Chronic pain is an enigmatic subject and the people who suffer from it can often be exposed to stigma or dismissive attitude. In this interview we delve into the topic of chronic pain management with Remia Kuriakose Panayil, a Clinical Nurse Consultant at the Peninsula Health Chronic Pain Medicine Service (CPMS), located in Mornington Victoria.
With over 17 years’ experience in Chronic Pain Management, Remia’s dedication to understanding the multifaceted nature of chronic pain management ensures that her patients receive the highest level of care. Join us to gain a deeper understanding of the physical and emotional impact of chronic pain and discover treatments that can transform lives and restore hope to those living with this enduring condition.
Understanding Chronic Pain
Chronic pain affects over 3.6 million Australians, but it’s often misunderstood. Remia explains that chronic pain is complex because it can affect each person differently.
“When you think about pain, for example, due to tissue damage, injury or illness, pain fibres get activated and send signals to the brain that there is some cause for pain. Once you get treatment for the pain and through natural processes in the body, you will better within the first three months. That’s a normal healing process.”
“Chronic or persistent pain, is a constant or daily pain that continues beyond three months, even after the initial injury or illness has healed. That’s where the condition becomes complex; it’s not just the pain, it’s also because of how it affects you, your function and how you’re dealing with it.”
Types of chronic pain
Remia says that there are 3 types of chronic pain, each one presenting with different causes, symptoms and treatments:
Nociceptive pain
“Nociceptive pain is associated with tissue injury, damage, or even a potential damage. It can also be caused by any kind of disease, illness or cancer which is not related to nerve damage or an infection. This type of chronic pain can be easily localised by the patient and might get worse with movement. Other common symptoms include dull or referred pain, especially with pancreatitis or any kind of ischemic pain.” Says Remia.
From Remia’s experience, common effective treatments for nociceptive pain include simple analgesic medications such as paracetamol or ibuprofen, and prescription medications such as short course opioids for more severe pain. Other beneficial treatments include Regional Anaesthesia, and a TENS machine (Transcutaneous Electrical Nerve Stimulation).
Neuropathic pain
“Neuropathic pain occurs where the patient has a nerve tissue damaged through a lesion or a disease. Essentially the nerves get damaged or dies and cause long-term pain. Diabetic neuropathy, Sciatica, shingles or Trigeminal Neuralgia are some conditions that can cause Neuropathic pain. Some people can experience pain after Multiple Sclerosis or a stroke.”
“Symptoms of neuropathic pain include stabbing, crawling pain, numbness and phantom pains, and some patients can feel kind of electric shock and be extremely sensitive to even a small touch.”
According to Remia, treatments for neuropathic pain can involve antidepressants or anticonvulsants, which some patients find confusing because they don’t have mood issues or suffer from seizures that necessitate using these medications. Opioids can also be beneficial for flare ups, but Non-Steroidal Anti-Inflammatory Drugs (NSAID) are usually not helpful. Remia says that patients can also feel better with ketamine infusion and a process of desensitisation which helps to retrain the Central Nervous system (brain).
Nociplastic pain
“We don’t really know the exact cause or clear reason for Nociplastic pain, but it could be an after effect of nociceptive or neuropathic pain”, says Remia. “There’s no clear evidence of tissue damage, disease or lesions causing the pain, but the but the painful experience or fear from previous injury/procedure /illness causes the patient to still feel ongoing pain. Some examples of Nociplastic pain are fibromyalgia, CRPS (Complex Regional Pain Syndrome), chronic fatigue syndrome and irritable bowel syndrome.”
When it comes to Nociplastic pain, Remia doesn’t think medications do a good job. Instead, she recommends training or retraining your brain through a multifaceted approach with different therapies: mind therapy, body therapy, meditation, mirror therapy, exercise, occupational therapy, physiotherapy, and even psychology or psychiatry involvement.
Remia suggests that a multi modal approach can provide great benefits and says that some people can get reprieve from the pain when they do things they love, like engaging in hobbies and activities. “You can take more medication to feel better, but if you control your mood with activities that you enjoy, you can feel more in control over managing your pain.”
Diagnosing Chronic Pain
Chronic pain can be tricky to diagnose and often requires different tests and detailed assessments by medical practitioners. Remia says that the first port of call for people in the community should be your GP. They will conduct an initial assessment and will send you for tests and imaging. Once your GP has more information about your condition, they can provide a referral to a specialist or pain clinic.
If you’re recovering from a procedure or injury and still have pain after the first three months, Remia suggests discussing your concerns with the medical practitioners at your follow up appointment.
Remia stresses that it’s important to address concerns early, and not leave it untreated or poorly treated for longer period of time, as that can lead to chronic pain.
Individual Approach to Pain Management
Remia’s approach centers on an individual and holistic pain management plan that is tailored to each person’s unique needs.
“Every person is different, and some people don’t understand why they’re getting certain medications or treatments. We explain to patients how their plan is going to work and that they need to take some time to let the treatment takes effect.”
Remia says that it’s important to try one medication or treatment at a time, evaluate to see if it’s effective or causing any side effects and only then proceed to the next step. “It can take a few days, or even weeks to know if a treatment is working well, like a trial-and-error process where you try different methods and see what benefit you get”.
“Another important thing is to set a goal for your treatment. Most issues cannot be fixed straight away so you need to have a clear goal in your mind about what you need from that appointment. It’s not just about pain control, sometimes it can be about better sleep, mood or mobility”, says Remia.
Empowering patients through education
At the Chronic Pain Medicine Service where Remia works, the first step in the healing process is an initial assessment and evaluation to determine an individual approach. Only then the patient can start an 8 week of pain management program which includes training and education. The program involves a whole team or medical professionals including psychology, physiotherapy, occupational therapy, Psychiatrist and nursing.
Once the 8-week program is completed, Remia and her colleagues evaluate the patient again to see what worked. “There is lots of positive feedback about the program and it feels good to hear how the patient feels after”, says Remia.
By empowering patients to take an active role in their healing journey, people can gain a better understanding of their condition and how different treatment options can support their condition. Addressing anxiety, mood, and stress is just as vital as medication in managing pain effectively.
Remia reminds us that it’s very important to understand that it’s not one size fits all. Just because a treatment works for one person it may not be applicable or appropriate for someone else. She feels that for the program to be successful, people need to really understand their pain and have a goal before they access pain management services.
Can a Personal Alarm help
Personal alarms are not a replacement for a pain management plan, but they can help by supporting people if they have a medical emergency.
Remia tells of a patient who fell at home and was on the floor for 3 days before someone finally came looking for her. The patient lived alone and couldn’t reach her phone to call for help.
“I think for chronic pain patients who live alone a medical alarm like MePACS could be beneficial.”
With chronic pain being a lead cause of disability, patients can be prone to falls or medical emergencies. A personal alarm with 24/7 monitoring service can be a real lifesaver in an emergency and give people and their families some peace of mind.
While there’s no one size fix for chronic pain, Remia says that Chronic Pain is not end of the world.
She finishes on a positive note by saying “There are things that can help people to manage their pain. So rather than sitting quiet and thinking about the pain, reach out for help and you will feel better.”
Please note:
The information provided in this article is for general informational purposes only and not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or medical practitioner if you have concerns regarding a medical condition.