Pain control
After recent changes to the availability of codeine, Professor Kerryn Phelps looks at alternative pain management methods.
The Federal government’s recent decision to make medicines containing codeine available prescription-only caused quite a controversy. My GP colleagues around the country have been having difficult conversations with patients who suffer from chronic pain. These people are now forced to either find a new medication, an alternative to medication or have to visit their doctor more often to get prescriptions.
One in five Australians lives with chronic pain. That makes it one of the most common reasons people have to see their doctor. There have been a lot of very reasonable questions for us to answer.
What’s the difference between acute pain and chronic pain?
The definition of acute or chronic pain is not about how severe the pain is. It is about the timing. Acute pain is recent in onset. Chronic pain is pain that has become long term, usually for more than about six months. For acute pain, the emphasis is generally on removing the pain by identifying the cause and providing pain relief while your body heals. In many chronic pain conditions, we may not be able to identify the underlying cause of the pain with certainty, or the cause may not be treatable.
Pain starts with damage to body tissues. Then a number of secondary changes in the brain and the nerves in the body amplify the pain experience. So the treatment of pain often needs to address these secondary changes as well as the origin of the pain.
What are my options?
Go back a few steps. Take this opportunity to have a case review with your GP. Was the original diagnosis of your condition correct? Have you had all of the appropriate imaging, such as ultrasounds or MRI scans, to confirm your condition? Is there anything else that can be done to treat the origin of the pain?
Depending on the type of pain you have, a second opinion may be reasonable. There are specialised pain clinics in some major public hospitals where your condition and treatment plan can be reassessed. You will need a referral from your GP.
What non-pharmaceutical pain management options can I try?
There are many treatments and techniques that you can use to help eliminate pain and/or reduce its effect on your quality of life. You may need to trial a few different techniques or combinations to figure out what works best for you. Here are some of the most popular:
• Psychological techniques: cognitive behavioural therapy, relaxation techniques, guided imagery
• Physical and manual therapies: physiotherapy, osteopathy
• Exercise techniques: yoga, Tai Chi, supervised rehabilitation, hydrotherapy • Relaxation techniques: meditation and mindfulness
• Music therapy
• Art therapy
• Acupuncture
• Low-level laser treatment
Affordability is a real issue for a lot of people, as there is usually an out-ofpocket cost for services in the private sector. Some treatments will be available in public hospital clinics and other treatments outside of the public system are subsidised by Medicare but you will need to ask your GP if you qualify for a Chronic Disease Management Plan. This is a plan to coordinate the different practitioners and medical specialists involved in your health care. Then you can have five subsidised (not necessarily free) treatments per year. These might include acupuncture, physiotherapy, osteopathy, psychology and exercise physiology.
When should I seek further medical attention and prescription medicine to deal with pain?
If your pain is not well controlled you need to keep trying to find solutions. Consider all aspects of your experience of pain, whether physical, psychological or spiritual, and what it means to your quality of life.
Could it be “all in my head”?
In a word, no. Pain actually caused by psychological issues is extremely rare. Psychological factors do contribute to the intensity and quality of your pain experience, as well as the way you behave because of your pain. Mood problems such as anger, frustration, anxiety and depression are also very common consequences of pain. You will manage your pain better if you include psychological techniques in your treatment plan, regardless of the cause. Your family and friends need to understand your condition and what you need to do to feel better. AWW