Understanding Chronic Pain

In this episode we hear from David Manning and Ben Weissner, who talk all things chronic pain. They share the ways they are working to help people with chronic pain to recover and function well. They also share a few tips for pain management.

Find more on the Wimmera and Southern Mallee Integrated Pain Service here.

Interested in the topic and looking for more?

You can also find more information on chronic pain in general at Health Direct.

In the episode David and Ben talked about how beneficial staying active can be for chronic pain. For more information on this check out Exercise Right. 

You can also check out the Pain Revolution. It has lots of information and programs for people in rural areas with chronic pain. 

You can also find other fact sheets and information on pain management here.

Join the conversation
Facebook: @FarmerWantsaHealthyLife                                            Twitter: @_FWAHL

Facebook: @FarmerWantsaHealthyLife                    Twitter: @_FWAHL 

Transcript

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BM

This is a West Wimmera Health Service podcast. Presented by me Brigitte Muir.

This series focuses around stories and issues related to health and wellbeing. Some of the people we hear from are sharing their stories, hoping that their experiences will help us with our own health and wellbeing. Please be aware that some of their life experiences may touch on issues that are sensitive to some. Please listen with care. You will find information on seeking help if you need it in the notes attached to each episode. 

Ahh…Chronic pain you know when you have it, don't you? But do you know what it is? I visited the Wimmera and Southern Mallee Integrated Pain Service in Horsham and met with David Manning, Clinical Coordinator, and with Ben Weissner, Physiotherapy Manager, at the Wimmera Healthcare Group to find out all about pain. First, here is Ben on what causes chronic pain.

BW

There's not one primary cause. But often times there's a musculoskeletal cause which is a long word for… bones, joints, ligaments, muscles, that sort of thing. So it might be that someone sprained their back and it might be, might be, that someone had their shoulder at work. Yeah, there are many reasons why someone can end up with pain that persists beyond the usual healing time.

BM

Okay, so is it always due to trauma?

BW

Noooo….Sometimes there isn't even a good reason for it. I can actually tell you that I experience…. persistent pain myself to some degree, and there's no reason for it. It's just there. Yeah

BM 

It’s just there *chuckles*

BW

*chuckles* yeah

BM

*chuckles* well it's a pain in the backside.

BW

It is!  Yep. Or just a pain in the back for me. Yeah. 

BM

Okay, and I guess besides injuries, and besides it… just being there. There may be also another reason like…. repetitive stress injury, something that you do too often... for a long period of time.

BW

Yeah. The reason why… the pain service exists is to help people understand what pain is… and you're, you're, you're cutting straight to the chase Brigitte. Pain is bloody complicated. It's actually not just a case of are you have a bad back, therefore you've damaged a disk, therefore you need this. Sometimes…we will find that people have pain in one circumstance but then the next person had the exact same injury, but their boss is really supportive. Their doctor gave them good advice to remain active. Their partner is nice and supportive, but not so supportive, that they do everything for them. And things align differently, and this person ends up getting back to the life that they want it to be. Whereas the other person ends up really debilitated. So, it's not as simple as I thought when I was studying physiotherapy, for example. Yeah.

BM

So, there’s was a mental component to chronic pain, chronic physical pain.

BW

Absolutely… 

DM

So pain is not just related to the damage of the tissues. That's what Ben's saying, we now know a lot more about pain. Pain is a complex experience that we talk about, and there's other factors that influence the brain interpreting that experience. And that's really what the pain is, ends up. So when it comes to us, assisting people to manage that we need to help address all of those factors because it may well be, that a lot of cases the original injury has actually recovered, but the pain is still there, and it's totally real pain is never fake. But the source of it or what's actually occurring with the experience of it, is complex in nature. So part of a team approach in our clinic is to unpack that and help give people, and develop strategies to manage that pain in a better way or understand it. And we know that even just understanding it does help to make it better in a way.

BM

All right, so there are different strategies to deal with chronic pain, whatever it's sources is, what are those strategies? Tools… let's call them tools 

DM

Well, I mean, there's a number of… number of things. We have a solid, suppose, assessment and intake process to try to work out what are the contributing factors and then from that we would develop strategies to help manage that, for example, improving activity levels, which Ben does, or just understanding the nature and biology of pain, which again, Ben does, has a big role in that. Other things like, just helping people to learn to pace themselves. People often with persistent pain have lost the ability to… modulate how they function. So they’re either pushing through the pain or they're scared of it so they don't do enough, so their whole body reacts to that. There may be some initial things that need to be done. Maybe some work done on reducing medication dependence, so doctor would be involved in helping people get off opioids, for example, because… well, the reason why we now have this service is because the government's finally realised that we have a problem in society that people become dependent and addicted to opioid medication, and that's not actually… greatly useful in the long term for people.

