TRANSCRIPT
The Australian College of Anaesthetists says there are a number of commonly recognised types of pain.
They include acute pain, cancer pain and chronic non-cancer pain - Including over 200 chronic pain conditions back pain, endometriosis and fibromyalgia among many others.
Whatever type of pain a person is experiencing the effects on all aspects of an individual's life can be profound.
Professor Lorimer Moseley is a professor of Clinical Neurosciences at the University of South Australia and the Chair of PainAdelaide.
He says this is a vulnerable population group.
"Chronic pain is extraordinarily complex and everyone's chronic pain is theirs. It's not a universal condition that contributes to it. And the things that hinder are different and they're quite individually specific. This is a large group of people who are challenged by chronic pain and they're a group of people that for decades have been on the edges, have been not believed and probably even worse than that have been called malingerers or been told you've just got to snap out of it or it's all on your head."
One in five people in Australia and New Zealand will experience chronic pain at some stage in their lives and it's recognised as a major global health issue.
Unrelieved pain can affect every area of a person's life with major social, financial and emotional consequences.
Along with medication and surgery other treatment techniques include education and psychological treatments such as behaviour and cognitive therapy.
Researchers at the University of New South Wales and Neuroscience Research Australia [[NeuRA]] have done a randomised trial focusing on the experiences of people with chronic pain and the role emotional processing plays in managing chronic pain conditions.
Dr Nell Norman Knott is a research fellow and clinical trial manager at the University of New South Wales and Neuroscience Research Australia.
"It's incredibly emotional. And we see this because people who we see and in the literature we know, they present with heightened levels of worry, they present with low mood. And from an emotional and mental health standpoint, we see increasing levels of anxiety and depression in up to about 80 per cent of people with chronic pain. But the aspect of we are particularly interested in is this concept of emotion dysregulation, which really means difficulties being able to bring up positive emotions and dampen down negative emotions. And increasingly we see in the literature that people with chronic pain have emotion dysregulation as a feature of their condition."
The study's authors says it doesn't matter which type of pain a person has - because the emotional effects are very similar.
The study included all types of chronic pain from migraine to chronic low back pain, fibromyalgia, neuropathic pain, musculoskeletal pain, inflammatory pain.
Professor Moseley says its logical that chronic pain would have a major impact on a person's emotional state.
"Of course it's going to make life more difficult in so many ways, including regulating your emotions. So that's an intuitively sensible link that if you're in a lot of pain, you're under a lot of stress, you're in fear, it's harder to regulate your emotions. What is less intuitive but is equally as important is that it's a two way street. So if for some other reason you struggle to regulate your emotions, then that will probably make pain more impactful and probably make pain worse, such is the complexity of pain. I mean the true story of how pain works inside the human body and brain is extraordinary and points to how much we've got in front of us to solve this problem. But it also raises opportunities for effective treatments, some of which look at all the factors involved, for example, the role of emotions."
The randomised trial took place from March 2023 to September 2024 and focused on the experiences of 89 people with chronic pain.
45 people received their usual pain management treatments plus a psychological treatment known as Dialectical Behaviour Therapy or DBT.
The other half only received their usual pain management therapies.
Even though the sample was small - Dr Norman-Nott says in post treatment questionnaires, D-B-T participants reported positive outcomes compared to those who did not receive the treatment.
"What we found that there was a significant improvement in emotion dysregulation in people who received pain and emotion therapy compared to those who continue to access the usual treatment. So we also saw that there were significant benefits in people's depression, anxiety, sleep problems, and their wellbeing in that those people that received pain and emotion therapy compared to those who didn't saw significant improvements in all of those areas."
A key element of DBT is that it's a type of group therapy, which the report's authors say is incredibly beneficial for people with chronic pain.
Janelle has had chronic pain for over 30 plus years and in that time has used opioids to manage her pain.
She says having chronic pain is a very stressful experience.
"I've been on a lot of opioids and things like that, but I've had nothing or found no course that's been able to help take away the pain or help control the pain at home. And having chronic pain is very emotional and very stressful. I've not really found anyone that's cared about my emotional side of my chronic pain. And as Sylvia and Nell have said, the more emotional you are, the more pain that you have, which is a bit weird, but that's the way it is. And by doing the course, I've been able to learn how to reduce my emotional side of my pain, which has helped my chronic pain in the end."
The course covered mindfulness, understanding emotions, naming emotions, how to change emotional responses, and also how to bring up positive emotions so that it reduces vulnerability to intense feelings and stressful situations.
Professor Lorimer Moseley AO says the key thing to remember about chronic pain is no one strategy works everyone but information from trusted sources is key.
"The evidence-based guidelines around the world when they list what are the most important treatment approaches for people with chronic pain, they all list education as the first one. And it's easy for us as health professionals or for people challenged by pain to think, well, I don't need more education. But what the evidence clearly shows is that if you can understand a bit more about the true complexity of how pain works, how your pain works and the evidence-based approaches to slowly retraining your hypersensitive pain system, your likelihood of improvement radically improves."
And listeners seeking more information on chronic patient management can check out pain.revolution.org or contact their GP.
