Pain is something we all experience at one time or another. When we’ve stubbed our toes as kids to when we’ve fallen down stairs as adults, breaking many bones. Acute pain from a serious injury or back pain, stomach pain, nerve pain, arthritic pain; all are common in our communities. How can you get pain relief quickly and effectively so you can get back to living your life?
The latest research into pain—and most importantly, strategies to make things better—was showcased in the in-depth article Pain: What You Need to Know and 4 Things to Start Doing Now for a Better Recovery.
As part of the research for that article, we asked pain professionals to share their top pain management tips for people going through a tough injury recovery. Much of what they say also applies to people suffering pain from illness and other long-term conditions.
Here’s what 7 pain professionals reveal as their tips for a better recovery
Professor of Clinical Neurosciences and Chair in Physiotherapy at University of South Australia
1. Respect your pain…
but don’t be afraid of it because it is providing a big protective buffer to protect your tissues so they heal.
2. Ask your clinician to teach you three new things
I.e. things you didn’t already know or wouldn’t have already worked out—that will promote your recovery.
3. Hang in there because your body is highly expert at healing and recovering
You might just need some patience, persistence and courage for the journey. It will get better.
Coralie shared her top tips for managing an acute injury. She noted that not all injuries are the same; some are minor and some involve fractures and other damage.
1. Know that most injuries will heal if you take the time to look after yourself
Seek reassurance from your doctor. Remain connected to your loved ones.
2. Make sure you have enough pain relief
There is evidence that inadequate pain relief at the time of the injury can sensitize the nervous system and lead to chronic pain.
3. If you have a work injury, avoid arguments with claims staff and other stakeholders in the picture
Arguments, stress, conflict; these all aggravate the nervous system. My experience is that people who have ongoing stress at the time of injury do worse than those that don’t.
If your pain does continue, seek early help from a team that you trust and who you feel connected to (at around three months).
A good physiotherapist is an asset. Stay as mobile as you can without aggravating your pain. If you have physiotherapy treatment and you are sore two days later and not improving, stop. You may be going too hard.
CEO of Painaustralia, an organisation established in 2011 with a focus to work with governments, health professional and consumer bodies, funders, educational and research institutions, to facilitate implementation of the National Pain Strategy Australia-wide.
1. Timely and effective treatment of acute pain is essential
Acute pain can transition into chronic pain and persist long after the injury has healed, if not managed effectively in the early stages post-injury. This happens when neuroplastic changes occur within the nervous system, which make the body more sensitive to pain and can create sensations of pain even without external pain stimuli. This is called pain sensitisation and the longer pain remains untreated (or poorly treated), the greater the risk.
2. A positive attitude is important
When recovering from pain, it is important to have a positive attitude. Negative feelings such as being distressed by the pain, catastrophising the pain and fearing re-injury can become obstacles to recovery.
3. Take your own journey to recovery
Pain is not just a physical condition. Rather, it is a highly subjective experience influenced by a range of factors—including attitudes, belief, personality and social environment. Therefore, people should avoid comparing themselves with others, even if their injuries are similar.
Medical Director Barbara Walker Centre for Pain Management (BWCPM) at St Vincent's Hospital Melbourne.
1. Never discount the impact of secondary muscle pain and dysfunction on: a) your level of pain; b) cause of pain; or c) reason for persisting symptoms
This type of pain can be usually reversed. An understanding of the mechanism of injury and response to pain is important and a well-trained physiotherapist and doctor should be able to help find the best approach to assist with this kind of pain. Restoring function and posture and movement patterns is critical.
2. Monitor your thinking and emotional state about the injury
This can contribute greatly to how you react to the injury and what eventually happens. This includes the early-stage treatment choices you make, or don’t make, and the ongoing treatment. I’ve seen it many times; where people with persistent pain from injury mistakenly believe that they have ongoing damage when they attempt to do things that cause pain. Ongoing damage or inflammation is not the case in many circumstances. The pain may however be significant and is often secondary to muscular changes and responses, meaning the muscles need to be coaxed slowly into more helpful movement patterns. In addition, fear associated with the meaning of pain and the potential consequences often increases pain levels. This predisposes the person to deconditioning and seeking answers by having treatments and interventions. When these do not help them much it makes them despondent because they are not improving. This can be further compounded by receiving incorrect information or confusing mixed messages from health professionals.
3. Be very careful about how you interpret the information you receive about the injury or pain including X-ray findings (or lack or X-ray findings) and specialist results and reports
Many patients do not realise that X-rays are often a poor indicator of the cause of pain. MRIs and CTs of spines will almost always show some changes related to aging, degenerative changes (e.g. wear-and-tear, which often are not the cause of pain and if not well-understood, this can mean patients believe that surgery on the abnormal area on X-ray will fix their problem. For this reason most authorised guidelines written for managing acute back pain, advise not to do X-rays unless there are features suggesting cancer or infection (red flags).
