Turn your back on PAIN

The lat­est word on the old­est agony, plus all-new back treat­ments to try

Sunday Herald Sun - Body and Soul - - FRONT PAGE -

“A HEALTH CRI­SIS LED ME TO THE PER­FECT CA­REER”

1 AVOID­ING A DI­AG­NO­SIS

The cause of sud­den back pain may be ob­vi­ous, but long-term dis­com­fort can of­ten spring from a less ob­vi­ous trig­ger. “If you’ve been in pain for more than three months, it’s classed as chronic pain, and di­ag­no­sis is im­por­tant,” phys­io­ther­a­pist Matthew Stan­lake, from Up­well Health Col­lec­tive in Mel­bourne, says. Find­ing the cause is vi­tal be­cause it may be some­thing that’s treat­able, but also be­cause nerve-based pain needs to be treated dif­fer­ently to mus­cu­lar pain. Also, the ear­lier you treat it, the bet­ter. “Think of pain like wa­ter running down a cliff – in time, the wa­ter carves a groove in the rock, and that’s what hap­pens to your nerves with chronic pain,” Stan­lake says. “The longer it goes on, the more read­ily you feel the pain and the more you have to do to man­age it.”

2 TRY­ING IN­EF­FEC­TIVE TREAT­MENTS FOR TOO LONG

When you use pro­fes­sional help to treat your pain, it’s im­por­tant that this leads to reg­u­lar im­prove­ment. “You should dis­cuss with your team how you might ex­pect to be pro­gress­ing and what should hap­pen by when,” Stan­lake says. “If you’re just float­ing along and noth­ing is chang­ing, then you

– or they – need to ex­plore other op­tions.” This doesn’t mean jump­ing from quick fix to quick fix, though. Stan­lake ex­plains that it can take as long as 12 months to see a sig­nif­i­cant im­prove­ment when work­ing with a chronic pain con­di­tion be­cause you’re ef­fec­tively hav­ing to com­pletely change the way your body re­sponds to pain. “Take things in four-week blocks,” he ad­vises. “Even a med­i­ca­tion might take that long to reach a ther­a­peu­tic dose in the body.”

3 DO­ING TOO MUCH ON ‘A GOOD DAY’

“In 32 years of treat­ing chronic-pain pa­tients, I’d say that do­ing too much is the big­gest mis­take peo­ple make,” phys­io­ther­a­pist Ka­t­rina Evans, from Holis­tic Touch Physio in New­cas­tle, NSW, says. “It’s tempt­ing if you’re hav­ing a pain-free day to try and make up for all those other days, but don’t. Pace your­self to do just 80 per cent of what you think you can do and try to ex­tend that by about 10 per cent each time.”

4 DE­MAND­ING AN MRI

Your GP can’t re­fer you for an MRI for nor­mal back pain un­der bulk-billing, so firstly, hav­ing one will cost you money. Sec­ondly, it might not ex­plain things any­way. “An MRI is good at get­ting a pic­ture of what’s go­ing on in the back and joints, but any dam­age it spots may sim­ply be de­gen­er­a­tive changes and not ac­tu­ally the cause of your pain,” Dr Jill Thistleth­waite, from NPS MedicineWise, says. “An­other prob­lem is that once you know those changes are there, this can al­ter the way you move, act or think about pain in ways that ac­tu­ally cause prob­lems,” Stan­lake adds. In fact, in one US study of more than 3000 peo­ple, those who had an early MRI ended up with a de­creased sense of well­be­ing and higher fees, thanks to the ‘false alarm’ find­ings.

5 TAK­ING EX­TRA PAINKILLERS

It can be tempt­ing to pop a few ex­tra tablets to elim­i­nate bad pain, but in the case of par­tic­u­lar pills, this can be ex­tremely dan­ger­ous. A study by the Univer­sity of Ed­in­burgh in Scot­land found that tak­ing just two to three ex­tra parac­eta­mol tablets a day for four or five days could cause po­ten­tially fa­tal liver dam­age. Even when tak­ing the rec­om­mended dose to ease back pain, you need to be wary if you’re prone to ten­sion headaches or mi­graines as it could make them worse. “Tak­ing painkillers too of­ten can cause the pain re­cep­tors to be­come over-sen­si­tive and this can trig­ger re­bound headaches when you stop us­ing them,” phar­ma­cist and clin­i­cal pain pro­gram con­sul­tant Joyce McSwan says. If this hap­pens, speak to your GP about the best way to con­trol both types of pain.

6 TRY­ING TO ELIM­I­NATE PAIN

In some cases of chronic back pain, it can’t be com­pletely cured, and ac­cept­ing this can make a huge dif­fer­ence to your ex­pe­ri­ence. A trial at the Univer­sity of Chicago in the US found that those who’d worked on ac­cept­ing pain re­ported lower pain in­ten­sity and bet­ter func­tion than oth­ers. “The more you stress and worry about pain, the more you prime the nerves to feel it,” Evans says. Work­ing with a psy­chol­o­gist is an im­por­tant part of a pain man­age­ment plan. If you can’t ac­cess this help, Evans sug­gests read­ing the book Re­wire Your Pain or ac­cess­ing the free ad­vice on the NSW Gov­ern­ment’s pain ser­vice site at www.hne­health.nsw.gov.au/pain

7 PUTTING HEAT ON A NEW IN­JURY

This in­creases blood flow to the area and can ac­tu­ally in­crease pain and in­flam­ma­tion. “As a gen­eral rule, if an in­jury is hot to the touch, put ice on it. If it’s cold, use heat,” phys­io­ther­a­pist Kusal Goonewar­dena, from Mel­bourne’s Elite Akademy, says. “An­other mis­take is us­ing ei­ther for too long – don’t ap­ply them for more than 20 min­utes at a time,” he adds. “Also, never ap­ply ice di­rectly to the skin. Use a towel or you could get ice burns.”

8 US­ING THE WRONG LAN­GUAGE

Stop us­ing dis­em­pow­er­ing lan­guage, like re­fer­ring to your­self as a ‘suf­ferer’. “This lan­guage can in­crease pain in­ten­sity and lead to poorer out­comes,” Evans ex­plains. If you work with a pain psy­chol­o­gist, they’ll help you re­frame your think­ing, but as a gen­eral rule, try to re­place words that cre­ate feel­ings of anger, re­sent­ment or pow­er­less­ness with fac­tual words. For ex­am­ple, say, “I have back pain,” rather than, “I suf­fer back pain.”

9 SEARCH­ING FOR THAT ‘ONE MAGIC SO­LU­TION’

“There’s no ‘magic bul­let’ that will switch off chronic pain – and be­liev­ing there is can lead to you chas­ing ev­ery new idea out there,” Stan­lake says. “I know, be­cause I did this for 10 years my­self. In­stead, take a more holis­tic ap­proach. Things like diet, med­i­ta­tion and ex­er­cise could each give you a 10 per cent im­prove­ment. Put to­gether a team of ap­proaches – and a team of peo­ple – to cre­ate the op­ti­mum re­sult.”

10 REST­ING A SORE BACK

While com­plete bed rest used to be rec­om­mended for back pain, it’s no longer sug­gested as the best op­tion. “We’re made to move and when we don’t, fur­ther prob­lems start,” Goonewar­dena says. “We lose flex­i­bil­ity, our joints stiffen and our mus­cles con­tract, lead­ing to less range of move­ment and more pain. Mov­ing little and of­ten, within tol­er­a­ble pain lev­els, is the key to get­ting bet­ter faster.”

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