Treating persistent pain

Things to remember

Persistent pain is pain that lasts for more than three months
There are many things you can do to manage your pain and live well

Persistent pain, sometimes called chronic pain, is pain that lasts for more than three months. It’s a common problem that affects 1 in 5 Australians, so if you live with pain, you’re not alone.

The good news is there are many things that you and your healthcare team can do to manage your pain, so you can get on and do the things that are important to you.

An important note – treatment that only focuses on reducing your pain for a short time isn’t the most effective treatment for persistent pain. A change in focus to slowly reclaim your functioning, without making your pain worse, is often more appropriate and more achievable.

Things you can do to manage persistent pain

Working as a team is the best way to manage persistent pain. Your health professionals (e.g. doctor, pharmacist, physiotherapist), family, friends and support groups all play a role in this team. And you’re at the centre.

As the central player in the team, it’s important that you take control. Here are some practical things you can do:

Find out more about your condition and treatments. 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.

Check out the list of websites and contacts at the bottom of this page for more information. A quick tip – when looking online, always be wary of sites that push a particular type or brand of treatment. And take celebrity endorsements with a grain of salt!

Set goals – The most important component of any treatment is whether it helps you to achieve your goals. Setting goals to accomplish specific activities important to you in a given timeframe can ensure that treatment is meeting your needs, or is being modified to ensure that you keep recovering.

For example, your pain may impact on your ability to walk your dog for long periods. Your goal may be that after 6 months you’re able to walk your dog around the local park for 30 minutes. By having a goal, something that’s important to you, you’re able to work with your healthcare team to ensure that your treatment plan is helping you achieve this goal.

Learn how you can use self-management strategies to manage your pain effectively. There are many things you can do to manage your pain – and different strategies will work for different situations. For example, heat packs can help ease muscle pain, cold packs can help with inflammation, gentle exercise can help relieve muscle tension. Try different techniques until you find what works best for you.

Write down and keep track of the things you notice trigger your pain, and the things you notice help you manage your pain.

Pace your activity levels to avoid flare-ups in pain. Prioritise and plan your activities so that you stop yourself from overdoing things. Alternate activity and rest periods, consider delegating some tasks to other people, do your most demanding tasks when you’re feeling your best – but don’t overdo it. It’s easy to push yourself too far, which can result in a flare-up of pain.

Pacing is an effective way to keep pain at lower levels and allows you to function at a higher level more consistently. Your doctor, occupational therapist, physiotherapist or psychologist can help you with tips and advice on pacing.

Try relaxation and other techniques to manage stress. Performed on a regular basis, this may help you cope better with your pain. Strategies such as stretches, massage, heat and gentle activity may help you recover from a flare-up and help you get back to your usual activity levels more quickly.

Reduce, don’t stop – when you’re in pain, it’s usually better to reduce the level of activity you would normally do, rather than stopping altogether. For example, walk the dog around the block for 5 or 10 minutes. Gradually returning to your normal activities is an effective treatment for pain following an injury, as well as for persistent pain.

Make a plan to gradually increase your activity levels by a small amount each week. Get advice from your doctor or physiotherapist about how to increase your activity levels safely. Soon you’ll be walking the dog for 15 minutes, a month or so later 20 minutes and by six months you will reach your goal of 30 minutes, with a few ups and downs on the way.

Keep your family and friends involved by discussing your pain management plan with them. They can be a great source of support and encouragement.

Keep participating – try to stay involved in your usual home activities, as well as your work, leisure and social activities. Social connections are extremely important.

Aim to stay at work, on restricted duties if required, and develop a plan with your employer to return to your full work. Staying off work for prolonged periods can have harmful effects on your ongoing physical and psychological health. And staying off work decreases the likelihood of ever returning to work. Your doctor, physiotherapist and occupational therapist can help you with information about how to stay at work.

Take small steps – waiting until you feel 100% before returning to activities or to work isn’t a good approach. Small, gradual steps allow you to stay connected and mean that you can continue to do the things that are important to you, sooner rather than later.

Your healthcare team

There is a range of different health professionals who can work with you to manage your persistent pain. You may see them on an ongoing basis, or you may visit them from time-to-time as needed.

