Managing chronic pain: Medicinal and non-medicinal interventions

For 1 in 5 Australians, the pain mechanism that’s meant to protect their body from harm doesn’t function as it should. Pain — particularly chronic pain — is a complex physiological operation and, for many, the reason for its persistence is difficult to determine.

Chronic pain’s diagnostic ambiguity, exacerbated by the pain itself, contributes to the two-thirds of Australians who suffer from this condition saying that their pain affects their day-to-day lives. If that applies to you or someone you love, it’s necessary to be aware of chronic pain’s nature and its various treatment options — both medicinal and non-medicinal.

The information below helps inform you about chronic pain and its various interventions. However, the guidance, diagnosis and treatment plan your local doctor provides is most essential. If you suffer from chronic pain, ensure you speak with your doctor, or book in with one of MedReleaf Clinic’s chronic pain specialists.

The causes and impact of chronic pain

There are two main types of pain: chronic and acute. Acute pain refers to momentary injury and the associated healing process, while chronic pain is ongoing and indefinite. Acute pain occurs when you get a papercut, scrape your knee, break a bone and similar — the expectation is that, through due course, you’ll heal and the pain subsides. Chronic pain, however, isn’t always of the same cause-and-effect relationship and is indefinite.

Chronic pain is defined as persistent pain that lasts for three months or more. The goal of chronic pain treatment isn’t the complete alleviation of the pain, but rather its management and regulation — helping patients reach a tolerable pain threshold without adverse treatment effects.

For certain patients, the cause of their chronic pain is clear: some are long-term sufferers of severe arthritis, for example, that manifests in chronic pain. Others may have experienced a spinal injury, resulting in indefinite pain. There are cases, however, where the cause isn’t obvious, referred to as psychogenic pain or psychosomatic pain. Further still, there are instances where the cause is evident (a minor infection, sports injury, etc) yet the reason for the pain’s persistence over time isn’t — in contrast to the natural healing process associated with acute pain. Among the sufferers of chronic pain in Australia, the most common causes are injury, surgery, musculoskeletal conditions (i.e., arthritis), and other medical conditions, such as cancer and endometriosis. Such causes can result in various potential symptoms, including:

  • Headaches.
  • Back pain.
  • Neck pain.
  • Neurogenic pain.
  • Testicular pain (orchialgia).
  • Lasting pain in scar tissue.
  • Muscle pain.
  • Burning sensations.
  • Pelvic pain.

The impact of chronic pain extends beyond physical to mental health. Depression, anxiety and insomnia are among the psychiatric conditions that sufferers of chronic pain commonly face, requiring a nuanced, multivariate approach to their treatment.

Chronic pain can range from mild to severe and may impact various areas of daily life. Sufferers report chronic pain’s impact on their rest, work, sexual function and relationships. Especially given that 68% of those living with chronic pain are of working age, the ability to maintain employment and engage in social activities can be significantly hindered, leading to financial stress and social isolation — further exacerbating their chronic condition.

If you suffer from chronic pain, ensure that you’re placed on a treatment plan as soon as possible by speaking with a chronic pain doctor.

Managing Chronic Pain: Medicinal and Non-Medicinal Interventions

Pain assessment methods

The pain assessment methods for chronic pain are generally holistic and multidimensional. However, when the cause of the chronic pain is clear (i.e., attributed to severe arthritis or cancer), condition-specific treatment plans are developed in conjunction with relevant specialists. When you consult with a chronic pain specialist, there are various diagnostic tools and methodologies they may adopt to inform your treatment plan, including:

  • Verbal scale ratings: Patients articulate their pain intensity using predefined categories ranging from minimal to severe.
  • Visual analogue scales: Patients mark a point along a line to represent the intensity of their pain, offering a visual measure.
  • Numeric scales: Patients quantify their pain on a scale from 0 (no pain) to 10 (worst imaginable pain), providing a precise numerical value.

The use of these tools is adjusted to the patient’s developmental state. A child, for example, may use a simplified or pictorial version of these scales, such as the ‘faces pain scale,’ where they choose a face that best represents their pain level. Furthermore, multidimensional scales are commonly used to help ensure a holistic account of the pain that factors its physical, emotional, social, and functional implications. These scales included:

The Brief Pain Inventory: Measures pain severity on four scales: worst, least, average and current pain in the last 24 hours. It also evaluates the impact of pain on seven dimensions of daily functioning, namely, general activity, mood, walking ability, work, relationships with others, sleep and enjoyment of life.

The McGill Pain Questionnaire: Provides a holistic qualitative and quantitative analysis of pain through scales, covering sensory, affective and evaluative dimensions. It allows patients to describe their pain in their own words using a wide range of descriptors, from its intensity and quality to the effects of environmental factors.

The Pain Outcomes Questionnaire: Details information about the patient’s pain intensity, locations, and types, as well as the impact of pain on physical, emotional and social functioning. Moreover, it evaluates areas such as pain interference with daily activities, mood states (e.g., depression and anxiety levels), the effectiveness of chronic pain management strategies and the patient’s quality of life — facilitating a thorough understanding of the pain profile and its broader effects.

Alongside this, your chronic pain specialist may account for other holistic factors, including your sleep patterns, environment, work and leisure activities, and the impact of your condition on family dynamics and social relationships.

You may look to keep a pain diary to monitor your progress, which you can present to your doctor in your consultation. This involves keeping a written record of where the pain originated from, where it’s most present in your body (i.e., chronic low back pain), triggers, remedies and other relevant information.

