Chronic & Complex Pain

What is Chronic or Complex Pain?

Chronic pain is a term banded around without people appreciating that it is not a diagnosis. The meaning of ‘chronic’ varies but really just means ‘long term pain.’ ‘Long term’ is defined as anything from 3 to 6 months or more. Chronic pain is NOT the same as ‘incurable pain’ but unfortunately the terms have become synonymous. That is why we prefer the term ‘complex pain.’ Just because someone has been experiencing pain for a long time it does not mean that it will not get better. What it does mean is that the treatments designed for acute or short term pain will not work. Or at least they will not work as quickly as they do for pain that has only been experienced for a short time. Basically the longer you have had your pain the longer it will take for it to get better and for you to return to doing the things you want to do.

So how long and how often will I need treatment?

For example, if you have had pain for six months, you will need to have physiotherapy for six months to a year to recover. If you have had pain for a year of more, you will be looking at a programme of up to eighteen to twenty four months. Unfortunately it is highly unlikely that your insurance company or the NHS will provide you with physiotherapy for this period of time and you will therefore need to pay for at least a proportion of it. The short term cost needs to be weighed up against the long term gain of being able to work and do the things you enjoy. You also need to consider that it may not be as costly as it sounds as long as you do all the things that the physio tells you to do (and not to do!) so that in effect you become your own physio and therefore do not need frequent appointments. In fact, I would recommend that you question the clinical reasoning of your physio if they ask you to have weekly appointments for more than about six weeks because after this time you should be becoming more independent and less reliant on hands on treatment. Hands on treatment will then only be appropriate during flare ups, and this should only be episodic. By the time a year is up your appointments should only be once every few weeks or months.

Key factors in treating complex or chronic pain

1. Setting a baseline and goals. These are particularly essential when the treatment period is going to be over a long period of time and sessions are going to be infrequent. These help to make sure treatment continually focuses on getting you back to doing the things you want to do and setting time frames to achieve these things.
2. Bio-mechanics. Your body is designed to work optimally by putting the forces we exert on it in day to day activities and sports through the structures that are designed to take those forces. Often with chronic pain the way the body moves has become inefficient. The first thing that needs to be done is teach you how to make your body move efficiently and in the way it is designed to. This will involve improving the way you stand, sit, walk, lift, carry, reach for things, go up and down stairs and any other regular sports or activities you do.
3. Hands on treatment and acupuncture. Treatments like massage, joint manipulations and acupuncture can give short term relief and able you to move more easily which is fundamental in reducing pain and returning function.
4. Pacing, activity charts and small increments. Guidance from an experienced physiotherapist who can explain what activities you can do,  and for how long is essential for your recovery. Building up all activities and exercises in small increments from the established baseline is essential. Using activity charts really helps in making sure you can control these things yourself.
5. Exercise and general conditioning. Without doubt, there is the most research on this topic. It clearly shows that the sooner we can get you back to regular exercise and get your general fitness and strength back, the sooner your pain will reduce and you will achieve your goals. This needs to be done gradually and under guidance otherwise there will be unnecessary flare ups and set backs.
6. Staying motivated. Your physio will explain the importance of all the things he or she are asking you to do or not do which will help you to stay  motivated. However, this fundamentally comes from a decision you need to make. It is easy to stay motivated for a few weeks, it is hard to be motivated for months or years. However, thousands have done it before you and you will be able to do it if you commit from the start. We are continuously inspired by the motivation of our patients.
7. Scans and referrals to doctors/other specialists. Sometimes we need to get scans or other investigations to find out a bit more about your underlying condition. We may refer you to your GP or one of the network of specialists we work with like an Orthopaedic Surgeon, Sports Doctor, Rheumatologist, Neurologist or Podiatrist. You can be sure that you will always been in safe hands.

Please do get in touch if you would like further information or to speak to one of our experienced Physiotherapists or Osteopaths.