What are my options for managing chronic pain?

Chronic pain is a common condition that affects 1 in 5 Australians aged over 45 years. Chronic pain can be difficult to cope with on your own. Your doctor can help you develop a tailored plan for managing your pain.

Medicines alone are not the most effective way to treat chronic pain. It is best managed using a combination of different approaches. These might include pain-relief medicines, together with other management options, such as:

• physiotherapy
• relaxation techniques
• other stress management techniques

People who actively manage their pain in these ways see more improvements in their mood, health and ability to function, compared with people who only use medicines to manage their pain.

Physical therapy

When you experience chronic pain, it might seem natural to avoid too much standing, bending or moving around. However, exercise and stretching can often decrease your pain and improve your ability to function.

If you are less active over time, you may start to lose muscle mass, flexibility, and strength. This makes it more difficult to carry out regular daily activities, especially as you become weaker as time goes on.

Physiotherapists and exercise physiologists can help teach you how to move your body safely. It can also help to pace yourself throughout the day by doing tasks in smaller steps, rather than all at once.

Psychological therapy

Mood and mindset can influence the way people experience their pain. Psychological techniques, such as cognitive behavioural therapy (CBT) and mindfulness, can help you limit or eliminate unhelpful thoughts. This may change the way you behave in response to pain.

It's helpful to include mood and social goals in your pain management plan. For example, one goal that a person might set as part of psychological therapy is to spend 30 minutes a day socialising with friends or family.

Mind-body therapies

Mind-body therapies include yoga, relaxation and meditation. These therapies can help you to reduce your stress levels, which may in turn reduce your experience of pain. Yoga and Tai Chi can also be a part of your physical therapy program.

Other therapies

Because everyone's experience of pain is different, individuals need different treatment plans to help manage their own chronic pain.

As well as the above, some complementary therapies may be useful:

• Learn strategies to improve your sleep, which can help improve your ability to function well during the day and feel less pain.
• Join a support group, where you can share your experiences and hear how others in similar situations manage their pain.
• Seek advice from an expert in pain management.

Watch this video from NPS MedicineWise: Australians talk about their experiences with a range of different pain management options.

What is the role of medicines in managing chronic pain?

In some cases, medicines can be helpful in managing chronic pain. These could include over-the-counter (OTC) medicines, supplements and prescription medicines. You can buy OTC pain medicines, such as paracetamol and ibuprofen, without a doctor's prescription.

Before taking any pain medicine (even OTC medicines), talk to your doctor or pharmacist. They can advise whether the medicine is suitable for you, and whether it's likely to help you manage your specific type of pain.

Some people find helpful other medicines helpful, including:

• Antidepressants — some medicines that are used to treat depression, such as amitriptyline, are also sometimes prescribed by doctors to reduce pain.
• Anticonvulsants or antiepileptic medicines — medicines commonly used to treat epilepsy can also help manage nerve pain. They include pregabalin and gabapentin.

In Australia, these medicines are only available with a doctor's prescription.

What medicines are not recommended to treat chronic (non-cancer) pain?

Opioid medicines (such as oxycodone, morphine and codeine) can be used to treat:

• acute (short-term) pain, such as pain after surgery or an injury; or
• chronic pain for people with cancer

It's important to remember that opioids are not recommended to help people with chronic, non-cancer pain.

Using prescription opioids for an extended period of time can be dangerous and may be addictive.

Evidence shows that the longer a person takes an opioid, the less pain relief they will receive. This is because the body gets used to the dose of opioid that's being taken — known as ‘tolerance'. When a person has tolerance to opioid medicines, they need higher doses of the medicine to feel the same effect. But higher doses also increase the risk of serious side effects.

Long-term use of opioids can also make someone more sensitive to pain. This is known as ‘opioid-induced hyperalgesia'.

What is interventional pain management?

Your doctor may recommend interventional pain treatments if you haven't responded well to other pain management methods. These treatments are usually recommended after consultation with a pain specialist.

Your doctor or pain specialist can discuss the risks and benefits of these treatments and whether they're suitable for you. In most cases, interventional pain treatments provide short-term pain relief. During the period of relief, you can modify your lifestyle and develop good habits. This makes it easier to cope with chronic pain if it returns.

Interventional pain treatments for chronic pain include a range of options:

• Transcutaneous electrical nerve stimulation (TENS) — This is a battery-operated stimulator sends a pulse of energy through the skin at the site of your pain.`TENS can help manage a range of pain types, including back and neck pain, arthritis, migraine headaches and post-surgery pain.
• Spinal-cord stimulation — Similar to TENS, this involves placing an electrical device under your skin near the spine. The device applies a current to the spinal cord, which interrupts the pain signals being sent to the brain. A hand-held control allows you to adjust the intensity of the charge.
• Radiofrequency ablation — This is a procedure performed by a doctor that targets joint- and nerve-based chronic pain. Needles are placed onto the nerves responsible for the pain, and the tip of the needle is heated. This interrupts the signals to the brain.
• Nerve block — This intervention is used to treat intense chronic nerve pain. A local anaesthetic is injected to stop the nerves from sending pain signals.
• Epidural injections — Medicines such as corticosteroids and/or local anaesthetic can be injected in the space around your spinal cord to reduce pain.
• Surgery — Some types of chronic pain may respond to surgical treatment.

When should I see my doctor?

If you have chronic pain, you should ask your doctor about the pain management options that could be suitable for you.

Chronic pain is best treated using a combination of physical therapies, relaxation techniques and stress-management strategies. Your doctor can help you create a chronic pain management plan that includes some or all of these methods.

Resources and support

• Call 1300 MEDICINE (1300 633 424) to talk about the medicines you are taking for your pain.
• Discuss your pain on the Pain Link telephone helpline (1300 340 357). These helpline volunteers have personal experience of chronic pain.
• Go to Painaustralia to find pain services and programs in your area.
• Learn more about how chronic pain can be managed on the Chronic Pain Australia website.