Medicinal chronic pain treatments

Your doctor-patient relationship is central to the formulation of pain medicine treatment plans, and the management of chronic pain more generally. This means having one professional as your GP who you entrust with your chronic pain management.

Treatment plans for chronic pain don’t generally rely solely on medications, instead including medicinal and non-medicinal interventions aimed at addressing both the pain and its root cause(s).

To address physical pain, you may be prescribed the following over-the-counter medications:

  • Paracetamol: Often used as a first-line treatment for pain relief, paracetamol helps alleviate mild to moderate pain without causing significant side effects for most people.
  • Aspirin: Also for mild to moderate chronic pain, aspirin helps to relieve pain by reducing inflammation and inhibiting the production of pain-provoking chemicals in the body.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs, such as ibuprofen and naproxen, are used to reduce pain and inflammation, making them viable for conditions like arthritis, muscle sprains and other inflammatory conditions.

Managing Chronic Pain: Medicinal and Non-Medicinal Interventions

Depending on the nature of the pain, your GP may prescribe one or more natural medicines, possibly including ginger, mint, turmeric, lavender, and capsaicin.

  • Ginger powder acts as an effective anti-inflammatory agent, reducing muscle and joint pain by inhibiting pain-inducing enzymes, similarly to NSAIDs, but without the gastrointestinal side effects.
  • Mint, particularly peppermint oil, contains menthol, which has cooling and analgesic properties that can relieve headaches and muscle aches by calming nerves and reducing pain sensation.
  • Turmeric is anti-inflammatory in nature and has been shown to reduce pain — by inhibiting inflammation pathways — associated with arthritis and other inflammatory conditions.
  • Lavender oil also has analgesic properties that can help reduce pain and inflammation — beneficial for headaches, neuralgia, and joint pain in particular.
  • Capsaicin depletes substance P, a neurotransmitter involved in transmitting pain signals, thus offering relief from neuropathic and arthritic pain over time.

Alongside these, feverfew may be recommended for migraine relief by modulating inflammation, while willow bark, containing salicin, acts similarly to aspirin in reducing pain and inflammation. Omega-3 fatty acids in fish oil, recognised for anti-inflammatory effects, can also aid in alleviating conditions like rheumatoid arthritis, alleviating joint pain and stiffness.

The medicinal management of chronic pain is subjective, based on your specific case. Ensure that the medications you’re prescribed are provided by a licensed doctor and account for the nuance of your pain.

Non-medicinal chronic pain treatments

Depending on the nature of your chronic pain, your health professional may assign you to one or more of the following non-medicinal interventions:

  • Heat or cold therapy: Such therapies may include applying heat to increase blood flow and reduce stiffness, or using cold packs to decrease swelling and numb the area, thereby alleviating pain.
  • Acupuncture: As a form of physical therapy, this involves inserting thin needles into specific points on the body to stimulate nerves, muscles and connective tissue — helping boost the body’s natural painkillers and increase blood flow.
  • Transcutaneous electrical nerve stimulation (TENS) therapy: TENS involves using a device that sends small electrical impulses through electrodes placed on the skin, helping to reduce pain signals sent to the brain.
  • Massage: Generally suited to soft tissue injuries, massage can help by increasing circulation, easing muscle tension and promoting relaxation — leading to a reduction in pain.
  • Cognitive Behavioural Therapy (CBT): CBT refers to the psychiatric intervention of understanding and changing negative thought patterns that can contribute to chronic pain, teaching coping strategies to deal with pain, and reducing the stress and anxiety related to or exacerbating pain.

Beyond Cognitive Behavioural Therapy, other psychiatric interventions — such as mindfulness-based stress reduction (MBSR), family therapy and biofeedback — may be utilised to help patients learn how to control physiological processes (i.e., heart rate, muscle tension, and blood pressure). The control of these processes may work to reduce the perception of pain, therefore assisting the patient in maintaining a tolerable state.

The decision as to what medical and non-medical treatments you take includes your medical history, the relationship between the various treatment options, and the specific characteristics of your chronic pain. Moreover, your practitioner will likely strategise with you as to how you can:

  • Reduce stress.
  • Improve sleep quality.
  • Refine your diet.
  • Partake in enough physical activity.

Managing Chronic Pain: Medicinal and Non-Medicinal Interventions

These four components are foundational and contribute toward a holistic treatment plan. While there is no definitive cure-all for chronic pain, the adoption of a personalised treatment plan can significantly improve your quality of life by managing symptoms and addressing the underlying causes of your pain.

Moreover, being a part of a support group or engaging with an online community can further improve the quality of life for those living with chronic pain. On top of the support services they offer, the following four platforms provide a sense of belonging as well as guidance on accessing medical professionals and treatment options:

Managing Chronic Pain: Medicinal and Non-Medicinal Interventions

Forming a treatment plan

Formulating a treatment plan begins by speaking with a licensed chronic pain doctor. With MedReleaf Clinics, you gain access to specialised chronic pain doctors who can work with you to address your symptoms and underlying root causes — encompassing your chronic pain’s physical, psychological and social implications.

Our process is as follows:

  • First, start by scheduling your telehealth consultation via an online booking.
  • Second, discuss your condition and history with your MedReleaf Clinic’s general practitioner.
  • Third, receive your personalised treatment plan.
  • Last, book a review consultation to assess your progress and make any necessary treatment adjustments.

If you’re looking for support with managing your chronic pain, book in with one of our chronic pain specialists.

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