater pain response than we would normally feel in response to the stimulus. 

Learning Pain 

Your brain has an incredibly frustrating ability to learn pain. At the end of the day our brains are an amazingly complicated association machine! All they do is connect one stimulus or emotion to another. We use this system all the time when we are learning about the world around us but on a subconscious level we are creating associations between things that we never wanted to. When I was 9 years old, I went to a party with a bunch of friends and I was introduced to rocky road. I’d never tried it so obviously I ate way too much. As it turns out, one of the kids at party must have had a gastro bug and I ended up being sick for 3 days. To this day, rocky road still makes me nauseous. This same phenomenon can apply to pain particularly if we are exposed to it for an extended time. If you hurt your back picking up a heavy box and we’re in pain for several weeks, your brain establishes an association between that activity and your pain. To the point where, even without any tissue damage at the back, you can have pain just like I can feel sick eating rocky road without having gastro. 

Whats the answer?

The above examples are just a couple of basic ways that our brain influences our experience of pain on a neurological, biological and psychological level. The simplest way to combat the complex nature of chronic pain is to identify all the factors that contribute to your pain and to slowly break down the negative relationships and replace them with positive ones. Never give up and resign yourself to pain, there is always something that can be done! You just need to take the first step.

https://www.painaustralia.org.au/about-pain/painful-facts

https://www.tandfonline.com/doi/full/10.1185/03007995.2013.810615

Sacroiliac Joint pain
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