Your general practitioner (GP) is central to your care and will help you access other health professionals and services. Make sure you have a 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 doctor to another, means that your care will be consistent and organised. This will lead to the best possible outcomes for you.

Physiotherapists use a variety of techniques to reduce pain to allow you to gradually increase your activity levels. They can show you how to increase mobility, strength and functioning by developing an exercise program for you.

Exercise physiologists can help you improve your health and fitness through clinical exercise programs tailored to your specific needs as well as support to live a healthy lifestyle.

Occupational therapists (or OTs) help you learn better ways to do everyday activities such as bathing, dressing, working or driving. They can also provide information on aids and equipment to make everyday activities easier.

Psychologists can help you to work through your feelings, particularly if you are feeling anxious or depressed. They can also help you with goal setting and prioritising activities.

Pain management programs – if pain continues to persist after three months despite treatment, a useful approach can be to participate in a pain management program. These rehabilitation programs are designed to specifically address the range of factors affecting your recovery including:

physical factors
any psychological issues including your mood, stress or poor sleep
social factors including how you manage your activities at home as well as how you can return to work safely.

At these programs, you’ll learn from health professionals such as doctors, physiotherapists, psychologists, occupational therapists and nurses how you can manage your pain more effectively with the least side effects. Talk with your doctor about whether a pain management program would be helpful for your situation.

Medical treatments

Medical treatments for persistent pain may include:

medication
injections of a local anaesthetic, steroids or strong anti-inflammatory
surgery.

Medication to reduce pain can play a useful part in your recovery in the early days following injury but the effects are often limited. Sometimes reducing your pain with medication can help you start working towards your physical activity goals.

It’s best to discuss with your doctor both the potential benefits and harms of pain medication.

It’s also important that you talk with your doctor before you stop taking your regular medication for pain, mood and muscle spasm. You may need to gradually reduce your dosage, rather than simply stop taking it, to avoid potential side effects of withdrawing from a medication. This isn’t a sign of addiction, but a common side effect of these medications. Your doctor will advise you on this.

Guidelines recommend that strong pain medications such as opioid medication (e.g. morphine, codeine, Endone) shouldn’t be taken for longer than three months if at all possible.

Injections of a local anaesthetic, steroids or strong anti-inflammatory into a painful area may be recommended with some conditions. If these injections provide an appropriate amount of relief they are sometimes followed up with other procedures that have a longer effect. Injections of strong analgesics such as pethidine and morphine aren’t used in the management of non-cancer persistent pain.

Surgery – in some cases surgery is recommended for painful conditions that aren’t improving.

Note: Injections and surgery are only effective in a small number of painful conditions. The degree of benefit, the risks of harm and the cost of surgery all need to be weighed up. If surgery has been suggested, it may be beneficial to seek a second opinion prior to proceeding. Remember treatment is only worthwhile if it helps you reach your goals.

Where to get help

Your doctor
Your healthcare team
Musculoskeletal Australia
National Arthritis and Back Pain+ Help Line: 1800 263 265

How we can help

Call our Help Line and speak to our nurses. Phone 1800 263 265 or email helpline@msk.org.au

We can help you find out more about:

arthritis and musculoskeletal conditions
ways to live well with these conditions
managing your pain
- read our A-Z guide to managing pain
- watch our excellent videos on pain, your brain and how you can retrain your pain system.
  - Pain, the brain and your amazing protectometer – Lorimer Moseley
  - Treating pain using the brain – David Butler
upcoming webinars, seminars and other events.

More to explore

Better Health Channel
beyondblue
Support Service – 1300 224 636
Choosing Wisely Australia
Employment Assistance Fund
Job in Jeopardy Assistance
Lifeline
Crisis Support – 13 11 14
National Prescribing Service
Medicine Line 1300 633 424
Pain Australia
painHEALTH
TAC
WorkSafe

Download this information sheet (PDF).

The whole or part of this material is copyright to the State of Victoria and the Better Health Channel. Reproduced with permission of the Victorian Minister for Health. Users are permitted to print copies for research, study or educational purposes.

Information has been produced in consultation with and aprroved by : Musculoskeletal Australia

Produced in partnership with Empower Rehab, a Melbourne based pain management clinic.