Pain Management

All pain is real enough to those who have it. All stand equally in need of compassion (Miller 1997)

Almost 20% of people in the world suffer with some kind of chronic pain….so if you’re reading this and have persistent pain, you’re not alone! People with pain are often frustrated that they are not able to do many of the things that give meaning, purpose and joy to their lives. Some feel angry, anxious, stressed or depressed, which makes them feel even worse. The good news is…..There is hope!


What is Pain?

Pain is complex. Understanding pain, and all that goes into making up the pain experience is the starting point to taking control and moving towards a happier and more meaningful life. In medical terms pain is describes as a biopsychosocial experience. This means that pain has biological components, psychological components and social components. There are many different factors that contribute to each component, and these are unique to each person. To illustrate this, below are a few examples of the factors that make up each component.

Pain is very seldom exactly the same day and night, and day after day- it is an ever-changing experience. In the same way, the contribution of each of the biological, psychological and social components in each person is a dynamic process, and shifts and changes.

What we do know is that if pain persists often a cycle begins develop that can slowly worsen the pain and the impact on the person’s life in all the component areas discussed above. This in turn worsens the pain and again worsens the impact on their life. It’s a vicious cycle that can continue until the cycle is identified, often with the help of a professional/s, and treatment can begin to dismantle the power and strength of the contributing factors.

What is Interdisciplinary Pain Management?

When we realise that pain is complex, and appreciate that many different factors contribute to a persons’ unique experience, it seems obvious that there is no single intervention or practitioner that can successfully treat all of the different factors. Interdisciplinary Pain Management is when a team of different disciplines of healthcare professionals (eg medical doctor, occupational therapist, pharmacist, physiotherapist, psychologist, psychiatrist, nurse etc) and sometimes complimentary medicine practitioners (eg homeopaths, acupuncturists, reflexologist etc) collaborate and apply their particular expertise to work with the patient to reduce their pain and the impact it is having on their lives. At times treatment may need to include the people around the person with pain, both to offer help and support to them but also to ensure that we’re all working towards the same goals.

It’s rather like a jazz band, where the best music is made when each musician has the opportunity to bring the best of their own in their instrument at the correct time to compliment all the other musicians and get a great rhythm and melody going. This makes good music!

    How is the pain experience assessed?

    Assessment begins with listening carefully to the clients’ story. This is usually followed by a physical examination and a review of any tests or records that have already been done, along with a review of all medication the client is taking. We also discuss all the different treatments that the client may already have tried, and establish which have been helpful and which have not. Sometimes the client may be asked to fill in a few questionnaires that can help the healthcare professional to clarify or learn more about their experience, and these can also serve as a way to measure progress. Importantly we explore the impact that pain is having on a clients’ life currently as well as on their plans and hopes for the future.

    The clinician (together with the patient, and sometimes in consultation with other members of the team) then tries to build the puzzle of the patients’ pain experience. We need to discover what factors may be contributing to a worse pain experience, as well as which strengths or resilience factors the patient already has ( and there are always some!) that we can use to dampen the pain interpretation and signals from the nervous system or strengthen coping.  Pain is complex and building the full picture of the puzzle may evolve over time, however together we usually have a good idea place to start.


    How do we treat pain?

    Following our assessment, we have a better understanding of the different biological, psychological and social factors that may be contributing to a clients’ pain experience. We also have a better understanding of those strengths and resilience factors that can help dampen the pain and can be used to create better coping strategies.

    Now it is important to establish our clients’ goals, combine these with the different options for the treatment and/or management of each contributing factor, and plan a way forward. The customised treatment options are presented to the client and together we discuss each one and it’s role in either reducing pain or creating more effective coping strategies.

    One of the pillars of effective treatment is for our client to understand what science currently tells us about pain. Research has shown that understanding our pain can take away a lot of the fear and anxiety around pain, and empower a client to work on the factors over which they may have (or may develop) control. It may also free a client to accept and release the factors over which they have no control.

    In other words, as Dr Campbell says in his book “the Language of Pain”:


    Don’t fight your pain- Outsmart it! 

    Once our client has decided which treatment options they would like to pursue, and in which order of priority, the interdisciplinary orchestra begins to play with each bringing their expertise at the right time to create as powerful and meaningful a tune as we can. This means that a client may see different professionals at different times in treatment. Importantly though, we (remember the “team” includes the professionals as well as our client) are all working towards the best possible outcome:

    A happy, healthy and meaningfully productive life in which you flourish with or without pain.