When we are in pain, it is more than just the body that suffers. Pain is interpreted by the brain and is a subjective experience that makes it very difficult to distinguish between what pain is worse, or in fact the pain that one individual may feel compared with another. No two people can experience pain in the same way and the measurements or scale of a pain experience are almost impossible to clarify or measure accurately. Pain is a perceptual experience, meaning that it can be experienced by many systems in a co-ordinated and influential fashion.
Our understanding and definitions of pain in the 21st Century have moved slightly forward of the documented and referenced works of Livingston, Melzack and Wall over the 19th and 20th centuries. Advances in neurophysiology and neuroanatomy, the role of modulation in pain and the ability to image the brain and how it reacts to pain have helped us to redefine how pain is viewed, measured, assessed and ultimately treated. We now perceive pain differently from a linear model (Loesers model) to a more global and intricate model that encompasses the effect of emotions and stimuli. The International Association for the Study of Pain (IASP) goes further to explain that pain is also associated with our perception of an event and thus influenced by our past experiences. In this way, pain is specifically individualistic and different for each sufferer, making it almost impossible to differentiate or ‘measure’ between persons.
Chronic Pain is an issue that is being more widely explored in our current contemporary expansion and definitions of pain. The old attitude of ‘having a bex and a lie down’ no longer suffices in diagnosis in the contemporary realm and we are fast becoming more atune to the nature of chronic pain and the social and fiscal effects it has on us as a society. “In 2018, chronic pain cost an estimated $139 billion in Australia” Australian Institute of Health and Welfare.
Chronic pain is defined as pain that lasts longer than 3-6 months or beyond the normal perceived period of time for recovery. It has an ongoing effect of a debilitating nature, preventing sufferers from being able to commit to work, social engagements and daily activities. The effects of this can result in social isolation, financial hardship and ongoing and expensive health care. The true nature of chronic pain vs acute pain is best described by the work of Serge Marchand, PhD, an expert in pain mechanisms. He talks about how ‘acute pain plays a protective role and acts as an alarm, enabling us to recognize that there is a problem. Conversely, chronic pain does not play a protective role if it persists long after the triggering event is resolved’
Our understanding of someone’s experience is perhaps becoming more varied and broad. GP’s in Australia are seeing a rise in patients with chronic pain conditions and complaints with an increase of 67% over the past 10 years. Diagnosis of these conditions is becoming more widely recognised. Conditions that fall into this category include alcohol and smoking related illnesses, diabetes, Alzheimers and Cancer treatments but also less
We now have come to realise that people with chronic pain are ‘more likely to experience mental health conditions, including depression, anxiety, sleep disturbance and fatigue’ (Painaustralia 2019a). The ability to focus, be cognitive, and process information is all affected by chronic pain as well as getting sufficient rest and restorative sleep. These debilitating factors often render a chronic pain sufferer unable to cope with daily actions and social responsibilities. The cost of these conditions in 2018 in Australia was estimated at $139 billion ($48.3billion on lost productivity and $12.2billion for direct health system costs - Chronic Pain in Australia (AIFW Report;16Apr2020Edition) Those most likely to suffer from these conditions include women, those in a lower socioeconomic demographic and already be suffering from a medical condition.
So how do we treat it? Chronic pain is often managed by medication including opioids and NSAID’s. This effect has an expensive cost to the community and can result in further issues of addiction and increasing use of medications without necessarily solving the issue. A combination of therapies have been seen to have more far reaching effects. Surgical interventions include spinal blocks and even BOTOX have been recommended as more aggressive forms of therapy. Electrical therapy and nerve stimulation have also been used to advance the reduction in pain symptoms. Physical therapy and exercise are also recommended to relieve the physical symptoms of chronic pain and recovery from past injuries.
Increasingly psychological and alternative therapies are being employed to address the Central Nervous System effects of pain. As our understanding of how pain is ruled by nervous system stimulation, these approaches are fast gaining momentum in treating the neurological aspects of chronic pain. Acupuncture, massage, chiropractic techniques are all aspects of treatment that have been utilised to treat the conditions as well as biofeedback techniques and hypnosis. Whilst scientific evidence is still out on these techniques they are being explored as part of the co-ordinated approach to pain management.
Oddly meditation a]practices are known to have documented results on managing pain conditions and having a beneficial result in reducing the stress, anxiety and mental issues that often accompany chronic pain. Even dietary and nutritional advice is being explored in limiting inflammatory agents such as a high meat intake or high fat intake into the digestion and thus reducing the amount of inflammation in the body that can ignite pain symptoms.
The awareness of chronic pain in medical fields is becoming much more widely diagnosed than previously considered and an increase in investigation into the subjective nature of pain is also leading to a more concilatory approach to chronic pain. Often it’s about exploring what you can do with treatment rather than what you can’t or shouldn’t do. There is an active approach to pain management that needs to come from the practitioner/patient relationship and this can often have good results, especially when that practitioner has a multi disciplinary approach. No doubt as we begin to understand the mechanics and definitions of pain in the contemporary medical field, our broad definition and understanding of pain will encompass these conditions and help to waylay some of the costs that they incur on us as a society.
