What is chronic pain and how can you manage it?

As singer Annie Lennox calls for the reopening of pain services, Lisa Salmon talks to a doctor about what chronic pain means.

Lots of health services have been impacted by Covid-19 - including pain management services, which singer Annie Lennox recently shone a light on.

The former Eurythmics star, who has lived with chronic pain following an operation over a decade ago, took to her website to call for these services to be restored, saying it's "indecent and inhumane" to leave people suffering.

Chronic pain - which can be caused by many conditions, including arthritis, cancer, fibromyalgia, injuries, lower back problems and persistent headaches - blights the lives of millions of people, causing huge physical, psychological and social problems. Yet it's thought to be one of the most underestimated healthcare problems in the world.

Lennox says she understands "only too well what it feels like to go through hours or days with extreme physical discomfort" - and although there's been a greater focus on phone and video consultations recently, she points out that due to the pandemic, many pain clinics have now been closed for months.

The International Association for the Study of Pain (IASP) estimates one in five people suffer from moderate to severe chronic pain, and up to two-thirds of them struggle or are unable to exercise, sleep normally, do household chores, attend social activities, drive, walk or have sex.

So what exactly is chronic pain and what can those affected do about it? Here, GP Dr Paul Stillman, co-author of Deep Relief's new 'Psychology of Pain' report (deep-relief.co.uk), tells us more...

What is chronic pain?

"Chronic pain is pain that persists for three to six months or more. It can continue for many months after a person has sustained an injury or has an illness causing pain. Sometimes a person suffers chronic pain for no identifiable reasons - i.e. when no injury or illness has occurred. - but this doesn't make the chronic pain any less real," says Stillman.

"Some of the most common types of chronic pain include lower back pain, musculoskeletal pain and headaches, as well as the pain of arthritis, pain after surgery or trauma, and very serious conditions such as cancer."

Who gets chronic pain?

"Chronic pain can affect anyone of any age. It becomes more common with age and women experience it more often than men." The nature and severity of chronic pain can also vary significantly from person to person.

What can people do about it?

Stillman says treating pain quickly is important, as this can be a factor in preventing it from becoming a chronic or more severe problem in the long run.

"Pain requires rapid management if it's not to escalate and become worse. In short, it needs to be nipped in the bud," he says.

However, seeking expert advice and ensuring treatment is appropriate is also vital. "While people sometimes turn to oral analgesics (painkillers) to manage chronic pain, these can be linked with side-effects and can become quite 'addictive', exposing a person to an even greater risk of side-effects. Oral pain killers may in some cases interact with prescription medicines," Stillman says.

Not everybody with chronic pain will require more specialist treatment, but where the underlying causes are more complex, or over-the-counter medicines have not helped, patients may benefit from a referral to a pain management specialist. Having a conversation with your GP is the best place to start.

Exercise and lifestyle plays an important part too

Regardless of the cause and severity of your pain issues and treatments prescribed, looking at your whole lifestyle is always a good idea. Small shifts can make a big difference - not only to your pain but the impact it has on your life and mental wellbeing.

"Exercise can be very helpful for pain, including musculoskeletal pain, lower back pain and headaches. Exercise causes release of endorphins (feelgood hormones) which can help with pain, as can simply being outside in the fresh air. Moving a painful joint or back, say on a walk, can help to manage pain.

"It's also important to practice relaxation, deep breathing, meditation and so on. Have a warm (not hot) bath and indulge in some positive reflection. Try to get a good night's sleep. Getting refreshed can really help with painful stressed muscles.

"Always practice good posture. Make sure your work station, driving seat and/or cycling position are properly adjusted. Sit upright and make sure your bed and sofa are comfortable and supportive. Try stretching exercises for muscle pain. And if you work out or run, always warm up before activity and cool down after," Stillman adds.

"Try to live a healthy lifestyle with a healthy diet that includes recommended amounts of calcium, magnesium and potassium, as these nutrients contribute to the health of the muscles. According to the National Diet and Nutrition Survey, a significant proportion of women have intakes of these nutrients below the Lower Reference Nutrient Intake (LRNI). Ensure you keep well hydrated. In terms of relaxation, enjoy a cup of tea."

Do some people need painkillers for life?

"Occasionally, yes. But doctors don't like to prescribe painkillers for too long, as they can become addictive. Painkillers can be associated with side-effects depending on the painkiller, with effects on the stomach (for example, they may cause nausea, dyspepsia or constipation) and in excessive doses, sometimes on the liver and kidney. However, in cases of very serious disease like cancer, painkillers may be needed long term."

Is chronic pain linked to depression?

"Pain is strongly associated with depression. A cross-sectional study in 1,227 people aged 62 or over with knee/hip osteoarthritis found a higher level of depressed mood, with women experiencing greater pain and fatigue. Chronic pain may also cause us to lose interest and be unable to concentrate, we may suffer sleep disturbances and changes in our appetite. Lack of sleep caused by pain wreaks havoc on moods," explains Stillman.

"Pain can cause us to withdraw from activities, not engaging with others, thus isolating ourselves from our loved ones, all of which can increase stress. Stress in turn can increase chronic pain, particularly chronic muscular pain, and may lead to that familiar sense of our muscles being tied up in knots."