Chronic Pain

So what is Chronic Pain? Well by definition it is:

"a continuous, long-term pain of more than 12 weeks or after the time that healing would have been thought to have occurred in pain after trauma or surgery" (British Pain Society - http://www.britishpainsociety.org/media_faq.htm)

It is estimated that only 3-10% of all low back pain presentations will progress to chronic status however despite this small minority it accounts for nearly half of the total resources allocated in the treatment of all low back pain. Over the last 2 decades clinicians and researchers have completely altered the way in which this complex presentation is both understood and perceived. This has resulted in many new and varied treatments available to the chronic pain patient and many of them are not medical in the traditional sense. For some, the notion of a pain without a 'fixable' physical cause can be hard to understand, or accept, so we hope that the following  information and links will go some way to addressing this.

Biomedical or Biopsychosocial?

The way in which the Western and developed world approaches medicine has been making a slow transition from a Biomedical framework to a Bio-Psychosocial framework in the last decade. So what does this mean, and how does it affect you?

Medicine has been historically built around what we call a biomedical framework. This basically implies that for everything that we have wrong with us, there has to be a physical or an organic cause.  The fact of the matter is that over the last two decades, increasing amounts of compelling research regarding our understanding of pain and rehabilitation is telling a very different story. Unfortunately, this belief is still widely held by much of the public (and some of the professionals!) and can cause difficult patient/professional situations when investigations come back ‘clear’, despite the pain still being present. 

Psychosocial components allow us a whole new dimension in the understanding of medicine, accepting the key roles that both the psychological and environmental factors can play in recovery.  There is, without doubt, a significant stigma attached to any medical phraseology containing the word ‘psych‘, the most common misconception being that there may be ‘a little madness‘ involved. This couldn't be further from the truth however (in most cases) and helping you to understand why this is can be one of the hardest tasks we have to undertake. The ironic thing is that most of you will be able to relate to many psychosocial factors, just without knowing it. 

Think back to your last bout of low back pain:

1) Did you panic and over react to your symptoms?

2) Did you take time off from work?

3) Did you change the way you dressed in the morning?

4) Did you change the way you walk to make it easier?

5) Did you alter how long you sit for, or even change your chair?

6) Did your family or friends help out with things you felt were to difficult?

All of these are considered to be psychosocial factors, reflecting the various ways in which we learn to cope with adverse situations, and most of you will be able to relate to at least one or two. Normally, as your symptoms decline so will your reliance upon these however this is not always true, and it is  in these circumstances that they can change from being normal to becoming harmful .

Examples of this may be:

1) 1) You still worry greatly about the symptoms you had – you may still dress in a certain way not because it hurts but just in case the socks are a stretch too far, or maybe you still walk with a limp because that used to help.

2) You are still off work – maybe you worry it may make your symptoms return or perhaps you don’t like work and this is a good opportunity not to go in.

3) The claim for the accident that caused your pain is going to take at least another 6 months and you can’t show too much improvement or it may affect the payout?

4) It was really nice that the lawn was cut by the neighbours when you were unable to do so and to be honest it was never your favourite task. Perhaps it would be good if they continued for a while so maybe you should make that last bit of pain last just a little longer!

5) Maybe the family came round to see you a lot more, helped around the house, just made a bit more time for you, it would be a shame if that stopped again……..

When you read this it may seem obvious that these are going to be stalling factors to your recovery, albeit for different reasons, however we must appreciate that what would seem appropriate in a pain free situation does not always mirror that of somebody in pain. We used to think that these changes only became apparent in cases of chronic pain (>3 month continuous) but more recently it has been shown to begin in some at the acute stage (less than 6 weeks continuous). This means we must be vigilant at a much earlier stage than previously thought. There also appears to be large variations in the size of the barrier with some specific types of psychosocial factors appearing to have a greater risk potential attached to them regarding your recovery rate and final outcome ,than others. It is these that as medical professionals we aim to screen for, identify, and manage as appropriate. There is more specific information on these factors within the psychosocial page.

I would encourage you all at this stage to take the time to read the Psychosocial, Cognitive Behaviour Therapy and Functional Restoration pages, and educate yourself on this area which for a select few may be vital to your long term recovery. Food for thought is that it is not uncommon for those of you who think you are exempt from these conditions, to be the very ones who may be the most susceptible!

The following two short videos come highly recommended by EMS and I am sure all of you with chronic pain who have not already seen these will benefit.

We are also happy to promote an excellent website that is being developed for those of you with chronic low back pain. There are many more videos, links and forums delivered here in a responsible manner from  someone with personal experience who lives with chronic pain.

Please be aware that EMS Ltd is not responsible for the contents of 'away with pain' and promotes the information contained within with the best intentions.

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