BW

We're really lucky with this service as well… to have great input from Dr. Horwood. He's a GP who has a special interest in pain… and a lot of expertise when it comes to opioids. We've got an occupational therapist involved. Occupational therapy are really interested in helping people with the functional side of life being able to do the things that they want to do. And we've got a psychologist involved as well, which some people think oh, I'm not crazy. Like yeah, psychology isn't involved because we think that anyone involved is crazy. But we know that there is such a strong psychological element to the experience of pain. Combined with physiotherapy, I guess those are the main elements of our pain service.

BM

Can I ask you what the percentage of farmers using the service is?

BW

I would say not enough. Is that, is that the best answer because I think a lot of farmers… look I grew up in, I grew up in the city and I moved out here a decade ago, and my experience with farmers has been that they often tend to… want to push through the pain. You know, they’re such a stoic bunch and I am yet to meet a farmer who complains. I think that…that can actually lend that population… to some approaches that don't help with pain. Because unfortunately, pushing through pain… doesn't help and there's it's a lot more nuanced. How many farmers are involved in the service? Gee, not many, but I know that a lot of farmers do experience persistent pain.

DM

I could probably put a figure we've had probably 100 referrals and I reckon we'd be lucky to be more than two…

BM

Really 

DM 

…that are from farmers. Yeah.

BM

I would say that the time factor is something, when you self-employed and…

DM

Yeah

BM

… your on the land… and you working with time pressures, it's very hard to make the time to deal with those things that should be dealt with, such as personal health, looking after the body which is obviously one of the main…. the most important tool on the farm. Looking after the body usually goes back to the bottom of the list of things to do, because it's so hard to see a doctor it takes so much time. 

DM

The sad thing about that is…. what often happens that when we do see people, not only just farmers, but all the time they do get to something because they've pushed on because of the time constraints their then in a terrible, almost catastrophic situation which is much more difficult to help at that point. 

BW

Yeah

BM

What is the process to be able to consult with you guys?

DM

Access is relatively easy. We do encourage getting a referral from the, from the person's GP because that supplies us with the background information medically of what they've already had as far as investigations, medication, and also keeps the GP in the loop. And then we go through a process of following the patient up from there. 

BM

Seeing the GP, hopefully that can be done by telehealth service to save one day, and then once you have you a referral you put it through the service and then how long is it before you actually get a face to face consultation, with whom?

DM

Well the most important thing is with a service like ours, we don't want people to end up where they don't need to be, we want to get them to the right place, at the right time, to the right person. That's, that's the underpinning of what we do. The referrals received. And then as the coordinator, I just make a phone call to every client first and just give them some idea of what the service is about and see from that point if they're interested in going further. You come into the pain service to be worked with. You know, so you're the captain, I say to them, you're the captain of this team. You know, so we want to design an approach that's around you. So we work with you, not on you. 

The next step is a more in depth assessment with myself or if it's there's highly visual medical issues that need addressing, and might send you straight to our doctor at point. Otherwise, I do an assessment, longer assessment which again is done either on the phone or via telehealth, so they don't have to leave their farm. We then report that back to the team and the team then discuss together what recommendations we might make to help the person in the next part of the journey.

BM

Sounds to me like it's really worth investing a bit of time in the long term saving a lot of time.

DM

Yes. 

BM

I was talking with a guy who had a really bad case of Ross River Fever, and he told me that the only way to… actually manage the pain was to use alcohol to wash down his pain killing medicine. Have you got that often in the cases that you see, and the people that you see, not necessarily farmers, just generally speaking?

DM

To me, I'll answer that because alcohol is one thing. Yes, alcohol can be something that people use. People, if they're not able, or if they're struggling to manage their pain can easily get addicted, or reliant on a lot of different things. Alcohol is one of those, you know I had a guy yesterday for example, who's strangely enough… he's addiction is exercise… even though it's a good thing, he pushes like crazy and if he thinks if he doesn't exercise to these ridiculous levels, he's gonna fall in a heap. So yes, smoking might be another one, you know like to help people relax. Yes, alcohol was certainly one of those…

BM 

It is probably the most accessible

DM

…Most accessible but that's probably a behavioural thing that can come out in lots of different ways. You know, sometimes people are even addicted to I'd say rest. They're so frightened of the pain, they just rest, rest, rest. As part of the team… we'd be looking to unpack that with a person. 

BM

Okay. All right, we're talking about chronic pain. Are there any ways to…. avoid getting chronic pain, good habits to get into every day from the moment you get up to the moment you go to sleep… and perhaps habits that can also work for someone who already has chronic pain?

