Chronic pain: A better understanding leads to better treatment possibilities

Recent advances in the field of pain management research may offer relief to sufferers of persistent chronic pain. Chronic pain affects approximately 1 in 5 working Australians and it is estimated to cost the country about $34.3 billion, annually. Relief may be on its way however, with the development of a number of different therapies specifically targeting the cause of chronic pain. Professor Michael Cousins, director of the Pain Managment Research Institute at the University of Sydney and Royal North Shore Hospital described some exciting steps forward in the field of chronic pain management.

"We have recognised what a massive problem [chronic pain] is, the other big change is that we now realise that persistent pain becomes a disease in its own right."

Professor Cousins explained that following an operation such as spinal surgery, pain can sometimes persist and health professionals "now understand that changes occur in the nerves leading into the spinal cord, in the spinal cord itself and in the brain" which then becomes the basis of the disease. "After all types of surgery a minimum of 10% of patients will experience chronic pain, most of which is due to nerve damage."

A new technique that has shown to be effective in pain management is called neuromodulation. "Neuromodulation relies on using the body’s own nervous system responses to combat the pain" whilst still being able to "preserve the nervous system" explains Professor Cousins. One type of neuromodulation involves the implantation of several very small electrodes across nerves at the body surface, or on the back of the spinal cord. A small pulse generator then sends signals to the electrodes, stimulating spinal cord nerves and causing the release of the body’s own pain-relieving chemicals. The patient controls the spinal cord stimulation pulses. Neuromodulation therapy allows many patients to stop taking high doses of opioid drugs.

Another form of neuromodulation involves drugs that specifically target changes in the nerves of the spinal cord that are associated with chronic pain. These drugs have been shown to be effective in the treatment of pain associated with spinal cord injury. Patients experiencing phantom pain following the amputation of a limb may also be candidates for neuromodulation.

Cognitive behavioural therapy (CBT) is another treatment approach for chronic pain that offers relief from the psychological effects of the disease. Patients are sometimes told that the pain is all in their head, which can lead to further confusion about what they should do. CBT involves giving patients correct information about their pain and helping to understand what factors are contributing to the pain and which therapies would be most appropriate.

"When people have persistent pain they start to adopt a very protective posture with their back or limb. Its been recognised now that you need very specialised physical therapy to reprogram the muscle activity, relearn how to walk properly, use an arm properly. It’s a very recent and very impressive change that has occurred. It makes a big different to get the right sort of help there" explained Professor Cousins.

Chronic pain is a disease that can dramatically affect all aspects of people’s lives, their movements, their mood, their social activities "and that’s why it’s very important to treat it effectively" said Professor Cousins.