Welcome to National Pain Week 2020! Each year Chronic Pain Australia, the national voice of people living with chronic pain, organises National Pain Week to champion the needs of the many Australians living with chronic pain.
Chronic pain was defined; the pain usually lasts more than three months. Latest data showed that more than 20% of Australian and NZ population has chronic pain. Chronic pain costs more billion dollars annually and is one of the disabling medical condition worldwide.
Unfortunately, despite a lot of researches during the last 50 years, the mechanisms of chronic pain are poorly identified. For years, physicians have used opioid medications for the management of acute and chronic pain. The advanced studies during the last two decades demonstrated that opioids medication does not have any role in the management of chronic non-malignant pain.
The reason might be that the mechanisms that cause chronic pain are not the same as acute pain; therefore, the way that health professionals treat chronic pain should be different.
The most recent studies showed that chronic pain requires assessment and management of social and psychological aspects of chronic pain suffers as well as the biological elements. Consequently, a socio-psycho-biomedical model of chronic pain management was offered from The International Association for the Study of Pain (IASP). This model of chronic pain management has had an excellent result based on Randomised Clinical Trials and nowadays, being supported by Governments in developed countries.
Commonly, it means that in assessment and management of chronic pain interaction between the chronic pain suffers, their family, relatives, friends and in general with the community and environment also have a significant impact of their pain intensity. In addition, in case of the presence of depressed mood, anxiety and other mental health disorders, the patients feel more pain in comparison to the time they treat or control their emotion and mental health problems. Any management plan without considering these factors will be unsuccessful.
In addition, later studies showed that in the most chronic pain conditions, the patient feels a persistent pain without any tissue damage. Further studies demonstrated the role of the central nervous system in the chronicity of pain. In a normal situation after tissue damage, the patient feels the pain due to a process of tissue inflammation that is called peripheral sensitisation. Usually, this tissue damage heals in a few days or weeks after initial inciting events. Hypersensitivity of the central nervous system that is called central sensitisation happens in case of the tissue damage, and peripheral sensitisation lasts longer than usual. It is one important mechanism that leads to Chronic pain. As it was mentioned before, central sensitisation continues even after the resolution of tissue damage and peripheral sensitisation. It is believed that Central Sensitisation of the nervous system is responsible for chronic pain and unfortunately cannot be managed medication that could help during the process of tissue damage.
It is essential to manage acute pain properly before it leads to chronic pain. In case of any sign and symptoms of chronic pain, stopping the medication that was used for acute pain and getting advice from a health professional and commencing the medicine and other treatment modalities that help to control the impact of central sensitisation is crucial.
Dr Ahmad Mir
Dr Ahmad Mir is a General Practitioner and have Fellowship of Australian College of General Practitioner and works as Pain Medicine Fellow of Faculty of Pain Medicine Australian College of Anaesthetics in the Department of Pain Medicine Liverpool Hospital. He has studied Master of Pain Medicine at The University of Sydney. He has been part of Castle Hill Medical Centre team since 2019.