BW

If I can answer that, and as someone who has experienced a reasonable amount of persistent pain in my life, I think the main thing to practice and this might sound a bit vague or a bit wishy washy, but is actually your understanding of what the pain means. Now for me, I had lower back pain, and whenever I felt the pain, I’d think oh no is that a disk? Is that a rupture? Is that is that a broken bone? Is that something serious? I ended up going through a number of scans and such, and what eventually was, was dawned on me by another colleague was that I had serious pain. But that didn't mean I was seriously damaged. And that knowledge is so crucial. And again, it might sound wishy washy, but it's really, really important. So for me now, when I experienced my back pain, I think, ‘Oh yeah, I'm experiencing pain. But that doesn't mean that I'm busted.’ It's safe, and it's appropriate for me to keep moving. My back pain doesn't actually have an impact on my life anymore. That practice in itself, I think is, is really good. If you do have pain, get checked out. It might be by a physio or might be by your GP, it could be by any range of specialist and find out okay, is this something serious? If there's no underlying broken bone, or… then the best thing to do is to stay reasonably active. Again, I know that we're speaking to farmers here. So, that approach of pushing through pain, if that means that you then end up in a heap and you're not able to do the things that you want to be able to do because you're recovering from that pushing through period, then I think it might be time to reconsider that approach. We know that if we were to scan a bunch of people that didn't have any back pain, we'd find really scary things on their scan results. I think about 50% of people …who are aged 50, who don't have any back pain, they have a disk bulge, but then if someone had pain and they got their back scanned, and they found that they had a disk bulge, then they’d go oh well that's it, that's the end of it, I've got a disk bulge, it's all over. Well actually no, a lot of people who do have no back pain at all have a disk bulge. So, that means that we can't focus on the disk bulges being the cause of that person's pain. Because so many other bloody people have a disk bulge and they don't have any pain. So, let's not focus on the… structures so much. Let's focus on all those other things that we know contribute to the experience of pain.

BM

I noticed that if I don't move my body in all sorts of different directions, I end up feeling sore and stiff, and that can become a chronic situation. Doing stuff like five minutes of Tai Chi in the morning or even putting on a YouTube video and dancing like crazy. 

BW

*chuckles* yeah great, yeah, yeah, yeah. There are a few points you go, ‘Oh gee, this is a bit, ah, there's a bit of discomfort associated here.’ Now imagine if you were to feel that discomfort and think oh gosh, that's my disk bulge. I'd better not do that anymore. Well, then you wouldn't do those exercises anymore. You wouldn't be moving like that. And then eventually when you had to go and pick up your favourite cat off the floor, you need to bend forward, then you're going to feel that even more so and then you're probably going to be really afraid of what damage you've done. You're going to avoid it even more and there goes that cycle… by you maintaining movement, exposing your body to those safe and appropriate movements, you can… avoid that cycle and actually head off in a different direction.

DM

The other thing with that too, is that you've actually then taken a positive step to be in control of the pain, and then you're in control of what's happening. So, so often we find that unfortunately with the other approach we’ve discussed, the ends up being that pain runs people…

BW

Yeah

DM

…and whereas in what you've done, is you found, and this is what we try to work on is find strengths that people have, and give them tools around those strengths to then shift the control from the pain to the person. So it doesn't mean that necessarily that you're not going to get stiff every morning or stiff occasionally, but you're in control of it by doing an exercise program, or your Tai Chi, or whatever that enables you to keep moving, keep your structures mobile, but also your mentally and everything else in control of that situation, which often is where people lose that and they become totally at the whim of the power of actually the pain experience.

BM

Then of course that can lead to mental problems. And in my experience… making the effort of getting that exercise session with other people, even if it's just once a week. It's really helpful to keep me mentally sane because I work from home, which is what farmers do as well. Being exposed to other people and doing something positive…

DM

Yes

BM

…and helping my body 

BW

So much of what is done in the world of health management is that you've got a sore tooth, well the dentist will fix that for you. If you have a broken bone, well the orthopaedic surgeon is going to you know screw that bone back together. If you've got a cancer then the oncologist is going to treat that. This is all about someone else doing something to you. When it comes to pain management. It's more about us giving you the tools so that you can do it yourself. And I reckon that would, that would resonate with a farmer I reckon the farming community they're generally people who are really willing to give things a shot for themselves and put some things into practice 

DM

Can do people 

BW

Yeah.

BM

And of course being aware that the service exists is the first step.

BW

Yeah. So, how broad is our service David for farmers listening, how far…how broad?

DM

We, we want to make it you know, the Wimmera Southern Mallee region. So yeah, we've set up contacts as far as Nhill, Yanac… Stawell, we've got somebody from St Arnaud, Donald. We want to try to make it as accessible as we can, even if that is electronically or using the phone. Because sometimes it's even just talking to people about this… can be enough to help set them on a different path. We want it to be as accessible as we can and we're gonna be continuing working on that because we're in a new phase. So we still got to develop yet more, but that's what we're working on to cover that anybody within those regions.

BM

Essential service. Thank you so much, and I look forward to more farmers using your service. 

DM

That’s great thanks Brigitte

BM

That was David Manning and Ben Weissner at the Wimmera and Southern Mallee Integrated Pain Service in Horsham. 

You will find as always contact numbers and details in the notes attached to this episode. And while you're at it, please give us a star rating. We'd also love to hear your comments and suggestions. Our Facebook and Twitter details are in the notes. Until next have a healthy life won’t you.

Transcribed by https://otter.ai edited by WWHS Health Promotion