Management of Chronic Pain: An Introduction

Management of Chronic Pain: An Introduction

Dr Dominic Aldington, Consultant in Pain Management

As we have discussed, pain is a complex beast. However, its treatment need not be so.

The first, and most important, step in the treatment of pain is to measure it. Many different methods exist and all have their pros and cons. However, regardless of which technique is used it is important that it is the patient that scores their pain and not a third party who estimates the patient’s pain. Often the simple act of measuring the pain will alter the patient’s experience of it.

“Pain is real when you get other people to believe in it. If no one believes in it but you, your pain is madness or hysteria”. (Naomi Wolf).

Secondly you need to decide what type of treatment the patient wants. It may be that they do not want anything, or if they do, it may not be what you can offer them.

Very often simple treatments are overlooked. Heat packs, cold packs, and simple exercise may be all that is necessary. Alternatively creams or patches may be offered, particularly for areas of sensitive skin. An ever-expanding number of medications exist and these should be approached in a methodical manner. Physical therapies such as physiotherapy, osteopathy, chiropractic, acupuncture or TENS machines should also be considered. Finally, there may be the option of injections. These tend to fulfill a dual function of being potentially diagnostic and of providing a period of less pain during which other modalities, particularly the physical therapies, can be optimised. Some clinicians now see these as a “bridging” technique, spanning the gap from where the patient starts to a position in which the rehabilitation can begin.

Of course, the emotional component of the pain should not be overlooked, especially in the treatment of chronic pain. Very often all that is required is for the individual to recognise that this is an integral part of their pain. If they feel it is a bigger problem than they can handle alone they may need specialist psychological support but it should be explicitly stated that this is not a sign of mental illness but another treatment option. There will be few Olympic competitors that have not had recourse to see a psychologist to help with the emotional component of their performance and this is very similar but the performance is activities of daily living rather than Olympic glory.

March 2019, M-C-UK-02-19-0001