Chronic Pain

Chronic pain describes any pain that  persists for more tLim three months.

Pain is thought of as either;  

*Neuropathic: caused by disease or damage to nerves This is often described as shooting, burning, tingling.

*Nociceptive:  caused by actual or threatened tissue damage resulting in activation of pain receptors.  This is often localised, sharp, throbbing or an ache.  

*Nociplastic: pain that arises despite no evidence of any tissue or nerve damage or pain receptor activation

Pain is a learned response and can be influenced by biological, psychological and social factors. Pain is usually a protective mecLimism. However, when pain persists to become chronic pain, it can influence certain aspects of your life and function; what you can do, how you feel, your mood, energy and relationships.  

How do we manage chronic pain?

Pain

Our bodies are closely connected to the nervous system in our brain.  This is why pain makes us feel worse emotionally, but also why if we are stressed, anxious or depressed our pain can feel worse.  It can be a really frustrating process.

Experiences throughout our life also influence pain.  Trauma, child abuse and domestic violence can all influence the way our brain processes information and worsen experiences of pain.  These experiences do not cause the pain but they can make your brain more reactive to anything it perceives as a risk.  

Pain is a signal telling our bodies there is a danger in the environment.  This was an important form of protection when we were cavemen and had to run away from tigers or fight opposing tribes.  

Movement

It is important in chronic pain for you to remain as active as possible within a paced limit.  Our muscles weaken quickly if we are not using them which then causes us problems in other areas and more pain. Movement can also desensitise the problem area to pain thereby improving symptoms.

There are lots of different types of movement and variety is the best for our bodies.  Dr Lim will work with you to find the approach that is best.  For many people hydrotherapy (exercise in warm water) allows them to remain fit and strong without worsening their pain.  Yoga can also be very helpful because of the gentle stretching and breath work which helps to relax the body and the mind.    

Medical

There are many medical conditions that can cause chronic pain. Treating these pain may require first managing the underlying diagnosis. Different types of  medications can be used  to treat and manage your pain. These can include anti-depressants which work on certain pain conditions.  Some types of pain medication can also increase the pain that you experience over time, which is why it is important that we use medication in conjunction with non medication strategies that address movement and our minds.   As pain is complex, your treatment may include combinations of medication, interventions and non pharmacological inputs.

Non medication options include; Tens machines, psychological strategies such as meditation and relaxation, gentle exercises,

(These are considered medicated)

It is important to remember that medication is not the complete fix for chronic pain and that tackling mind and movement at the same time creates the best long term outcome and solution.  

I want help with my chronic pain.  What do I do?  

You can either book directly with Dr Lim, but for a higher rebate from a medicare you need to get a referral from your GP.  A referral letter will provide Dr Lim with more information about the investigations and treatments you have tried before as well as allow for Dr Lim to communicate with your GP.  Chronic pain is best addressed by a team that may involve;  GP, pain physician, psychologist, physiotherapist, exercise physiologist, occupational therapist and rehabilitation physician.

You will have a 45 minute initial appointment with Dr Lim, where he will address your chronic pain from a whole person perspective.  His questions will include asking about your childhood, your mental health, when your pain started, the impact it is having on your daily activities and what treatment you have tried so far.  This allows him to develop a plan that targets all aspects of your pain.   

Before the appointment you will also be given questionnaires to fill out which find out further information about the impact of your pain.  These take about 20 minutes and can be completed just before the appointment or sent out to you to do at home.

 

Helpful resources

Books

Explain Pain by David Butler and G Moseley

This is a easy to follow book talking about how pain is influenced by our thoughts, beliefs and context

The body keeps the score by Bessel van der Kolk

This is a detailed book aimed at health professionals or those who like stories mixed with research discussing how traumas including car accidents, domestic violence and child abuse can put people in a constant state of stress or numbness, leading to a host of physical problems including chronic pain.

Videos

Brainman chooses – towards an evidence based approach – YouTube

 

Websites

Hunter New England Pain Service 

Whole person flyer July 2023 (nsw.gov.au)

Balancing Health (nsw.gov.au)

 

Opioid facts.

Home page | Reach For The Facts

Non medication options include; Tens machines, psychological strategies such as meditation and relaxation, gentle exercises,

(These are considered medicated)

It is important to remember that medication is not the complete fix for chronic pain and that tackling mind and movement at the same time creates the best long term outcome and solution.  

Frequently Asked Questions

A specialist pain physician is a medical doctor with additional training in diagnosing and treating various types of pain conditions. You should consider seeing one if you have been experiencing persistent pain that affects your daily life and function despite trying other treatments.

Specialist pain physicians employ a variety of treatments to help manage pain, including medication management, physical therapy, injections (such as nerve blocks or epidurals), acupuncture, nerve stimulation techniques (like spinal cord stimulation), and psychological treatments like cognitive-behavioral therapy. The specific treatment recommended will depend on your individual condition and needs.

Opioids are not usually indicated in the treatment of chronic, non-cancer pain. Dr Lim will work with you to explore alternative treatments and develop a comprehensive pain management plan that may or may not include opioids, depending on the circumstances.

The timeline for experiencing improvement in pain can vary greatly depending on the underlying cause of your pain, the treatments being used, and individual factors such as your overall health and response to treatment. Some people may experience relief relatively quickly, while for others, it may take more time and adjustments to find an effective treatment regimen.

Chronic pain is often a complex and ongoing condition that may not have a definitive cure. However, with proper management and treatment, many people are able to experience significant improvement in their symptoms and quality of life despite persistent pain. Specialist pain physicians focus on helping patients learn to effectively manage their pain and regain function, even if complete elimination of pain may not be achievable.  Seeing a rehabilitation physician can also help reduce the impact on your day to day function and reach your functional goals