Up to 90 per cent of us will experience musculoskeletal pain at some point in our lives. For one in five Australian adults it becomes chronic, meaning it doesn’t just resolve itself within a few months.
Distressing as it may be, chronic pain won’t kill you. At least, that’s the refrain of many health practitioners.
We need to rethink the way we treat chronic pain, say the authors of a new study.Credit:iStock
New research by the University of Sydney has challenged that notion and suggests that our attitudes to pain may be causing us harm.
The study, published EClinicalMedicine, looked at nearly 200,000 people with chronic musculoskeletal pain, including back pain, albany new york pharmacy neck or shoulder pain, hip pain, osteoarthritis, and fibromyalgia.
It found that, compared to people without pain, those with musculoskeletal pain had a much higher risk of dying prematurely. The more areas of pain in the body, the higher the risk. So, in people with pain in four areas (shoulder, neck, back, and knee, for instance) the risk was 46 per cent higher.
The researchers wanted to understand the extent lifestyle behaviours might mitigate the risk or be to blame.
So, they adjusted for adequate physical activity levels, stopping smoking, moderating alcohol intake and avoiding regular opioid use and found the risk decreased.
“At least half of the association of chronic musculoskeletal pain with increased premature mortality may be accounted for by healthy behaviours,” said the lead author, Lingxiao Chen, from the Faculty of Medicine and Health at the University of Sydney.
Chen says it suggests that supporting healthy behaviours and stopping opioids from being prescribed “is an important strategy to decrease the premature mortality risk associated with chronic musculoskeletal pain”.
Currently, about 20 per cent of Australians with pain are prescribed at least one opioid.
Professor Paulo Ferreira, a physiotherapist and pain expert at the University of Sydney, says most people believe that pain medication and rest are the best ways to manage chronic pain, but their research suggests the opposite is true.
What is chronic pain?
According to Health Direct, normally, if you have an injury, nerves carry signals from the injured part of your body to the brain, telling the brain that there’s a problem. The brain reads these signals as pain. But when someone has chronic pain, the nerves that carry pain signals to the brain, or the brain itself, are behaving in an unusual way. The nerves might be more sensitive than usual, or the brain might be misreading other signals as pain.
“We don’t want to alarm people,” he says. “We are trying to fight the concept that musculoskeletal-pain means staying in bed. The general public doesn’t know that, and they still enter a very wrong course of care most of the time… [They are often prescribed opioids] for their pain and that’s where the danger is. That’s where the odds of dying do increase.”
GPs who are “under the pump” and only have 15-minute consultations may simply prescribe pain medication and, perhaps, a referral to get an X-Ray because “they don’t have a lot of time to discuss lifestyle interventions”, Ferreira adds.
And while rest and medication are valid treatments for acute pain – if you fall off a ladder and break your back, for instance – and for pain caused by cancer, opioids are unhelpful for chronic pain and “cause unwanted harm”, says Professor Mark Hutchinson from the School of Medicine at the University of Adelaide.
Chronic pain is a complex problem where there is interplay between body, mind and environment, meaning that anxiety and fear as well as financial, work or family stress can exacerbate pain while chronic pain can also exacerbate psychological distress.
Then how do we treat it?
“We now know you can’t separate the sensory experience of pain from the emotional experience of pain,” says Hutchinson, who was not involved with the new study. “And if you can’t separate that, that means your mind and body are connected… poor life choices are experiences of the mind and the body.”
So, he posits, there must be a multidisciplinary approach to treating it, which includes a physiotherapist, occupational therapies, psychologists, counsellors, surgeons, pain specialists and GPs.
“There is not a single medicine fix,” says Hutchinson, who says we need a national centre or alliance for pain solutions. “It’s going to be physical activity… ‘A prescription from your doctor that you need to take exercise’… and it might be coming off all of your meds and ‘let’s talk about some psychological practices’ – it’s not just a feel-good thing, it changes the brain structures, it changes how our body responds.”
“Exercise gives patients a sense of increasing function… and a small increase in function has a very strong psychological effect.”
Ferreira agrees: “Cognitive behavioural techniques where we support patients to take small steps into getting out of that cycle can be helpful because pain is encrypted on people’s mind and the perception of pain is increased.”
He adds: “For most cases, the most effective, evidence-based treatment is exercise. That’s true for back pain or knee osteoarthritis – the two-most common musculoskeletal pain conditions.”
The best type of exercise is whatever is easiest and most enjoyable for the individual, he says. A physiotherapist can help to create a program or people can access free programs through government-funded programs like Get Healthy NSW.
“Exercise gives patients a sense of increasing function… and a small increase in function has a very strong psychological effect,” Ferreira explains. “All of a sudden, they go ‘I’m not going to focus on my pain, I’m going to focus on my function’.”
It’s about empowering the person and also acknowledging that we need to rethink the solutions to it because pain is a huge problem, says Hutchinson: “My mantra has always been ‘you don’t die from pain, you live with it’ but this data is saying no you do die from it… Pain is not just going to go away… it is central to the problem that we are facing in the health system.”
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