The Canadian Pain Society states "Evidence supports that chronic pain is not just a symptom of underlying illness or injury, but it is a disease in its own right, with significant changes in complex biological, and psycho-social functions." - 2018
A good chronic pain plan involves whole person care and a multi-modal team. This means education, psychological therapy, manual movement, spiritual care and care of the body need to be part of the care plan.
Medications and interventions are just a SMALL part of the overall management process, but are often relied on as the only option. These treatments should be a means to be able to engage in the things that will provide long-lasting improvements, such as movement and psycho-education therapies. The goals should always to be to improve your overall function and getting back to doing the things you want to do and enjoy.
Medication itself can be a trial and error process, and can be very frustrating. But it is well worth the trials to find a combination that works for you, along with your plan incorporating all of the other modalities.
Dr. Holowaty works with a growing team of healthcare providers to be able to deliver high quality assessments, diagnostic clarification, treatment planning suggestions, and psycho-education for your chronic pain concern. She will send suggestions to your primary care provider and set up referrals to other services if they are thought to be helpful. She provides a limited number of interventions such as onabotulinum toxin A for chronic migraine, joint and bursa injections, trigger point injections and dry needling.
The SCPS offers a 6 week psychoeducation course for people with lived experience in person at City Hospital. Next session starts Feb 29th.
Trauma and Pain
Treating and addressing trauma can assist with your pain experience.
There is an overlap in the symptoms between chronic pain and PTSD, with both sharing hyperarousal, avoidance behaviour, anxiety, emotional reactivity, and a somatic focus (doi: 10.1016/j.jpain.2021.04.015). Chronic pain is reported in 20 to 80% of individuals with a history of trauma, and 10 to 50% of individuals with PTSD report chronic pain (doi: 10.1016/s0272-7358(00)00071-4).
We also are learning that early life experiences may influence chronic pain in adulthood. Adverse childhood events (ACEs) are associated with increased pain complications, pain catastrophizing and depression (doi: 10.3389/fpain.2022.923866). Wondering what your ACE score is and what it might mean for you? Take the ACE questionnaire here.
Cognitive Behvioural Therapy (CBT) for Pain
CBT is helpful for pain because it teaches you how to change thoughts and behaviours that can make pain worse. While it may not get rid of the pain entirely, changing some of these thoughts or behaviors can help to decrease the pain over time.
There are some online courses available specifically for this without any wait times, although they may have a fee associated with them:
- self paced workbook from NHS
- internet based program Dr Wilderman
- online program ThisWayUp from Australia
- Permission to Move app and online course
This book is also quite useful if you prefer books you can hold and write in - Managing Chronic Pain: A Cognitive Behavioral Therapy Approach Workbook.