Hunter Integrated Pain Service

We all accept medicine advances s knowledge grows.

In treating chronic non-cancer pain, there’s been too much focus on opioid medication and not enough on the most effective ways to improve pain and wellbeing.

Most people taking opioids experience early gains, but it doesn’t last.

Taking more may seem to help at first but in fact it makes matters worse.

Along with well known side effects, scientists have also discovered that people taking opioids often develop other problems.

They’re more likely to fall, have lower sex drive, lower immune function and poorer quality sleep.

There’s also an increased risk of accidental overdose and death.

We now know that opioids can quickly sensitise the nervous system and actually increase pain.

Some people using opioids say it gives them a little bit of comfort, but that’s not a reason to remain on them.

There are also those who develop addiction and this makes it very difficult to stop opioids, despite the harms.

Knowledge changes, we now know that when it comes to chronic pain, use of these drugs often makes matters worse.

Opioids are no longer recommended for chronic non-cancer pain.

Instead, get support, get an active recovery plan and get started.

Many people with long-term pain don’t feel believed and get trapped in a never-ending loop of suffering.

Changing direction brings hope. New ideas have revolutionised pain thinking and care.

The focus is more on the whole person and less on the body structures.

Persistent pain can change; it’s not always an enduring disease or problem.

First getting assessed and ruling out anything dangerous is important.

Then, it’s time to shift focus, get informed, and manage pain from a broad, active perspective.

Next, everyone can benefit from making the mind-body link.

Drawing a timeline helps make sense of the emotional impact of life events before, during, and after the onset of pain.

Addressing underlying depression or anxiety early is critical to reducing pain over time.

People also say they feel isolated.

Reconnecting with life can make a real difference.

Finding new purpose and positive ongoing support benefits the recovery process.

Sleep, rest, and physical activity habits all impact on function.

Taking practical steps toward improving sleep, limiting rest, and establishing regular activity helps.

In time, confidence builds, and trusting that the body’s rhythms and limits can change brings a renewed sense of wellbeing.

Last, good nutrition can’t be ignored.

Optimising our diets with plenty of natural food lets healthy gut bacteria thrive and brings less inflammation and pain.

This is not just new-age thinking; these discoveries have shifted the world’s understanding of how best to treat pain.

Decreasing pain starts with knowing about pain and choosing to work on sustainable strategies.

Knowledge about pain now and less pain in the future – now that’s a reward worth working for.

Introduction
Once upon a time, all the lands were fraught with persistent pain. So widespread was this affliction that one in four people experienced it. The pain lasted for more than three months; it shadowed their daily lives, held them back from everyday activities, and the interventions they tried proved useless. "Hey pain, go away! We've tried it all but still you stay, moving less, taking pills, knives and needles, and still we're sore. We can't take no more! No more!" But the pain remains like a loyal companion. The people's hopes faded, and they became resigned to living with the pain. Only now, the pain was a beast.  

Then along came a group of researchers, of which I am one. Back off, big fella! I'm Professor Lorimer Moseley, and I'm a pain scientist. 

What is pain
Pain scientists are starting to think differently about pain and its causes, and we're making exciting discoveries, like how the way you think about your pain can change the way it feels. Over the next few minutes, I'll help you to understand your pain. Understanding is important because it can change how much things hurt, how much your body can do, and it can help you to tame the beast. 

First, trust me about this: pain is not an accurate measure of tissue health. Pain is a protector. By making unpleasant feelings, your brain changes your behaviour so you can avoid injury or your tissues can heal. Sometimes, pain is not helpful, like phantom limb pain. You don't expect a missing limb to ache, but it does—and the pain is very real. 

So how do we explain this? Well, pain is a warning signal from your brain that depends on credible evidence to say your body needs protecting. Sometimes pain is too protective, and you get unnecessary warning signals. Pain scientists now understand that there are many ways our nervous system ends up reducing unnecessary warning signals. Take conditioning, for example. Think of Pavlov's dog. Every time food was offered, Pavlov rang a bell. Of course, the dog would salivate seeing the food. This went on for a while, eventually the dog was conditioned to salivate for the bell alone. 

How does pain work?  
Well, conditioning is just one of the ways your body learns pain. The longer your nervous system produces pain, the better it gets at producing it. Your body learns pain. So, what feeds this beast? Well, let's look at how pain works. In your body's tissues, there are specific neurons which normally only respond to harmful stimuli—whether mechanical, chemical, or thermal. When they are activated, they send a warning signal to your spinal cord, which can in turn send the signal to your brain. 

This activity in neurons is called nociception, and it's happening all the time, but only sometimes results in pain. Most of the time, the brain protects you with other things, like movement. Once the warning signal reaches the brain, the brain makes sense of it based on the information arriving and a vast amount of information already stored. If there's good reason to think protection is required, then your brain makes pain. One of our amazing discoveries is that you can have pain without any physical stimuli. Thoughts and places might activate the warning signals, and the pain feels exactly the same. 

It's not just your brain—your spinal cord also learns how to generate unnecessary warning signals. So, how do you know when your nervous system is learning pain? You may notice if your pain spreads or comes on without warning, your body feels odd, and it's hard to move properly. Your pain changes quickly with your mood, and small annoyances can set it off. Old injuries start to hurt again, you're more sensitive to stimuli, and the longer the pain goes on, the more all of this occurs. 

The old way we understood pain could not explain these things and left many sufferers feeling like no one believed it was real, or that for it to hurt so badly, there must be a major tissue problem. But we now know how persistent pain happens.  

So, how can you tame the beast? Pain is a very personal thing. There's no one-size-fits-all solution, and while you probably have well-thought-out coping strategies, it's time to take a new approach to dealing with and reducing your pain—one that focuses on retraining your pain system. 

This might mean testing yourself physically and moving more than you normally would. Being honest about your current attitudes and beliefs can also help, as can asking your health professional new questions like: "How do I know if my pain system is being overprotective?" "How do I retrain my pain system to be less protective?" "How do I know if I'm safe to move?" 

So be brave and have hope, because it is possible to tame the beast. Visit our website for more information and questions to ask your health professional - tamethebeast.org.