A focus on the importance of understanding your pain, with its impact on your life; and therefore the role of the physiotherapist in implementing coping strategies to help manage your pain.

Everyone has an understanding of pain, which is usually based on our own experiences, the experiences of those close to us, as well as ideas and information we get from wider society. When it comes to pain we often have a clear expectation of how much an injury or impact should hurt, where we should feel it and long it should last.

However, for many people this expectation is not met and pain does not behave they way we expect.

The cost of persistent pain on Irish society

There are a rare few people who are born insensitive to pain which can lead to an accumulation of injuries and problems that as a result in some cases can reduce life expectancy.

For a much larger group of people pain can become a constant feature in their lives by and large arriving without warning, affecting many areas of their body and lasting for a long time. This type of pain is called persistent pain and in Ireland a 2008 study found that over 20% of the population have had persistent pain for over 10 years.

Persistent pain has a huge impact on peoples’ lives affecting their mood, work, family relationships and moreover finances. It is also a very costly problem for the health service with the the same 2008 study estimating the total cost of persistent pain at €4.7bn per year, which at the time was 2.55% of GDP.

Learning how to manage your condition

We now know that pain is multimodal with a number of factors affecting our experience. The complexity of persistent pain as a condition can seem like the greatest hurdle in both assessing people looking for help with their pain, and working with them to improve their symptoms.

However, our understanding of how the body works in relation to how we experience pain is developing all the time. This new understanding is placing neuroscience education for people in pain as a core part of recovery. Allied to this are developments in exercise physiology and prescription in persistent pain. Along with management strategies for mood and sleep, these strategies offer a solid platform upon which to base recovery. Physiotherapists also play an important role in helping people with persistent pain.

A multi-disciplinary approach to treating your pain

The best framework to understanding and managing persistent pain is the bio-psychosocial framework. By understanding this very complex condition from a biological, psychological and social perspective we have the best chance of planning a successful recovery.

Acknowledging this complexity is very important because, in my opinion, there are usually no quick fixes for persistent pain; there are slower paced solutions, which involve planning and teamwork between the physiotherapist and the person in pain.

Implementing pain management strategies with your physiotherapist

The role of a physiotherapist is to listen to the person in front of them and identify the factors affecting the person in pain. Using their knowledge of pain biology, exercise, goal setting and problem solving a physiotherapist can help the person in pain understand their condition and develop a recovery plan.

It is important for a physiotherapist to explain the significance of the many tests and scans people may have had, ensuring that the management plan in place is the right one. Developing fitness, education and management strategies take time for people in all walks of life and it is no different for those suffering with persistent pain. A strong relationship between the person in pain and the physiotherapist is key to a positive outcome.

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Life with chronic pain can worsen our mental health; and in turn, poor mental health can worsen our perception of pain.

“Chronic pain can impact every facet of everyday life resulting in low self-esteem and loss of meaning. Patients often question what this new life with chronic pain will look like. Research shows a high comorbidity of chronic pain with depression and anxiety, but one, often overlooked issue, is grief. 

Many of those we support mention what they ‘used to’ be able to do and compare life with chronic pain with life before. For example, “Well, I was always the one everyone came to for help. How will I ask them?”, or, ”I used to be able to weed the whole garden, but now I can only manage 10 minutes, then I can’t do anything else for the rest of the day”.

There are huge losses associated with any chronic pain or health condition. Loss of hopes and dreams of the future. Similarly loss of identity or role in the family or at work. This loss of physical capacity and dignity are just a few.

While treating the physical problem is usually the main approach, life with chronic pain is complex and usually involves a psychological component. Often, what patients hear is that it’s, ‘all in their head’.

But what we think and feel impacts how we perceive pain, and life with chronic pain will impact our mental health. It’s vital that anyone with chronic pain addresses their mental health and allows themselves the time to grieve and adjust to life with a chronic condition. 

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The importance of pharmacists working with patients, doctors and hospital pain teams to ensure the most suitable pain care treatment pathway.

Pharmacists have a central role in counselling and educating patients in pain management. When pain killers are taken correctly, they can provide a useful option for responsibly managing pain. Pharmacists are experts in medicines. They are one of the first ports of call should be your local pharmacy if you are experiencing pain.

The ‘Pain Ladder’ recommends that patients always begin with the lowest form of appropriate pain-relief for the shortest amount of time for their symptoms in order to reduce the incidence of side effects and dependence, for example a simple paracetamol in the first instance.

Pharmacists can advise on pain relief medication

Pharmacists can provide advice on the strength and type of painkiller that is best for you. Depending on the type of pain you are experiencing.

They can also provide advice on your condition, the directions for use, the recommended dose, the precautions for use, if it is suitable with your current medicines and when the product should not be taken for both over the counter and prescription medicines.

Your pharmacist can help if you are not experiencing any relief from your symptoms after a number of days. Or, if you are experiencing side effects from taking painkillers you can revisit your pharmacist who will recommend a suitable alternative or refer you to the doctor.

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