Painful Facts (and what to do about it).

Chronic pain is a BIG problem.

• 24 million Australians were living with chronic pain in 2018. 53.8% are women (1.74 million) and 46.2% are men (1.50 million).

• For the majority (56%) of Australians living with chronic pain, their pain restricts what activities they can undertake.

• The prevalence of chronic pain was estimated to increase from 3.24 million Australians in 2018 to 5.23 million people by 2050. (painaustralia.org)

Did you know that commonly used treatments for pain may have created MORE pain?

Over prescription and over reliance on opioid medication is not just a problem in America, Australia is one of the many countries to see significant growth in the use of pharmaceutical opioids over the past 20 years. Similar to the USA, Australia also saw a shift towards a higher rate of casualties relating to pharmaceutical opioids rather than as a result of heroin. In 2017, it was estimated that 1,600 Australians died from drug overdoses related to opioids (Campbell 2019; Hayes 2019)

What are Opioids?

Opioids include the entire family of opiates (derived from the natural ingredients of opium). This includes synthetic and semi-synthetic substances. Opioids include strong prescription pain relievers. It has been shown that a significant number of patients who use opioids for longer than the recommended period will develop a dependency (Medline Plus 2019; Charumilind 2018).

What is Opioid-Use Disorder?

‘Opioid-use disorder’ is the clinical term for opioid addiction. Opioids are highly addictive because they trigger the release of endorphins in the brain. A person may feel compelled to increase their dosage or seek out illegal means of obtaining opioids, such as heroin, in response to a developed tolerance.

 Morphine Madness – (from Explain Pain Supercharged, Mosely & Butler 2017.)

Most people get a few hours of pain relief from morphine. However, when it comes to persistent pain, morphine is a bit of a problem. There are two reasons for this – One is that it is addictive and some people start to crave it. The other reason involves the biological effects that morphine has on our danger pathways. While morphine dampens down danger messages in the central nervous system, thus decreasing pain, it also activates immune cells that make the danger pathways more efficient. This will normally increase pain. Over time, the balance between the anti-danger effect and the pro-danger effect shifts towards an overall danger effect. In this situation, the morphine is actually making the pain WORSE!

Over reliance on passive and manual therapy is also a bit of a problem.  Research suggests (and recommends) that passive manual therapy alone is actually not helpful overall for chronic or persistent pain and that active strategies (including self-management) such as exercise and even mindfulness should be a central part of a broader management strategy that takes into account the whole person.

What’s more, in persistent pain, we can develop changes in the sensitivity of our tissues and what was once a minor ache can be “turned up” to something more troublesome (hyperalgesia) OR what would normally be a non- painful or even pleasant sensation and be perceived as painful (analgesia).

Insights from science

Below are 10 target concepts that are helpful to understand if you suffer from chronic pain, or know someone who does. Remember learning about pain is therapy and knowledge can be the greatest pain liberator of all!

1) Pain is normal, personal and always real: All pain experiences are normal and are an excellent, though unpleasant response to what your brain judges to be a threatening situation. All pain is real.

2) There are danger sensors, not pain sensors: The danger system is just that – there are no pain sensors, pain pathways or pain endings.

3) Pain and tissue damage rarely relate: Pain is an unreliable indicator of the presence or extent of tissue damage – either can exist without the other.

4) Pain depends on the balance of danger and safety: You will have pain when your brain concludes that there is more credible evidence of danger than safety related to your body and thus infers the need to protect.

5) Pain involves distributed brain activity: There is no single ‘pain centre’ in the brain. Pain is a conscious experience that necessarily involves many brain areas across time.

6) Pain relies on context: Pain can be influenced by the things you see, hear, smell, taste and touch, things you say, things you think and believe, things you do, places you go, people in your life and things happening in your body.

7) Pain is one of many protective outputs: When threatened the body is capable of activating multiple protective systems including immune, endocrine, motor, autonomic, respiratory, cognitive, emotional and pain. Any or all of these systems can be over protective.

8) We are bioplastic: While all protective systems can be turned up and edgy, the notion of bioplasticity suggests that they can change back, through the lifespan. It is biologically implausible to suggest that pain can’t change.

9) Learning about pain can help the individual and society: Learning about pain is therapy. When you understand why you hurt, you hurt less. If you have a pain problem, you are no alone – millions of others do too. But there are many researchers and clinicians working to find ways to help.

10) Active treatment strategies promote recovery: Once you understand pain, you can begin to make plans, explore different ways to move, improve your fitness, eat better, sleep better, demolish DIMs (danger in me), find SIMs (safety in me) and gradually do more.

Some of these may seem obvious, some may challenge some of our current beliefs. They are based on current available evidence and we should take them seriously! As Frank Zappa said beautifully “our milds are like parachutes, they don’t work unless they’re open!

References:

Campbell, G 2019, ‘How is Australia Responding to the pharmaceutical Opioid Problem?’, National Drug and Alcohol Research Centre, Sydney, viewed 31 October 2019, https://ndarc.med.unsw.edu.au/blog/how-australia-responding-pharmaceutical-opioid-problemhttps://ndarc.med.unsw.edu.au/blog/how-australia-responding-pharmaceutical-opioid-problem

Charumilind, S, Latkovic, T, Lewis, R and Mendez-Escobar, E 2018, ‘Why We Need Bolder Action to Combat the Opioid Epidemic’, McKinsey and Company, viewed 31 October 2019, https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/why-we-need-bolder-action-to-combat-the-opioid-epidemic

 Hayes, J 2019, ‘Tasmanian Poppy Farmers are at the Centre of the US Opioid Crisis, But They Say They’re Not to Blame’, ABC News, Sydney, viewed 31 October 2019, https://www.abc.net.au/news/2019-10-13/tasmania-poppy-farmers-in-crosshairs-of-us-opioid-crisis/11588766

Medline Plus 2019, Opioid Misuse and Addiction, Medline Plus, viewed 31 October 2019, https://medlineplus.gov/opioidmisuseandaddiction.html

Mosely, L, Butler, D, 2017, ‘Explain Pain Supercharged’, noigroup publications, Adelaide.

Painaustralia.org, Deaken, ACT. https://www.painaustralia.org.au/about-pain/painful-facts, viewed 17 February 2020.