Pain has important medical consequences because
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If a person is not breathing, or if they are unresponsive, seek help straight away. Call triple zero (000) and ask for an ambulance. Show Key facts
What is chronic pain?Chronic or persistent pain is pain that lasts for more than 3 months, or in many cases, beyond normal healing time. It is different from acute pain, such as pain from an injury, which develops quickly and doesn't usually last for long. Chronic pain is a complex condition, and everyone experiences it differently. The pain can range from mild to severe and is experienced on most days. What causes chronic pain?There are different types of chronic pain, including nerve pain, pain caused by a bone, muscle or joint condition, as well as pain due to cancer. Chronic pain can also be caused by illnesses such as migraine, osteoporosis, arthritis and other musculoskeletal conditions, or after an injury or surgery. Sometimes there is no apparent cause of chronic pain. 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. Acute pain can develop into a chronic pain condition if left untreated or if the acute pain is poorly treated. The longer pain remains untreated, the greater the risk of pain becoming chronic. If you are concerned about your pain, talk to your doctor. ASK YOUR DOCTOR — Preparing for an appointment? Use the Pain Question Planner to prepare for your doctor’s appointment. Living with chronic painChronic pain can make it hard to work, take care of yourself and do the things you enjoy. It can also affect your sleep and mood. More than half of Australian adults with chronic pain become anxious or depressed because of their pain. It's important to treat this if it happens to you. Just as pain can affect your mood, improving your emotional health and wellbeing can also help you manage your pain. Watch this video from NPS MedicineWise: Australians talk about their pain experience and the impact that pain has had on their lives. Managing chronic painMedicines alone are not the solution to managing chronic pain. If you have chronic pain, you will also need other treatments such as self-management, physical activity and psychological approaches. People with chronic pain who actively manage their pain on a daily basis do better than those who rely on passive therapies such as medication or surgery. Most people benefit from a range of different treatments and self-management, including: Talk to your doctor about developing a plan for managing your chronic pain. You will probably see several health professionals as part of the plan. FIND A HEALTH SERVICE — The Service Finder can help you find doctors, pharmacies, hospitals and other health services. Medicines can play a role in managing chronic pain and include: Opioids are not usually recommended for chronic pain, unless it is caused by cancer. Long-term use of opioids is potentially harmful, including accidental fatal overdose, life-threatening breathing problems, dependence, tolerance and addiction. Their long-term use of opioids can also make a person more sensitive to pain — known as ‘opioid-induced hyperalgesia’. Sometimes, medicines won’t relieve all your pain symptoms. But the aim of managing chronic pain is to stop pain from disrupting your life so that you can resume doing the things you enjoy, such as socialising, working and being active. You might also consider being referred to a pain management program at a pain clinic, available in most major public hospitals and also privately. Your doctor can help you arrange this.  Dr. Scott Strassels of the College of Pharmacy wants people to speak up about pain and says the first step is to begin a national conversation among patients, health care providers and related organizations. Because pain is highly subjective, it is important for doctors to trust what their patients tell them. “Many of us don’t know what to expect from pain relievers or how to best advocate for ourselves and our loved ones who have pain,” said Dr. Scott Strassels of the College of Pharmacy. Untreated or undertreated pain can rob people of the ability to function and can cause depression, irritability, sexual dysfunction and disruptions in sleeping, eating and mobility, according to Strassels and Dr. Eun-Ok Im of the School of Nursing. Proper treatment can help return people to their lives. Pain is one of the most common reasons for which individuals visit the doctor. Yet many health care providers do not receive adequate training on how best to care for people with pain, Strassels and Im said, adding that health providers also are often unfamiliar with how best to use the wide array of pain-relieving strategies available. “The result is unnecessary suffering with myths and misplaced fears about pain and pain relievers being reinforced at all levels of society,” said Strassels, assistant professor in the Division of Pharmacy Practice. When prescribed appropriately by knowledgeable health care providers and taken as directed, prescription pain medication can make a tremendous difference for people suffering from pain, he added. Even with all the descriptive and colorful words, it is surprisingly difficult to describe how pain feels because each of us experience pain differently. School of Nursing researcher Dr. Eun-Ok Im says more than 80 percent of cancer patients experience pain during the course of their illness or treatment, but the pain is often undertreated. She has developed a computer program to help oncology nurses better manage the pain of their patients. In other words, on a 0-to-10 pain scale, one person’s two can be another person’s 10. Because it is highly subjective, it also is a challenge for the health care provider to evaluate. “People may have pain even if they are not able to communicate it,” Strassels said. “The subjectivity of pain is part of what makes pain so difficult to treat and explains why it is so important that clinicians accept patients’ reports of pain.” Strassels was among six pain management experts from the United States and Canada who received Mayday Pain and Society Fellowships last fall. The fellowships provide leaders in pain management with tools and skills to advocate on behalf of better treatment for pain. Strassels wants people to speak up about pain and says the first step is to begin a national conversation among patients, health care providers and related organizations. He has been working with Paul Christo, a doctor at Johns Hopkins University School of Medicine, and Bonnie Stevens, who teaches nursing at the University of Toronto, in spreading the word about good pain management. One such step already is under way. The Joint Commission on Accreditation of Healthcare Organizations has introduced a “Speak Up!”campaign to encourage patients to talk about their pain. Also, in its “Roadmap for Medical Research,” the National Institutes of Health (NIH) calls for reengineering the way health care providers respond to patients’ pain and other symptoms. Im, too, believes education about pain management should be a priority for the nation’s health care system. Her research on cancer pain, funded by NIH, has dealt with gender and ethnic differences in cancer pain experience. “Erroneous assessments and subsequent undertreatment and mistreatment of cancer pain disproportionately affect women and ethnic minorities,” said Im, who holds the La Quinta Motor Inns, Inc. Professorship in nursing. She points out that there have been very few studies on the subject of gender and ethnic difference in cancer pain experiences.
