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Chronic pain

Updated 04.04.2022
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The brain and the spine are a complex system that work together as part of the central nervous system. The spinal nerves send messages from the rest of the body to the brain, so it can process what’s in the environment and anything that might be feeling good or bad within the body. It is the brain that interprets some of these messages as pain. The brain’s response to pain is to one that has evolved to protect us, as animals, from threat and danger. In the simplest terms, it tells us of an injury so we can protect the area and recover. But pain can be complex: the brain occasionally misinterprets messages as pain when there is none, or the response to minor pain can be disproportionate. Pain is expected to settle down over time, especially when related to an injury or trauma, but chronic pain persists for more than 3 months and sometimes without any clear triggers. Behaviours build around this that can exacerbate the problem and reinforce the nerve signals, making treatment difficult.

How does chronic pain start?

Chronic pain is pain that starts small and persists and grows, in a complex neural network of feedback and reinforcement of nerve messages. It can start from any part of the body, organ or any body system. Injuries or conditions affecting the muscles, joints or bones, such as back pain or arthritis, can be a common cause, and similarly fibromyalgia, which is chronic widespread pain in the muscles and bones. Endometriosis is a condition affecting women, where cells from the lining of the uterus grow outside of the womb cavity, causing pain and discomfort. Irritable bowel syndrome (IBS) can have varying gut symptoms, but many experience abdominal cramps and aches either persistently or in flare-ups. Chronic fatigue syndrome brings prolonged and extreme tiredness, which can be associated with pain.

How can I help my chronic pain?

Exercise is a great way to manage chronic pain. It’s important to get the balance right and try to incorporate exercise as part of your daily routine. It brings benefits to both mind and body. Good options include swimming, walking, yoga or any other activity that you enjoy. Physical therapy is usually delivered by a physiotherapist. It can also be given by a chiropractor, osteopath or occupational therapist. It involves a short course of stretching, manipulation and pain-relieving exercises. Your GP can refer you on the NHS and it is also available privately. Continuing to work is also important to keep the mind and the body active and provide a healthy distraction from the pain. Research has shown that those who stop work due to chronic pain are more likely to get depressed than those who don’t. If you find work difficult, talk to your supervisor about any workplace-based adaptations that may help – your GP can support in this and act as advocate, or Occupational Health if your employer has this. We have a tendency to consider body and mind as separate entities and want to treat one or the other. There’s a reluctance to accept that the mind plays in on physical symptoms. As such, stress reduction is important in managing chronic pain, and taking time out to relax and recuperate can help. You may know what works for you, but many find mindfulness, yoga, meditation, reading, listening to soothing music, or even dancing or listening to any music that feels invigorating or freeing – all of these can be a great way to give your mind and body a rest from the vigilance and effort of chronic pain.

Will medications help?

Painkillers can be used to manage pain, allowing for their side effects. Paracetamol, ibuprofen and some low-dose codeine are available over-the-counter. Give these a couple of weeks, and if they haven’t worked, consider booking with your GP to discuss whether stronger painkillers on prescription are suitable. A complex relationship exists between chronic pain and depression. As a result, antidepressants can be useful in managing symptoms or depression and anxiety. A TENS machine (Transcutaneous Electrical Nerve Stimulation) may be helpful, whereby electric shocks are sent to your muscles to reduce the sensation of pain. They are most known for helping in labour, but have a wide application outside of this. Acupuncture is another option with evidence to say it helps, although we don’t fully understand why. It involves pricking needles into the skin to reduce pain. Surgery can be used if there is ongoing pain from a poorly healed wound or injury, but this is only used in certain circumstances.

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