Also communication between health professionals and patients can cause problems: language may be used loosely by health professionals without realising that patients may interpret their comments or the radiology reports in a catastrophic way. Alternatively patients sometimes only focus on some words and misinterpret what they have been told. It is important that patient and doctor know that the correct information has been given and received as it was meant. In addition, there are considerable misnomers used commonly, for example, the term “sciatica” really means there is some type of problem occurring around the sciatic nerve and particularly the nerve root as it leaves the spine. This term is commonly, and incorrectly, used as a description for pain travelling down the leg (which can have many causes). Thus patients often visualise a prolapsed disc pressing on the sciatic nerve root. True Sciatica is in fact a relatively less common cause of pain radiating down leg: the more common cause which is referred pain coming from non-neural structures such as muscles, ligaments and joints.
Pain medication (analgesia) is most useful in the early phase of injury particularly when there is inflammation going on
It helps to aid recovery as patients can move more and is best used in conjunction with therapies like physiotherapy. Some medications can help nerve pain however as time goes on strong opioid analgesia becomes less useful and the body has become to dependent on it. Therefore, taking it away results in temporarily increased pain due to withdrawal effects. Analgesic medications and procedures are generally most useful as ‘vehicles’ to aid recovery; to promote functional movement and can be very helpful when used in conjunction with other therapies, like physiotherapy. If you are not improving on these and still needing pain relief medications or you feel like you need higher doses it is time to get an expert opinion.
Senior Physiotherapist at Get Active Physiotherapy in St Leonards, Sydney, Australia
1. Understand that pain is an output of the brain and a protective mechanism designed to stop you causing further injury
Pain is not a feeling caused by the injured structure itself, instead it is produced by a very complex process that takes in to account many factors (tissue trauma, past experiences and injuries, emotions, cultural factors and the perceptions of what the injury will mean for you as an individual, for example, loss of income, loss of independence etc.). The level of pain, therefore, is not an accurate representation of tissue damage. (This is something I always stress to the person on the first session.)
2. Address the many factors causing pain (not just the physical pain)
Education and advice regarding pain and its physiology can be one of the most crucial aspects of treatment, particularly if you have ‘persistent pain’ (previously referred to as chronic pain). There is a great deal of research showing if a person understands why they feel pain and that not all pain is a threat then they have great empowerment over their pain and the level of pain reported is reduced.
3. Be aware of language
Negative language, for example “your spine is crumbling” or “the hip is out” is both inaccurate and alarming. Research shows that by health professionals using this language can create a negative perception for you, which may result in a higher severity of symptoms being reported. Positive and accurate explanations of symptoms will have the opposite effect and will likely improve the outcome of rehabilitation. If a health professional uses this language, ask them to stop.
Maintain an active lifestyle
This is the best form of management of many musculoskeletal injuries. The body as a whole (joints, muscles, tendons, cartilage) works better when we move. From the outset for the majority of injuries (not all), I get people moving their injured area. It’s important to remember at this point, however, that I do not mean that you should push through pain. There will be a way that you can move most body parts even with an injury. With this, you get pain reduction through desensitisation of the pain centres of the brain. A reduction of pain improves muscle activity and increases the effectiveness of muscle activation/strengthening exercises. Range of movement are therefore a great adjunct to strengthening exercises.
Director of ESP Consulting. Qualified Senior Clinical Physiotherapist, specialising in Orthopaedics, General Surgery and Emergency Case Management
1. Maintain your physical self in whatever way you can
This is often recommended to athletes, but not to more recreational pursuits or weekend warriors. Maintaining your fitness could vastly differ depending on site of injury, but as examples: if you cannot run, walk. If you cannot walk, try a stationary cycle, swimming, or maintaining fitness with upper body programming. Not only will you feel more in control of your condition, but the endorphins released with exercise will also make you feel more positive about this glitch or hiccup in your life.
2. Take control of your management. This does not need to be a passive healing experience
Ask for exercises, and do them daily, and with consistency. Report back to your Physiotherapist and ask for more. Follow instructions and feel in control of your healing process as a result. Set goals according to the timeframes provided for recovery: don’t be a passenger on this journey, be the driver.
3. Maintain your social contact
Often an injury can mean a break from sport, work and more. If training for your chosen sport is something that meant regular contact with your friends – go to training and help in other ways. If travel is an issue, ask a team-mate to collect you on their way to training. Often work is essential for routine, stimulation and social contact. Discuss options for working from home if at all possible; consider reduced hours; consider using video-conferencing to attend team meetings from home.
1. Allow enough recovery time following injury
This is due to the fact that insufficient recovery time delays the healing process and physiology of the tissue damaged. This can result into persistent pain leading to a variety of consequences (ie increase in stress, further injury, depression, central nervous system and peripheral nervous system changes).
2. Avoid pushing through pain
‘’The no pain no gain’’ response can be very harmful to the injury and also the bodies danger alarm system that is connected to your pain response. It can also lower your pain threshold and as a result decrease your independence and mobility.
3. Seek professional help
Seeking help is very important following an injury to help you get on the right track. Physiotherapy can manage your pain symptoms and exercise physiologists can put you on the road to recovery with a tailored exercise rehabilitation program.
If your doctor or health and wellbeing team isn’t listening to you about your pain, find others who are up-to-date with the latest best practice around treating pain. You could also seek a referral to a reputable pain specialist.
Download this handy resource kit to help you learn more about pain.
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