Persistent Pain

What is Persistent pain and why have I Got it?


You are not alone: the 2012 national pain audit estimated that around 7.8 million people in the UK suffer from persistent pain, around one in seven. This is only the reported cases.

Long term pain is very different to acute pain. Acute pain is a warning signal telling us when a part of the body is injured, and lasts anything from a few days to three months.Persistent pain may develop from an initial injury or sometimes there is no obvious injury triggering it. It lasts for more than three months and can persist for months or years.

It is known that everyone responds to and experiences pain differently. Medicines to treat pain (analgesia) may help but sadly no analgesia can treat persistent pain completely and often the side effects of the analgesia outweigh the pain relief gained.

Persistent pain can affect many different areas of your life. The pain cycle diagram below shows how physical symptoms, levels of activity and mood are closely linked and influence each other.


What are the signs and symptoms?

Everyone will experience signs and symptoms differently. If your persistent pain has developed from an initial injury it may not subside post recovery. Sometimes there is no obvious injury but an acute onset of pain with no cause, lasting for three months or more. Pain medicine may stop working and the pain may affect your moods and make you feel negative at times.Persistent pain can limit what you do in your life and you might find it stops you doing the things you enjoy.

Do I need any tests to confirm the diagnosis?

Unfortunately, there are no diagnostic tests to confirm persistent pain.

What treatments are available?

If you are on regular medication it is important to understand what you are taking and why, and to always try to take medicine as prescribed and on time. You should also remember to eat and drink as advised.

Remember no medication will stop persistent pain completely and the side effects of some medication outweigh the benefits for some people. Think about how well your medication is working for you.

Some techniques to help with persistent pain are outlined below. Other treatments not discussed in this section but which you may still wish to try are: hot/cold packs,  TENS machine use, and massage and aromatherapy which can all provide short term relief from persistent pain.

What can I do to help myself manage pain?

If you feel that you fall into the persistent pain cycle, you may wish to try the following tools to help you self-manage your pain. These self-help tools may have an extra benefit of giving you more confidence and a feeling of control and empowerment:

Prioritising and planning

Try listing your daily and weekly activities and prioritising them from urgent to not so urgent to things that can be left for another day. Creating an action plan can help you set simple and easily achievable goals.

Break up your tasks to keep each day manageable.

Try not to overdo it and don’t be scared to ask for help.

Keeping a diary

Keeping a daily diary of your activities and experiences with persistent pain may help you see how well you are doing and show you how much you have achieved. You can also write down when things don’t work so well so you can reflect on this and learn from it, perhaps trying to avoid these in the future.

Pacing

You may find that you have a tendency to overdo things when you are having a “good day” or that your pain makes it hard to stay motivated. Being active is important but it is also crucial to pace yourself and to carefully plan your activities and goals. You could try to break up activities into smaller, more achievable chunks, having short rests in between to get your energy back. This should help you keep motivated and focused and prevent you burning yourself out or causing a flare-up of your pain. Try to be patient with yourself and try not to set goals you can’t achieve.

Exercise

Regular stretching and exercise can help strengthen weak muscles, lift your mood and improves mobility. Exercise also helps keep your heart and body healthy, and releases endorphins which can give you happy feelings (euphoria).

Pain can flare up after exercise so it is important to start with low impact activities like stretching, swimming, walking or any gentle exercise you enjoy. Start slowly and gradually build up.

Relaxation and distraction

Pain can make you feel overwhelmed, frustrated and less motivated and can cause a build-up of stress and tension in your body. Try to find time to unwind your body and mind. You may wish to try the following techniques:

1. Deep breathing exercises.
We often only take shallow breaths from our upper chest. Instead, try to breathe deeply from your abdomen, filling your lungs with as much fresh air as possible so you inhale more oxygen. As your breathing slows down and you continue to take deeper breaths you should find that your body and mind become calmer.

2. Visualisation or guided imagery.
Try and think of a relaxing image or memory which you find calming e.g. your favourite place, your garden, the beach or the countryside. Focus on this image in your mind while listening to soothing music or in silence. Close your eyes and picture your relaxing place as clearly and in as much detail as you can. You may find this helps you let go of your worries or negative thoughts.

3. Mindfulness.
You may find you get more stressed when you think about the past and what could have happened differently or if you worry about what may happen in the future. Mindfulness can help you live more in the here and now by making you aware of how you feel moment by moment. If you stay focused on the present moment more you may feel a calming effect. Mindfulness can be applied to all activities of daily life, and can benefit anyone with regular practice.

Other types of relaxation and distraction techniques you could try are: reading listening to music dancing or singing walking gardening meeting family/friends cooking or baking colouring or painting.

This information has been provided by Leann Chaganis from the Inpatient Pain Service, St George's University Hospitals NHS Foundation Trust