Treating persistent pain

Persistent pain, also called chronic pain, is pain that lasts for more than 3 months. It is a common problem that affects around one in five people, so if you live with pain, you are not alone. The good news is that there are many things you and your healthcare team can do to help you manage your pain so you can get on with the things that matter to you.

Treatment that only focuses on reducing your pain for a short time is not the most effective approach for persistent pain. A change in focus, slowly reclaiming what you can do without making your pain worse, is often more appropriate and more achievable.

Working as a team is the best way to manage persistent pain#

Your health professionals, family, friends and support groups all have a role in this team, and you are at the center of it. As the central player in your pain management team, it is important that you take control.

Here are some practical things you can do.

Stay informed#

Access good quality, up-to-date information and stay informed. Quality information can be a powerful tool to help you take control of your pain.

A quick tip: when looking online, be wary of sites that push a particular type or brand of treatment, and take celebrity endorsements with a grain of salt. The most important thing about any treatment is whether it helps you achieve your goals.

Set goals#

Setting goals to accomplish specific activities that matter to you, within a given timeframe, helps make sure your treatment is meeting your needs or is being adjusted so you keep recovering.

For example, your pain may affect your ability to walk your dog for long periods. Your goal might be that, after 6 months, you can walk your dog around the local park for 30 minutes. Having a goal lets you work with your healthcare team to check that your treatment plan is helping you.

Use self-management strategies#

There are many things you can do to manage your pain, and different strategies will work in different situations. For example, heat packs can ease muscle pain, cold packs can help with inflammation, and gentle exercise can relieve muscle tension. Try different techniques until you find what works best for you. This is an important way to gain control over your health.

Keep track of the things you notice trigger your pain, and the things that help you manage it.

Pace yourself#

Prioritize and plan your activities so you do not overdo things. Alternate activity with rest periods, consider delegating some tasks, and do your most demanding tasks when you are feeling your best, but do not push too far. It is easy to overdo it, which can cause a flare-up of pain. Pacing keeps pain at lower levels and lets you function at a higher level more consistently.

Your doctor, occupational therapist, physiotherapist or psychologist can give you tips and advice on pacing.

Manage flare-ups#

Strategies such as stretches, massage, heat and gentle activity may help you recover from a flare-up and get back to your usual activity levels more quickly. When you are in pain, it is usually better to reduce your normal level of activity rather than stop altogether. For example, walk the dog around the block for 5 or 10 minutes.

Reduce, don’t stop#

Gradually returning to your normal activities is a very effective treatment for pain, both soon after an injury and for persistent pain. Get advice from your doctor or physiotherapist about how to increase your activity levels safely. Soon you may be walking the dog for 15 minutes, a month or so later 20 minutes, and by 6 months you may reach your goal of 30 minutes, with a few ups and downs along the way.

Don’t wait until you feel 100% before returning to activities or work. Small, gradual steps keep you connected and mean you can keep doing the things that matter to you, sooner rather than later.

Stay connected#

Keep your family and friends involved by discussing your plan with them. They can be a great source of support and encouragement. Try to stay involved in your usual home, work, leisure and social activities, as social connections are extremely important.

Where possible, aim to stay at work, on restricted duties if needed, and develop a plan with your employer to return to your full duties. Staying off work for long periods can harm your ongoing physical and psychological health and reduce the chance of ever returning to work. Your doctor, physiotherapist and occupational therapist can give you information on how to stay at work.

Your healthcare team#

A range of health professionals can work with you to manage persistent pain. You may see them on an ongoing basis, or visit them from time to time as needed.

• Your doctor is central to your care and will help you access other health professionals and services. Try to have a regular doctor who knows you, at a practice that can see you when you need to be seen. Having the same doctor, rather than moving from one to another, keeps your care consistent and organized.
• Physiotherapists can show you how to increase the mobility or strength of an affected body part by developing an exercise program for you.
• Exercise physiologists can help you improve your health and fitness through clinical exercise programs tailored to your needs.
• Occupational therapists can help you find better ways to do everyday activities such as bathing, dressing, working or driving, and can advise on aids and equipment.
• Psychologists can help you work through your feelings, particularly if you are feeling anxious or depressed, and can also help with goal setting and prioritizing activities.

Pain management programs#

If pain continues after 3 months despite treatment, taking part in a pain management program can be useful. These rehabilitation programs are designed to address the range of factors affecting your recovery, including physical factors, psychological issues such as mood, stress or poor sleep, and social factors such as how you manage your home and social life and your safe return to work.

In these programs, you learn from health professionals, such as doctors, physiotherapists, psychologists, occupational therapists and nurses, how to manage your pain more effectively with the least side effects. Talk with your doctor about whether a pain management program would help you.

Medical treatments for persistent pain#

Medication to reduce pain can play a useful part in your recovery in the early days after an injury, but its effects are often limited. Sometimes reducing your pain with medication can help you start working toward your physical activity goals. Discuss both the potential benefits and risks of pain medication with your doctor.

It is also important to talk with your doctor before you stop taking a regular pain medication. You may need to reduce your dosage gradually rather than stopping suddenly, to avoid side effects of withdrawal. This is not a sign of addiction, but a common effect of these medications, and your doctor will advise you on this.

Guidelines recommend that strong pain medications, such as opioids (for example morphine and codeine), should not be taken for longer than 3 months where possible.

Injections of a local anesthetic, steroids or a strong anti-inflammatory into a painful area may be recommended for some conditions. Injections of strong analgesics such as pethidine and morphine are used in the management of cancer-related persistent pain.

Surgery is rarely recommended for persistent pain unless all non-surgical options have been exhausted and it is considered medically necessary. Injections and surgery are only effective for a small proportion of painful conditions, and the degree of benefit, the risk of harm and the cost all need to be considered. If surgery has been suggested, it may help to seek a second opinion before proceeding.

Remember, treatment is only worthwhile if it helps you reach your goals.

Key points#

• Persistent pain is a common problem that affects around one in five people, so if you live with pain, you are not alone.
• As the central player in your pain management team, it is important that you take control.
• When looking online, be wary of sites that push a particular type or brand of treatment.
• Having a goal lets you work with your healthcare team to make sure your treatment plan is helping you.
• Using self-management strategies is an important way to gain control over your health.

Where to get help#