What is Chronic Pain?

Most people with chronic pain have had an injury or injuries at some stage, however some have not. If there has been a definable initial injury, we know that for all tissues in the human body, the healing process is complete after up to 6 months. For some people, however, the pain persists beyond the stage of healing. This is chronic pain. Chronic pain is not therefore a warning signal indicating that ongoing or further damage is occurring.

Acute pain Acute pain is short term pain - it can last seconds, minutes, hours, days, or weeks, but does eventually stop. It is usually a warning signal that tells us something is wrong with the body, for example pain as a result of an injury such as a sprained ankle, a burn, or toothache.

Chronic pain Chronic pain is long-term pain. This Chronic pain can be classified as pain that persists after 6 months after the initial injury, and can then go on indefinitely, despite treatment.

Causes of Chronic pain

The causes of chronic pain are not completely understood, and knowledge about chronic pain continues to grow, but it is known to be due to changes in the functioning of the central nervous system (the brain and spinal cord). Normal signals of touch, pressure, movement etc. pass to the central nervous system but are interpreted by it as abnormal/painful. Thus pain is felt even though there is no damage occurring. This is called central sensitisation.

These central nervous system changes do not show up on X-rays or any current tests available for patients. It is known that widespread areas of the brain are involved in chronic pain. Chronic pain is thus to all intents and purposes invisible and can be present even in the absence of evident damage, disease or deformity. The pain the sufferer experiences is, however, very real, and is not imagined or 'in the mind.'

The condition falls under the definition of a disability as described in the Disability Discrimination Act of 1995, ('a physical …impairment which has a substantial and long-term effect on a person's ability to carry out normal day-to-day activities.') Therefore, people with chronic pain are entitled to all the provisions under the Disability Discrimination Act for 'reasonable adjustments' to be made, both in terms of their workplace and the way that they work, and in terms of access to all the usual public facilities.

Pain management strategies

Chronic Pain causes a great deal of suffering, and can have an enormous impact on a person's ability to manage their daily living activities, and on how he/she feels about him/herself and his/her life. Many people find that they have to give up activities, e.g. work, social life, housework and hobbies, as a result of their pain. In short, it can have a very negative impact on the whole person and his/her overall quality of life. Only after people have gone through all the usual medical channels, with no relief from their pain, are they referred to our unit.

The residential pain management course at INPUT, St Thomas' Hospital teaches strategies to people with chronic pain to help them manage their pain more effectively. These include practical relaxation techniques, exercise and stretch to make movement easier, cognitive strategies to help deal with difficulties and the effect of pain on the mood, and goal setting and pacing to help the person build back gradually to important activities again. The latter strategy involves dividing activities into shorter amounts by incorporating regular short rests and changes of position (e.g. sitting, standing or walking.) These amounts (known as 'manageable times') are carefully calculated to permit the maximum amount of activities whilst aiming to avoid the increased pain that comes from doing too much. It is very important that people with chronic pain are able to continue using these strategies and applying them to their domestic and home life, work and social activities.

It is also important to note that, due to the nature of the condition, there will be times when spontaneous and unpredictable increases in usual pain levels can occur, despite using pain management strategies. During these episodes, sufferers can find themselves struggling with tasks that they can usually manage, and their manageable times for different positions and movements may be reduced. Whilst they have learned techniques to help them manage times of increased pain, they are particularly stressful and challenging to deal with.

Moving forward

Some people with chronic pain have had to give up their jobs, due to their pain. If they have not been able to work for some time, they will need to build up their activity levels gradually and systematically before they can return to work. There are various schemes to help people with disabilities to return to work, which can be accessed through the Disability Employment Adviser at the local Jobcentre. However, we cannot predict how long this is likely to take, owing to the normal fluctuation in pain levels that is part of the Chronic Pain condition. This means that progress may not fit a predictable time-frame.

Some people with chronic pain may still be working, but struggling to manage due to their pain. It will be important for them to be able to incorporate Pain Management strategies into the way they are working. Pain Management strategies such as pacing could be seen as 'reasonable adjustments' which should be made under the Disability Discrimination Act (1995) to enable people to do their jobs. Such strategies may help people to continue at work in a sustainable manner.

Although the INPUT programme is helpful in teaching people strategies to manage their pain for the future, and can improve their quality of life, it does not mean that the chronic pain problem will be cured, or that the intensity of the pain will necessarily reduce. Even if pain management strategies are used effectively this is no guarantee that pain levels will reduce significantly. People who attend the Pain Management Programme will have already tried a number of treatments and exhausted all channels of possible cure and relief from their pain. They will therefore need to use pain management strategies for the rest of their lives and in all spheres of their life.

If you require further information, please visit www.inputpainunit.org.uk.

The INPUT Pain Management Team