Chronic Pain

Around 20 percent of patients in the UK, Australia and the US experience “chronic pain” so if you have this you are not alone. This often causes real suffering, disrupts normal life and can lead to poor mood or even depression.  Pain that lasts longer than 6 months and is not associated with ongoing inflammation or infection is defined as chronic pain. This type of pain continues after tissue damage has finished, often leading patients to worry that there is still damage going on. This is not usually the case. There is good science to show that chronic pain continues as an echo of the original pain in the nerves, brain and neurological system. Modern lifestyles, stress and lack of activity can worsen this situation.

Because chronic pain resides in nerve pathways it needs a holistic (whole person) approach and often a combination of medication, structured physiotherapy and activity. This can help retrain the nerve pathways. Medications can at best only reduce pain by about 30 percent, still a worthwhile improvement, but looking for complete pain relief is usually unrealistic. It is realistic to be able to continue a fulfilling life even after chronic pain is diagnosed, but this will take adaptation and change.

Strong morphine related painkillers, often used in the past for chronic pain, are now known to be largely ineffective in the long term. They can lead to weight gain, dependency and poor immune function. The most effective scientific treatments for chronic pain is activity, studies showing improvements in pain of up to 47%.

As the brain controls much nerve activity, calming down unhelpful brain impulses can be helpful. Cognitive behavioural therapy aimed at targeting negative thinking, stress and worrying thoughts is an effective treatment. It is also a good treatment for tiredness, poor sleep and poor mood, which often accompany chronic pain. Some patients feel that because the doctor recommends some “brain training”, that the doctor is suggesting the pain is in “in my head”. In reality all chronic pain resides in nerve networks, connecting the brain and the body – so targeting both is necessary.

Doctors and physiotherapists work together in Aviemore Medical Practice to offer some selected patients with chronic pain a structured course: “Managing Pain Skills Course” or MAPS. If you are prepared to spend 30 minutes a day working on course materials then speak to your GP about if you are suitable for this. In the meantime:

• Make small regular increases in your activity
• Make sure you are don’t do too much, not so much that you have to rest the next day
• Speak to your GP if you are concerned about your medication use, or wish a medication review
• Address other causes of concern, worry and stress by building positive relationships and meaningful activity
• Consider learning skills such as relaxation techniques, yoga, meditation such as mindfulness, or one based on your own spiritual tradition.
• Try and live a fulfilling life within your current limitations, and gradually expand what you do.

You will find additional information for patients and professionals below:

MAPS for Patients:
MAPS Patient Guide PDF
MAPS Patient Guide Brochure (for printing)

MAPS for Professionals:
MAPS Practice Guide PDF
MAPS Practice Guide Brochure (for printing)
MAPS Opt In Invite Template
Modified CA Pollard Pain Index