Of chronic pain

to suggest treatments that might be really effective in the early stages. If things aren’t improving, or you have had pain for years and it isn’t resolving, ask for a referral to a local pain team – they should be able to talk through some of the management options below: ❚ Firstly, keep active. I know that sounds difficult if you are in pain, but activity of any sort (as long as it isn’t exacerbating an injury) is helpful. Becoming inactive leads to loss of muscle tone and fitness, hence increased pain and difficulty when you do start to move again, as well as impacting on your mental wellbeing, hindering recovery. You may find you can’t do your usual type or level of activity, but think outside the box – anything water-based tends to be amazing for joint and muscle pain, and stretching and strengthening activities such as pilates or yoga are great for improving flexibility as well as helping reduce stress and anxiety levels (associated with higher levels of experienced pain). Even talk to a physio or good personal trainer to help design a programme that will fit your needs. ❚ Secondly, be involved in the management of your pain. It is likely to be multifactorial (that is, have many causes contributing to it), so your doctor won’t be able to wave a magic wand. They can help, but so can you, so taking a proactive partnership approach will give you a much better outcome, as hard as that may feel when you are sore and distressed. That includes seeking support from your network, remaining involved in activities, and accepting that doctors won’t have all the answers. Keeping a positive attitude can be really hard, but it will help. ❚ Trial medications when suggested, and take them as recommended. There are numerous options – from simple analgesics (such as paracetamol), to anti-inflammatories (such as diclofenac or ibuprofen), and pain-modulators (including some antidepressants and epilepsy drugs). I would advocate trialling things one at a time if you can, so you know which has been beneficial, and give them all several weeks to take effect – many won’t work overnight, and you may be stopping an effective treatment too early. I offer caution to my patients about starting an ‘‘opioid’’ or morphine-based treatment, though it is, at times, the only option that will work. Opioids tend to lead to side-effects, and are addictive, so can quite rapidly lead to more problems than you had in the first place – that said, if you have tried all other options unsuccessfully, don’t rule it out. ❚ Look after your mental health – although it is thought to be a predictive factor for developing chronic pain in the first place, it is also a natural consequence of living in pain and being unable to do all the things you love. Most patients with chronic pain will also have stress, anxiety or depression at some point. Talk to those around you as well as health professionals. CBT (a therapy offered by psychologists) can be really useful in coming to terms with a change in lifestyle that chronic pain may have caused. Antidepressants can help with the pain and lift your mood, helping you cope. ❚ Lastly, think broadly – the best outcome for chronic pain is when different approaches are tried, and different people are involved. That may include a GP, counsellor, physio or acupuncturist – it may also include someone who can give you advice about what career may be more suitable if chronic pain is impacting on your ability to work, or talking to other sufferers about what they have found helpful. For more information, visit healthnavigator.co.nz