Strassels and Im believe health care providers of all types must be comfortable with pain management tools. “We actually have good, safe pain medications and not all of them make you feel ‘fuzzy,'” Strassels said. “And, people can have optimal pain management–including use of potent drugs like morphine and codeine–without intolerable adverse effects. But medicines are tools just like anything else.” Strassels and other pain management specialists worry about those who think pain relievers are a necessary evil at best, and at worst, habit-inducing substances to be avoided at all costs. Media coverage of high-profile celebrities’ alleged misuse or abuse of prescription medication further increases the stigma faced by legitimate pain patients or increase barriers to these important medications. “But what many people don’t understand is that pain itself can cause harmful side effects and can affect concentration and mental clarity just as profoundly as any drug,” Strassels said. “People with pain have a right to timely and appropriate pain care. There is a relatively small percentage of patients who are using drugs inappropriately.” Strassels has conducted several studies on pain at the end of life and after surgery. He also has been involved with research on other pain reliever interventions like corticosteroid injections and nerve blocks that can be used alone or in combination with pain-relieving medications. Non-drug treatments, including acupuncture, massage, yoga and meditation also help people with pain.
Total pain relief is desirable but sometimes reducing pain to a tolerable level is more realistic, Strassels said. Depending on the type of pain, an interdisciplinary approach is often useful, he said, adding that treating pain at its onset is more effective than waiting until it worsens. Before Strassels came to the university, he worked as a hospital pharmacist and began to see first-hand evidence of poorly treated pain. He remembers a man undergoing lung surgery and how hard it was to get his pain under control. “Pain management after surgery is particularly vital,” Strassels said. “If a person’s pain is undertreated, he or she is less likely to want to get up and moving. Then, you’re asking for more problems like possibly developing pneumonia or having an increased risk of developing persistent pain.” Undertreatment of pain also can contribute to higher costs directly by lengthening hospital stays, he said. There are several factors that contribute to poorly managed post-operative pain. Clinicians’ may have mistaken attitudes and beliefs about adverse effects and addiction. Patients may believe they should not complain about pain, they may be concerned about addiction or believe pain is to be expected and is not treatable. Clinicians’ also may fear legal action for aggressive treatment of pain. Another barrier to good pain management is that some people do not tell their doctor they have pain because they want to be “good patients.” “They may not want to bother the doctor with complaints. Or they also may have a fear of what the pain means,” said Strassels. “Does it mean my disease is getting worse, has the cancer come back?” How to Describe Pain to Your DoctorWe have a lot of words to describe pain. Scott Strassels suggests you use them when talking to your doctor. Other tips to maximize your appointment:
More information about pain can be found at these sites:
To improve patient care, Im has developed a computer program to help oncology nurses better manage the pain of their patients. Her decision-support computer program will assist nurses in dealing effectively with gender and ethnic differences in cancer pain experience based on cancer patients’ own views and experiences. “Managing cancer pain effectively, economically and responsibly is a growing challenge that can be aided by technologies, ultimately helping oncology nurses make decisions about care,” Im said. “More than 80 percent of cancer patients experience pain during the course of their illness or treatment, but the pain is often undertreated.” In her research, Im has found strong ethnic differences in cancer pain intensity. Each ethnic group displayed a unique cancer pain experience. Asian participants, for example, had significantly lower cancer pain scores than those of Hispanic and white participants. African American participants had significantly lower pain scores than Hispanics and whites. “The low pain scores do not necessarily mean that they rarely experience pain,” said Im. “Rather, they often exhibit stoicism toward pain. Asians, for example, highly value stoicism and many times want to be considered ‘good patients’ by health care providers.” In addition, misconceptions about powerful pain relievers, including that they shorten life and cause addiction, have been reported to be common among Asians. This also makes them reluctant to manage their pain as does their sense of reported fatalism about cancer pain. The study showed that Hispanics had the highest functional status, meaning they are functioning in their daily lives better than other ethnic groups. The reason for high functional status among Hispanics is due in part to strong family support, Im said. All in all, pain is an integral part of being human, Strassels said. “But fear of side effects is not a good reason to avoid pain-relieving medications,” he said. “Our hope is that people who suffer from pain will come to understand that you don’t have to choose mental clarity or pain relief. You can have both.” What are the effects of pain?Pain acts as a survival signal for the brain: it signals the brain to prepare for fight or flight. In response, the brain changes physically and chemically. This is coupled with changes in the body like increased heart rate, prioritization of blood flow to the muscles, and other stress responses.
What happens if pain is left untreated?Untreated or undertreated pain can rob people of the ability to function and can cause depression, irritability, sexual dysfunction and disruptions in sleeping, eating and mobility, according to Strassels and Dr.
How does pain affect a patient?Pain itself, and the fear of pain, can cause you to avoid both physical and social activities. Over time this leads to less physical strength and weaker social relationships. It can also cause further lack of functioning and pain.
Why is it important to treat pain before it gets severe?And pain can make it hard to eat and sleep, which can make other symptoms worse. Pain causes distress and suffering for people and their loved ones. Pain can also increase blood pressure and heart rate, and can negatively affect healing. Managing the pain helps ease suffering.
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