The natural healing force within each of us is the greatest force in getting well. HIPPOCRATES, 400 BCE
In modern medicine the successful management of chronic pain poses a great challenge. Not only does the doctor need to address the patient’s suffering of pain, but also their interpretation of the pain’s significance and subsequent functional impairment.
Chronic pain’s management or mismanagement is a yardstick of the excellence of that important bond—the doctor–patient relationship. GPs naturally want to alleviate patients’ pain and have historically used analgesic agents (notably opioids) that have ultimately caused harm. Evidence is increasingly proving that medication has a reduced role in chronic pain management, in favour of non-pharmacological therapies and active self-management.
Key facts and checkpoints1,2
Twenty per cent of GP consultations in Australia involve chronic pain
Chronic pain affects 1 in 5 Australians aged 45 and older
In 2020, the financial cost of chronic pain was estimated to be $144 billion (approximately 10% of Australia’s GDP)
The majority (68%) of Australians with chronic pain are of working age
Fifty-six per cent of people with chronic pain have functional restrictions as a result
Forty-five per cent of people with chronic pain also have depression and anxiety
Suicide is reported to be two to three times higher in people with chronic pain
Best practice does not support long-term use of medication for chronic pain management
Australian data in 2018 revealed that opioids accounted for 3 deaths per day, the majority of which were unintentional and due to prescription opioids
Pain is defined as ‘an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage’.
It is worth noting that pain and nociception are different phenomena. The International Association for the Study of Pain has added that individuals learn the concept of pain, which is a personal experience influenced by biological, psychological and social factors. A person’s report or experience of pain should be respected.
The box below defines the variety of types of pain.
Glossary of terms
Allodynia Pain due to a stimulus that does not normally provoke pain.
Mechanical—light touch feels painful. Temperature—hot/cold stimulus (normally not painful) is painful.
Anaesthesia dolorosa Pain in an area or region that is anaesthetic.
Analgesia Absence of pain in response to stimulation that would normally be painful.
Breakthrough pain Pain which occurs between regular doses of analgesics and reflects increase in pain level above set baseline.
Causalgia A syndrome of sustained burning pain, allodynia and hyperpathia after a traumatic nerve lesion, often combined with vasomotor and sudomotor dysfunction and later trophic changes (now known as complex regional pain syndrome II).
Central pain Pain associated with a lesion of the central nervous system.
Central sensitisation Increased responsiveness of nociceptors in the central nervous system resulting in ...