Chronic Pain

A high percentage of our patients come to us with chronic pain. We do have great success and they do get better.

What is chronic pain?
Chronic, persistent or long-term pain is pain continuing beyond 3 months or after healing is complete. Affecting adults and children, it may arise from tissue damage or inflammation or have no identified cause. It can affect a specific body area (e.g. Complex Regional Pain Syndrome, low back pain (LBP), pelvic pain) or be widespread (e.g. fibromyalgia).

Chronic pain is a complex condition with physical, social and psychological components, which can lead to disability, loss of independence and poor quality of life. It is helpful to understand the differences between chronic, persistent pain and acute pain.

Acute, short-term pains
act as an alarm, telling us that something is wrong. While most minor pains are easily treated and quickly forgotten, others are a sign of something more serious that we shouldn’t ignore. For example, the pain of a broken leg is helpful because it makes us rest the leg until it heals.

Chronic, persistent pain though often serves no useful purpose. The pain messages linked to long-term conditions such as back pain or arthritis are not helpful and can be annoying and sometimes devastating. Over time, the pain may affect how we function, including our ability to work and our sleep patterns. It can also have a negative effect on our family and friends. The causes of chronic pain are not always clear but in some conditions, the pain is thought to be due to the pain signals through the nerve fibres becoming confused.

The brain is then unable to understand the signals properly. Chronic pain can affect any part of the body and people of any age, including children. The nerve network associated with chronic pain is also linked to those parts of the brain concerned with emotions. So, pain can affect our emotions, and our emotions can affect our pain. If we are angry, depressed or anxious, for example, the pain often feels worse. If we are feeling positive and happy, we may experience less pain and will often be better able to cope. Pain then is never “just in the mind” or “just in the body”, but a complex mix affecting our whole being.

How is pain managed?

If your pain persists and becomes chronic then the emphasis might shift more to managing the condition and minimising its impact on your life, rather than necessarily finding a cure. Research shows that the causes of chronic pain are complicated and can be hard to resolve. Some treatments are available which can reduce the pain intensity. For example, you might be prescribed medication, from simple pain-killers to more complex drugs. Other treatments to help reduce the pain include “hands-on” treatments, massage and acupuncture, although the benefits of these treatments tend to wear off after each treatment session. Another way of managing long-term pain is to find ways to reduce the impact of the pain on the overall quality of life.

This might include learning relaxation techniques, developing goal-setting skills, and learning ways of improving sleep quality. You could be referred to a specialist pain clinic or a specific pain management programme. Some pain clinics have teams of expert healthcare professionals including doctors, psychologists and physiotherapists. However, pain clinics are not available in every area.

How can I help myself?
Everyday activities such as walking, swimming, gardening and dancing have been shown to improve wellbeing for people with chronic pain. Exercise helps by increasing levels of chemicals known as endorphins which occur naturally in your body and act as pain killers. Exercise can also help relieve tension and stiffness in your muscles, ligaments and joints: all of this helps to keep the body more functional. If you increase your activity gradually you can help relieve problems such as stiff joints and weight gain, and reduce the risk of heart disease, osteoporosis, poor balance and falls. Relaxation techniques can help to reduce persistent pain, can reduce muscle tension, and can help to improve broken sleep. There are many types, including breathing exercises and meditation.

There may be local classes available, perhaps through your local pain clinic. Ask your physiotherapist, GP or other healthcare professional for advice. Pain can send you into a downward spiral of fatigue, low mood and anxiety. Talk to someone who understands what you are going through. Several organisations have helplines staffed by people living with chronic pain and they can also put you in touch with local support groups. It can help to see a counsellor or psychologist.

Your GP can advise you about where you can find help. Try distracting yourself from the pain with an activity that you enjoy. Many hobbies such as photography, sewing or knitting can be done even when your mobility is restricted. Many people find the pain is worse in bed, but sleep deprivation can add to the problem. Give yourself the best chance of a good night’s sleep by going to bed at the same time each evening, getting up at the same time each morning and avoiding taking naps during the day. If sleep problems persist, speak to your physiotherapist, GP or other healthcare professional.

Keeping in touch with friends and family is good for your health and well-being. If getting out and about is difficult, try shorter visits, perhaps more often. If you can’t get out, phone a friend, invite someone round for a coffee or have a chat with your neighbour. Aim to talk about anything other than your pain.
Cost of chronic pain

Pain is the second most common reason for claiming incapacity benefit, costing £3.8 billion annually £584 million a year is spent on prescriptions for pain. Annual healthcare costs for patients with chronic LBP are double those of matched controls (£1,074 vs. £516).

​Recent Physiotherapy in hospitals, clinics and the community aim to achieve healthy levels of activity and self- management for people with chronic pain.
Clinical and cost-effectiveness evidence supports using a cognitive behavioural approach addressing both physical limitations and people’s beliefs about, and understanding of, their condition.
People with multiple health issues or whose pain is causing significant physical, psychological or social problems may require management by a multidisciplinary pain service.
Specialist physiotherapists identify reasons for lack of progress in rehabilitation, such as fear avoidance of movement or unhelpful patterns of over-and under-activity. GP referral to services for advice and exercise improves outcomes and is cost-effective.

Using a risk-stratification tool and providing risk-matched treatment improves the condition, shortens time off work, reduces sickness certification and healthcare costs. ​Manual therapy or acupuncture produce short term benefit but evidence supports the use of active treatments such as therapeutic exercise. Multidisciplinary pain management programmes (PMP)(including physiotherapy are an effective intervention for people with chronic pain and cost-saving compared to physiotherapy alone.

25% of people with chronic pain lose their jobs.

Physiotherapy supports and enables people with chronic pain to remain in or return to work. Mindfulness and acceptance & commitment therapy (ACT) have been shown to be as effective as cognitive behavioural therapy (CBT) and are used in some centres.

Physiotherapists can signpost people to online and community resources to support ongoing self-management. Increasingly physiotherapists use prescribing skills to optimise medication use.

How can physiotherapy help?
Physiotherapists often see patients with chronic pain on an individual basis. Your physiotherapist will assess you and work with you to agree a treatment plan. A specific manual treatment such as massage or soft tissue mobilisation may be appropriate. However, treatment is more likely to include advice about movement, posture and finding ways of achieving your goals.

A physiotherapist can also identify practical ways to help, such as making sure you have the correct equipment or the right shoes. Physiotherapists also see patients at a pain management clinic, working as part a specialist team. This is more likely to be a group session.

It is important to have regular reviews with your physiotherapist and ask to see them if your condition changes

What will happen when I see a physiotherapist?
Your physiotherapist will assess your condition and difficulties, give you advice and perhaps offer you a physical treatment. You might need to remove some clothes so that the physiotherapist can see your movement and muscle activity that may be contributing to your pain, so it’s a good idea to dress comfortably and wear suitable underwear.

The conclusion on chronic pain
Chronic pain can impact significantly upon physical, emotional and social wellbeing. Physiotherapy utilising a broad scope of practice can safely and cost-effectively support and guide people with long term pain towards the best possible quality of life.

  • Chronic back pain affects 1.6 million adults per year…
  • 7.8 million people in the UK live with chronic pain
  • Chronic pain accounts for 4.6 million GP appointments per year.
  • 25% of people with chronic pain lose their jobs
  • Contact us for more information or to discuss your situation

Acknowledgements:  ​Information from The CSP and ​Executive Committee of the Physiotherapy Pain Association (PPA)