Chronic pain (mamaenga roa) is pain that lasts longer than 3 months. It is also called persistent pain or long-term pain. It is often described as pain that does not go away as expected after an injury or illness.
- About 1 in 6 New Zealanders live with chronic pain and no two people are affected in the same way.
- Chronic pain can range from mild to severe and can continue day after day or come and go.
- Chronic pain is thought to occur when nerves become over-sensitive and send warning messages to the brain even when there is no injury, or the original injury causing pain has healed. In other words, ‘the fire has been put out, but the fire alarm is still going off’.
- Chronic pain is complex and can be difficult to treat. Chronic pain can be distressing and can impact on your emotional and physical wellbeing. The aim of treatment is to find ways to support the person with pain and reduce the impact of the pain on your life.
- Medicines alone are not an effective way to manage chronic pain because of the harmful side effects of using them on an ongoing basis. Rather, non-medication treatments and strategies for helping you cope with your pain and come to terms with it are more effective.
How is chronic pain diagnosed?
Effective management of chronic pain requires a comprehensive assessment of your pain and its impact on your life. This may include assessments by a psychologist, pain medicine specialist, physiotherapist, social worker or occupational therapist.
There is no one specific test or scan that can diagnose persistent pain, so it can often take some time to determine what is going on.
To help with the diagnosis, your doctor will want to know about such things as when your pain started, where you feel the pain, what your pain feels like, when it is worse and what, if anything, makes it feel a bit better. See describing your pain for more information.
What are the symptoms of chronic pain?
Everyone feels pain differently and your experience of chronic pain may be different. It is usually described as pain that does not go away as expected after an illness or injury. The pain can be shooting, burning, aching or electrical in nature and can lead to discomfort, soreness, tightness or stiffness. Having ongoing pain can be distressing and often leads to other symptoms, such as:
- fatigue, which can cause impatience and a lack of motivation
- trouble sleeping, often because the pain keeps you awake during the night
- not being active and an increased need to rest
- a weakened immune system, leading to frequent infections or illness
- low mood and feelings such as hopelessness, fear, anxiety and stress
- disability, which may include not being able to go to work or school or perform other daily activities.
Chronic pain cycle
Chronic pain is often described as a cycle where your pain causes feelings of anxiety, low mood, fatigue and sleeplessness, which results in increased pain. The increased pain then causes you to have more low mood, tiredness and stress, so you can get caught in an endless cycle. The good news is that means there are a number of ways you can approach managing chronic pain to get improved wellbeing.
How is chronic pain treated?
Chronic pain is complicated and not easily cured. The goals of treatment are to reduce your pain and increase your ability to do the things you want to do. While medications are a useful option for treating short-term pain, they are not very effective in treating chronic pain and when used in the long-term, can have more side effects. Fortunately, there are a number of other strategies to help you live well with pain.
(Health Navigator NZ, 2018)
Learn to accept the pain
This can be a difficult idea to get your head around but it can really help. By accepting that the pain isn’t going away and shifting your focus onto what you can do about it instead, you can start to regain a sense of control over your situation.
Change the way you think about pain
Three months after an injury, any pain that remains is no longer a response to tissue damage. Instead it is like a song playing over and over in your brain. To help change the song, or turn the pain volume down, you can retrain your brain to respond differently to it. Instead of reacting to the pain, you can learn to respond:
- with reassuring thoughts about it not causing you harm
- with positive thoughts about what you can do to manage the pain at that moment.
For most types of pain, moving more and getting more exercise such as walking, swimming and gentle stretching can help improve muscle strength and reduce pain and stiffness. Try to keep moving throughout the day, rather than having long periods of inactivity followed by short bursts of doing a lot.
Ask your doctor, nurse or physiotherapist to help you create a plan for regular physical activity.
Avoid doing too much in one go on ‘good days’ then feeling so tired you have to rest all afternoon. Instead, try doing your tasks in stages with rest breaks.
Certain triggers can make your pain worse. Examples of triggers include alcohol, anxiety and stress, poor sleep habits, negative thinking and over-exertion. Identifying your triggers will help you know what you can do to reduce your pain.
Identify strategies to help you manage stress
Emotional stress and physical pain are closely related, and persistent pain can lead to increased levels of stress. Learning how to deal with your stress in healthy ways can help you to cope more effectively with your chronic pain. Eating well, getting plenty of sleep and engaging in approved physical activity are all positive ways for you to handle your stress and pain.
Engaging in activities you enjoy will help take your mind off your pain and can help reduce stress, tension and anxiety. Mindfulness is a useful meditation technique that focuses your thoughts away from your pain and directs them in a way that is helpful to managing your pain.
Learn about mindfulness
Mindfulness reduces stress, tension and anxiety. It can help you to avoid focusing too much on your pain as well as directing your thoughts in a way that is helpful for managing your pain. Read more about mindfulness.
Have a support network
Engage family and friends to help you manage your pain. Join a support group or find a hobby that makes you feel good and helps you connect with family, friends or other people. Being engaged and connected can help you feel more positive and experience less pain.
Take a pain-management course
Doing a pain-management course is a useful way to learn about your pain. Ask your healthcare team if there is a self-management or pain course in your area or do an online course such as the free Retrain Pain course from the Retrain Pain Foundation. You can also view the New Zealand version of the Pain Self-Care Toolkit or visit the Pain Toolkit website and app for more resources.
Consider non-medication treatments
Chronic pain is best managed with a multidisciplinary pain management approach that takes into account the physical, psychological and environmental factors that influence your experience of pain. This usually involves the use of non-medication treatment options.
There are a variety of non-medication-based treatment options to manage pain such as massage, acupuncture, TENS and CBT. Many of these don't have scientific evidence as to whether they benefit or harm people and not all of these will be suitable for everyone. Read more about non-medication treatments for chronic pain.
If your pain persists and is affecting what you can do, ask your doctor or nurse about referral to your local pain service, a pain specialist or pain programme.
Pain relief medicines
Commonly used pain relief medications are not very effective in treating chronic pain and when used long-term, can have more side effects. However, there are some medication that can be used alongside physiotherapy, exercise, balanced diet, relaxation and different ways of thinking and responding to pain. Read more about medicines for chronic pain.
Pain can affect you in many ways and can stop you doing the things that you want to do. It is normal to feel frustrated about having chronic pain and the impact this has on you.
Depending on the cause of the pain and the impact that it has on your life, one or more of the following support options might be helpful in addition to the appointments that you have with your GP or specialist.
Family and friends – support, reassurance and assistance from family and friends with daily activities can be very helpful while you recover.
Counselling – this can be especially helpful if your pain arose from a trauma e.g. a car accident. Speak with your GP about counselling services available through your GP practice. You could also phone:
Managing non-cancer pain with opioid medicines Choosing Wisely, NZ
Navigating pain NZ Pain Society
Chronic pain Fresh Mind, NZ
Preventing and managing discomfort at work Habit at Work, ACC, NZ
Safety at home ACC, NZ
Occupational Therapy Board
University of Michigan Health System