What a (chronic) pain!

Dr Joe Kosterich analyses the management methods and offers some advice on how we can maximise quality of life for chronic pain sufferers.

  Some one in five Australians suffer from chronic pain, with this number rising to one in three in those aged over 65. Chronic pain is generally defined as constant daily pain present for at least three of the preceding six months. Of course, severity can vary.

  Like all things in medicine managing chronic pain begins with history examination and appropriate investigations. Diagnosis is critical - if there is an underlying cause of the pain then this needs to be identified and treated. But that’s often easier said than done.

  Chronic non-cancer pain may not always have a clear diagnosable cause. The pain may be neurogenic, musculogenic, from the skeletal system or elsewhere. Chronic conditions like fibromyalgia can cause chronic pain as can auto immune conditions like Lupus. Post herpetic neuralgia or other neurogenic conditions can lead to chronic pain, as can prior injuries and degenerative conditions like osteoarthritis.

  In simplest terms, management options for chronic non-cancer pain divide into pharmacologic and non-pharmacologic. In the first group options include simple paracetamol. The benefit of the regular use of this is underestimated especially in arthritic pain. Whilst not a “cure” or even by itself the answer, it can allow lesser does of other medications to be used.

 Non-steroidal anti-inflammatory medications can have a role but long term (and sometimes even short term) use can have significant side effects especially in the older age group. Use must be monitored carefully ensuring that benefits are outweighing adverse effects.

 Oral opiate medications have become one of the mainstays of chronic pain management over the last 15 years. Significant side effects and tolerance can be issues, and use for longer than 30 or 60 days (depending on state or territory legislation) needs health department approval and must be initiated by a specialist. However, GPs will be prescribing on an ongoing basis and generally have to manage any side effects.

  In neuropathic pain, pregabalin and gabapentin together with some anti-epileptic medications can be used. Pregabalin, in particular has become quite popular and is, generally, well tolerated.

 Much research has highlighted the importance of non-pharmacological treatments. Physical therapies such as physiotherapy, hydrotherapy and exercise can make that little bit of difference to your patient. In arthritis, there is often a reluctance to exercise and while activity needs to start very gently (and possibly under physio guidance) the benefits are considerable. Simple measures like a comfortable mattress and pillow, heat applications and stretching all can help. Simple measures like these have no side effects.

 Many with chronic pain will also have depression and anxiety. Self-help programs which teach people coping skills and how to live with their pain and manage it are very helpful for many. Unfortunately, they are not always easily as accessible or affordable as one would like. Access can be made easier via a chronic disease management team care plan.

 Psychological counselling (possible under a mental health plan if appropriate) can also be beneficial. Some may need antidepressants or other medications but remember, one needs to be very attuned to possible drug interactions.

 Ultimately chronic pain is a common, often complex condition. There’s no quick fix, and outcomes are not always as good as hoped. Our aim as GPs is to help people minimise the impact of chronic pain and maximise the quality of their life. What this means will be different for each person.

Jow KosterichDr Joe Kosterich MBBS
Doctor, speaker, author of three books, media presenter and health industry consultant, Dr Joe Kosterich wants you to be healthy and get the most out of life.He is a regular on Channel 9 and radio, writes for various medical and mainstream publications, as well as maintaining a website and blog providing health information. He is the health ambassador for locally grown fresh potatoes. Dr Joe also gives practical motivational health talks for the general public and organizations.