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Episode 13 - Chronic Pain

What is the Difference Between Acute and Chronic Pain?

 

Before exploring the differences between acute and chronic pain, it's important to understand the broader definition of pain. Pain is most commonly defined as:

 

"An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage."

 

This definition is particularly relevant when distinguishing between acute and chronic pain.

 

Acute pain typically comes on suddenly, is caused by a specific event, and usually resolves within a few months once the underlying cause is treated. Examples include labour during childbirth, surgical recovery, or a broken bone.

 

Chronic pain, on the other hand, persists beyond the expected period of healing, often lasting longer than six months. This type of pain can persist even when there’s no apparent injury or ongoing tissue damage. In chronic pain, changes within the nervous system continue to generate pain signals.

 

The key takeaway is that all pain, whether acute or chronic, is both a sensory and emotional experience. Effective pain management requires addressing all the components that influence the pain experience.

 

How Common is Chronic Pain and What is Its Impact?

 

Chronic pain is considered almost endemic in Australia. A large 2018 study found that nearly 4 million Australians live with chronic pain, affecting people of all ages, with 68% of these individuals being of working age.

 

The impact of chronic pain is profound, affecting individuals, families, and society as a whole. Financially, chronic pain cost Australia nearly $140 billion AUD, including $73 billion in healthcare expenses. Of this, $12 billion was attributed to indirect costs such as family members taking time off work to support loved ones.

 

The real burden of chronic pain, however, is personal. It impacts all aspects of quality of life, including relationships, mobility, function, mood, and self-esteem.

 

What Are Some Common Treatment Myths About Chronic Pain?

 

There are numerous myths surrounding the treatment of chronic pain, which can hinder effective management.

 

For example, many patients fear that their treatment options are limited to addictive medications, ineffective injections, or that being referred to a psychologist means their pain is "all in their head." These are misconceptions.

 

While medications are a part of chronic pain management, specialists carefully monitor and manage any that may cause dependence, ensuring their safe use. Interventions like injections can be very effective, but they require accurate diagnosis and are most beneficial when combined with other therapies like quality physiotherapy.

 

Psychological support is also crucial. Pain is not just a physical experience but also an emotional one, and how we perceive and react to pain can greatly affect our experience. The role of psychologists in pain management is to address these emotional components, not to dismiss the pain as imagined.

 

What Are the Treatment Options for Chronic Pain? What is the Role of a Specialist Pain Medicine Physician?

 

Managing chronic pain often requires a team-based approach. Specialist pain medicine physicians typically coordinate this process, working closely with other healthcare providers, such as physiotherapists and psychologists.

 

In terms of medical treatment, pain specialists utilize various medications tailored to the type of pain, such as those specifically for nerve pain. Interventional procedures like nerve blocks, radiofrequency treatments, and, in rare cases, implantable devices, can offer short- to intermediate-term relief.

 

How Do I Facilitate a Review?

 

In the private sector, pain specialists are often based in capital cities. It’s advisable to discuss a referral with your GP or another treating specialist who may already have connections with a pain specialist. A GP referral is beneficial not only for continuity of care but also because it qualifies you for a Medicare rebate.

 

In the public sector, most major teaching hospitals have pain departments. Again, discussing local referral options with your GP is recommended.

 

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