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Frequently asked questions about persistent pain

Persistent pain (also called chronic pain) is pain that continues past the time you were expected to recover from an injury or illness. The term "acute pain" refers to pain that recently began and is likely to end soon. It does not refer to how bad the pain is or how serious the problem is. The difference between these two types of pain is important, as different approaches are recommended for treating and managing them.

Why am I still feeling pain?

alarm bellsA person can continue to experience persistent pain long after the initial injury has healed, or even when the initial problem has been removed or repaired.

It is not a simple problem. There is no dividing line between skin, muscles, nerves, the spinal cord, the brain and thoughts, beliefs and emotions – it is the nervous system as a whole that produces your pain experience. The fact that environmental and emotional factors can influence pain does not make it any less real.

Isn't pain a signal of damage to the body?

Not necessarily. Persistent pain often reflects a problem with the pain system itself rather than damage in a particular part of your body. It's a bit like a fire alarm that sounds without a fire.

Can't you just cut the nerve or remove the problem area?

Unfortunately the solution is seldom this simple. It is not always possible to pinpoint what causes the pain or where it starts. What's happening with the nerve may only be a small part of the whole pain picture. Also, there is no guarantee with this sort of procedure that the pain would not return (possibly even worse than before) and there is a risk of serious complications such as loss of function. A good example of this may be phantom pain after a limb is removed – there is no limb but the pain problem persists.

Why haven't I been given a diagnosis?

Persistent, or chronic, pain is a valid diagnosis. Just because you haven't been given an acute diagnosis (such as ruptured ligament or compressed nerve) doesn't make your persistent pain any less real.

Why don't doctors give me stronger medication?

Stronger medication is not necessarily more effective and can result in unpleasant side effects. You might even become dependent on the medication. People can develop a tolerance to medication they use regularly, meaning they need stronger and larger doses to get the same pain relief.

Also, the drugs that are often used for acute pain are not usually effective for persistent pain.

Something has to be done!

Something can be done! Clinicians sometimes say that nothing further can be done to deal with the pain problem, but this is not entirely accurate. Usually, this comment refers to the idea that there are no further medications or interventions that could cure or fix the problem.

However, all is not hopeless! Depending on what contributes to your pain experience, there are many recognised pain management techniques you can use to help manage your pain so it doesn't have as big an impact on your life.

If something is sore doesn't it make sense not to move it?

Pain does not necessarily mean you have to give up all your activities. There are ways you can manage how you approach activity when you have pain. If you avoid activities you are likely become less physically capable, which will harm your confidence and probably increase your pain over time.

Overdoing activities can also lead to problems. Learning to change your approach to activities can be difficult, but if you are patient and persistent it is possible. Ask for help if you are not sure how to do this.

Is it my fault that I have this pain?

No. No one asks for a persistent pain problem to develop, and no one deserves the suffering that can come with it. In New Zealand it is estimated that one in six people experience persistent pain, making it a significant problem.

Is this problem all in my head?

It is common for people with persistent pain to feel like others doubt that their pain is real. Persistent pain may not be visible on a scan or to others around you, but it is a recognised condition that is based in the central nervous system (brain and spinal cord).

When should I accept the pain and give up trying to find a cure?

When the specialists are satisfied that you have been appropriately investigated and they have diagnosed a persistent pain condition, it may be time to look at the ways you can manage this condition.

It is important however, to know that giving up trying to find a cure does not mean giving up on the problem entirely – it simply means that you may have to take a different approach. This will likely mean enhancing your ability to self-manage the pain.

I've been told I have to learn to live with it – what does this mean?

A pain management approach shows you how to develop skills that help you to stop the pain from interfering in your life so much, and increase your confidence in coping despite pain. As many factors contribute to your persistent pain problem, your management plan needs to consider all these things.

Why should I bother when nothing else has worked?

Only you can answer this question. By using pain management strategies you can learn to be more in control of your pain rather than it controlling you. Structured pain management input can be useful, but what is essential is your willingness to try and your belief that change is possible.

Does this mean that I will have to stop taking medication?

Medication can be useful in managing persistent pain, and you should talk about this with your GP. Remember that medication is only one part of a larger pain management plan.

I already know how to manage my pain – I have been doing it for years!

accept painYou may very well have developed useful ways of dealing with your pain problems, and if what you are doing is working for you then well done! If you think there may be room for improvement then it may be worth taking another look at your pain management plan with a healthcare professional.

I don't want to accept that my pain will be there forever!

You don't have to resign yourself to indefinite pain in order to take part effectively in a pain management programme. But it is important to recognise that, for the time being, the pain is there. This does not mean having to like the pain or giving in to it, but rather finding a healthy way to live with it.

I'm scared that the pain will get worse

This is an understandable and very common concern, and is usually related to the idea that you would not be able to handle or cope with more pain. However, as people become better at using their pain management skills and more confident in managing fluctuations in pain, their worries and fears usually lessen. Setting down a plan for dealing with problems can help you to feel more in control of the situation.

My family doesn't understand

It is very frustrating for people to see someone they care about in pain, especially if it seems that there is little they can do to help. Most people do want to help. It is important to let people know what you need to strike a balance between doing things for yourself and having good support from others.

I've read about this new breakthrough with persistent pain – does it work?

Very often you read in newspapers and magazines or see on the TV some new technique for managing persistent pain. The possibilities are mind-numbing and explanations so confusing and conflicting that you may feel like giving up before you start. Try to learn as much as possible about each technique so that you know what you are getting into and don't be afraid to ask questions. Also be aware that all the techniques will not work for everyone. What works for your best friend may not be the key to your recovery.

Explore your options and choose the strategies that fit your life and your situation, being aware that it is not necessary to try everything. Always remember to weigh up the pros and cons of any technique.

On the next page: Living with persistent pain

Written by the Burwood Pain Management Centre.Adapted by HealthInfo clinical advisers. Reviewed June 2017.

Page reference: 79022

Review key: HICHP-79018