Pain Medicine is perfectly imperfect but there is hope in our approach

National Pain Week 2024 is about drawing awareness and attention to those living with Chronic pain.

This year’s theme is “Pain colours your world”, recognising that living with chronic pain can affect how we see, taste and experience our lives.

In recognition of this, I will be writing an article each day from my experience as a Pain Medicine Fellow about how you and others can be a pain changer.

Note, that the views expressed here are those of my own and not my employer or of Chronic Pain Australia.

One thing I learned during my Pain Medicine Fellowship is that there is NO perfect chronic pain treatment, procedure or medicine.

Pain Medicine is perfectly imperfect.

This is because pain can be generated by a myriad of causes and it can become chronic and persistent due to a variety of individual factors and circumstances.

Therefore, the pain-changing difference is that pain management needs to be individually crafted because we are!

We can often view a person with persistent pain as analogous to another but therein lies the trap.

Everyone experiences pain differently.

No matter what we believe, our background, experience and innate neurological wiring influence how we perceive, interpret and respond to pain.

With no brain, we’d have no pain.

Our memories and experiences, whether good, bad or traumatic can influence the outcome of our pain. And add to this whether we are stressed, psychologically distressed, emotionally spent or medically compromised, the meaning and experience of our pain can be altered.

However, there is a systematic way to approach the management of chronic pain that considers the physical initiators and disease, our psychological and emotional response and the social outcome of pain.

The socio-psycho-bio-spiritual practice of pain management.

This however in practice can become skewed by the relentless pursuit of a cure, an antidote, or the one thing that may take the pain away.

This might constitute a medication-only approach, reliance on procedures or surgery that may or may not worsen your pain, resting excessively, avoiding activity due to the fear of pain or more commonly, a combination of these practices.

A passive approach to managing chronic pain does not work.

One of my most important tasks and what I spent much of my time doing in consultations is educating my patients about their pain issues and how to approach these in a whole-person manner.

My management plans are usually broken down like the following:

1. Physical/Procedural
2. Pharmacological
3. Psychological/Social

This doesn’t mean neglecting medications or procedures but implementing these if appropriate as not the foundation but an adjunct in achieving better function, social engagement and mental well-being.

When I consider a person who is living well with chronic pain, my assessment is multimodal:

1. They are self-efficacious — they can engage in the duties of life and achieve their goals with a clear plan.
2. They are mentally well — they aren’t burdened by anxiety or depression and if they are, they are receiving appropriate help.
3. They do not catastrophise — they do not let negative thoughts get the better of them and influence their function and goals.
4. They employ an active approach to pain management — they are not reliant on passive therapies as their saviour but engaged physically and mentally in rehabilitation or maintenance
5. They manage their pain intensity and pain interference — every day presents a new challenge but having a clear plan and paced goals can help to reduce pain flares.
6. They aren’t reliant solely on medications but have a range of active measures that they employ each day

So, what does a good pain management plan look like?

I like to think about the interventions in chronic pain management in terms of a pyramid.

We need to get the fundamentals right before we start building upwards.

Focussing on medications and procedures without addressing a person's mood, how they think about their pain or even their sleep, diet, exercise or alcohol consumption can lead to varied and less than satisfactory results.

My encouragement to you is to consider chronic pain as uniquely multi-dimensional which requires an equally multi-modal management plan.

Whether you, a friend or a loved one are a patient of a tertiary pain service or a person learning to live and manage chronic pain, consider a socio-psycho-bio model for your pain care.

This is because pain medicine is perfectly imperfect but when approached systematically and safely, it can offer the hope of living well with chronic pain.

Take care and see you tomorrow.

Dr. Jonathan Ramachenderan

Live intentionally
Love relentlessly
Enjoy your health

How I think about chronic pain management

To find out more please visit https://chronicpainaustralia.org.au/painchanger/ and register for free events and support Chronic Pain Australia this week.