Best 5 Ways to Treat Chronic Pain
Chronic pain, sometimes referred to as persistent pain, is a complex multi-faceted challenge. Many patients suffer with chronic pain, and many see us for physiotherapy, osteopathy and other therapies in a desire to not feel pain.
Persistent pain is complex, and subjective. This makes measuring pain challenging. One person may bang their elbow on a wall at a certain angle and speed, and have pain for 5 minutes. Another person may bang their elbow on the same wall at the same angle and speed, yet feel pain for several weeks.
Persistent pain is recognised not just as a symptom, but as a complex interplay of biological, psychological, and social factors. Research has shown that the brain and central nervous system play pivotal roles in the maintenance of chronic pain. Neuroplastic changes in the brain, where the brain “learns” the pain over time, can lead to pain persisting even after the original tissue damage has healed. Additionally, factors such as emotional state, past trauma, beliefs about pain, societal influences, and even genetics can influence one's experience of pain. This has led to a shift in treatment approaches, emphasising not just physical interventions but also addressing psychological and social aspects.
Techniques like pain neuroscience education, which educates patients about the mechanisms of pain, and cognitive-behavioral strategies are becoming integral components of comprehensive pain management programs. The goal is not just to reduce pain, but to improve function and quality of life, recognizing the multifaceted nature of persistent pain.
Different specialties treat chronic pain in different ways. A physiotherapist will typically use education, exercise advice, and activity modification. An osteopathy will often use manual therapy. A GP will often prescribe medication such as pregabalin, gabapentin, and amitriptyline. A pain management clinic may use injections and epidurals to numb pain.
Let’s look at our best 5 ways to treat chronic pain:
1. Education and Support
Educating patients is key. This involves teaching patients about the physiology and neuroscience of pain. By understanding that pain is not always indicative of tissue damage, patients can reframe their beliefs about pain, which can reduce fear and avoidance behaviors. Educating patients on pacing, graded exposure, and the importance of regular movement can empower them to take control of their body, mind, and their pain.
2. Exercise Therapy
Graded exercise therapy is a good way to improve people’s tolerance to exercises. For example, not everyone is able or ready to go to the gym. Let’s look at some examples of graded therapy for someone with chronic lower back pain:
Step 1: Gentle mobility exercises can help to improve range of movement and improve function, such as knees bent and rotating to the side.
Step 2: A gentle core activation exercise is a good next step:
Step 3: Let’s move on to a stronger core exercise:
Step 4: Lets introduce some dynamic movement:
Step 5: Let’s add multiplane multi-direction movements:Step 6: Let’s get to the gym and make the exercises more dynamic:
This is just an example of a graded exercise routing, under supervision of a physio.
3. Manual Therapy
While there are skeptics on the benefits of manual therapy for chronic pain, my personal experience is that manual therapy has significant benefits. Patients feel better when having manual therapy. Patients feel immediate relief following joint mobilisations. We all feel better after receiving massage. When we are in pain, the laying of hands is incredibly therapeutic. During manual therapy, we often spend time talking, coaching or educating patients so that they can also help themselves.
4. Injection Therapy
While medication has recognised short-term benefit, there are widely accepted and known side-effects that occur from over-use, or long-term use of medication. However, some injections can use medication as a way to break the pain cycle. Epidurals and steroid injections can help break the inflammation pattern, and numb pain. This can give people a window to recover.
At Surrey Physio our joint injections cost £140.00 and we do most joints except the spine.
5. Mindfulness, breathing, relaxation
Physios and osteos will support you with breathing exercises, de-stressing, reducing anxiety, and being more mindful. They will help you to put your concerns into perspective. Diaphragmatic breathing exercises can help significantly. Relaxing the body and improving sleep can also help people. Physios use a multi-faceted approach looking at many areas of lifestyle, nutrition, stress and sleep to help patients improve.
It's important to note that the effectiveness of these treatments can vary from person to person. A comprehensive assessment is crucial to determine the most appropriate interventions for each individual. Collaboration with other healthcare professionals, such as psychologists, pain specialists, and consultants, can also be beneficial in managing chronic pain.
If you would like to speak to one of our team about chronic pain, please email the clinic and we’ll get you connected with the right therapist for you at one of our clinics at Surrey Physio. Our contact number is 0208 685 6930.