Chronic pain

Pain is diagnosed as chronic or consistent pain when pain lasts longer than three months in duration.

"Left untreated, chronic pain can have a devastating impact on all aspects of sufferers' lives. About 65% of people with chronic pain report interference with daily activities including sleep, sex, work, exercise and routine self-care, which can have a negative effect on personal relationships, social interactions and lifestyle."

For more information visit Pain Australia.

The nursing and midwifery profession has specific workplace challenges and demands. Sometimes the pressure, either perceived or real, in the workplace can lead to poor practice and shortcuts and result in injury. Violent incidents at work can also put you at risk of physical injury.

All organisations have policies about 'no lift' and manual handling as well as procedures, guidelines and training for staff, but the nature of nursing and midwifery work sometimes leads to manual handling injuries that may result in chronic pain.  

One of the most common health problems for nurses and midwives is back injury. Chronic lower back pain can lead to physical and emotional problems, decreased quality of life, and impact on the ability to complete daily activities, and eventual disability.

It is estimated that one in five people in Australia are affected by chronic pain.

In 2011 the Australian Institute of Health and Welfare (AIHW) reported that musculoskeletal conditions, such as back pain and problems, and other musculoskeletal disorders emerged as one of the top five causes of burden of disease in those aged between 25-44. In the same report, it was identified that for males aged between 45-64 years of age the most common burden of disease was coronary heart disease. For females the leading burden of disease was musculoskeletal disorders, which included ill-defined arthritis, chronic pain in joints, muscles and other soft tissue.

Chronic back pain

Can be caused by an injury, or it can develop with age. Common sources of chronic back pain include:

• slipped or bulging discs — as a result of twisting or lifting injuries, damaged discs protrude into the spinal canal, pressing against nerves as they exit the spinal cord
• spinal stenosis — due to narrowing of the spinal canal, which can compress nerves
• compression fractures — commonly associated with osteoporosis
• soft tissue damage — to back muscles, ligaments, and tendons.
• traumatic fractures — caused by falls, car accidents or crush injuries, and 
• structural deformities — such as scoliosis, kyphosis or lordosis put a strain on the muscles that control posture, causing pain and fatigue.

Chronic headaches

A headache is considered chronic if it happens for three months in a row, for at least 15 days out of each month. The most common types of chronic headaches are:

• muscle tension headaches — often caused by stress, fatigue or 'sleeping wrong' muscles of the neck, shoulders, and scalp tighten, cause pressure on the head, and lead to pain
• eye strain headaches — ocular muscles become fatigued and cause head pain, usually caused by sitting at a computer for too long or the wrong glasses prescription
• migraines — can be caused by nervous system triggers or hormonal changes in the body
• cluster headaches — often confused with migraines, severe headaches usually caused by enlarged blood vessels leading into the head, and
• chronic headaches — may be present with diseases such as MS, cancer, brain injuries, HIV and high blood pressure, may be unpleasant side effects of medications.

Chronic joint pain

Arthritis is the most common type of joint pain. Joint pain is not, however, only felt by the elderly. Depending on its source, chronic joint pain can begin at any age. The common types of joint pain include:

• Osteoarthritis — wear and tear on joints over time, it is common in the elderly and usually affects one or more of the larger joints in the body.
• Rheumatoid arthritis — often present in early adulthood, causes swelling in the joint spaces and eventually damages bones, ligaments, and tendons.
• Repetitive strain injury — common in athletes, frequent injuries over time can result in chronic pain, typically these involve larger joints like the knee or the shoulder.

Neuropathic (nerve) pain

Nerves that carry pain signals to the brain may be triggered by swelling, compression or damage. Nerves that are healing may also over-fire, causing sensations such as pain to be more intense. Some examples of neuropathic pain:

• Sciatica — the sciatic nerve runs from your back to your feet, compression or damage of this nerve often causes pain to shoot down the leg on one side of the body.
• Bulging or slipped discs — nerve compression in the spinal cord can cause local pain, or pain referred elsewhere along the nerve’s path.
• Diabetic neuropathy — sensory nerve damage is a common side effect of diabetes, it can cause numbness or pain, most often in the hands or feet.
• Carpal tunnel syndrome — swelling in the wrist tunnel irritates the median nerve, causing tingling, numbness, and pain in the thumb, first and middle fingers.
• Chronic neuropathic pain can also be present in disorders of the nervous system such as MS, spinal cord injury and stroke.

Fibromyalgia

Though the exact cause of fibromyalgia is unknown, its effects can be devastating. It causes widespread muscle fatigue and pain and is often accompanied by chronic fatigue, sleep disorders, and irritable bowel syndrome.

Cancer pain

Pain in cancer patients can be caused by tumours or lacerations to tissues or nerves. Pain is also a common side effect of many cancer drugs, such as those used for chemotherapy and radiation.

Depression

While depression is commonly thought of as a psychiatric disorder, it is often accompanied by unrelenting pain. In fact, many drugs used to treat depression today are also effective at treating the physical symptoms of this disease.

If you or someone you know has chronic pain, you may notice irritability, anger, depression and difficulty concentrating. The psychological side effects of living with chronic pain can be as debilitating as the pain itself. This is what makes chronic pain such a complex condition.

Management for chronic pain disorders requires a multidisciplinary approach that involves assessing physical, psychological, environmental or social factors that influence your pain. Each of these areas need to be supported and treated to achieve positive outcomes.  

Finding a supportive GP is a good start. A treatment plan with a holistic approach may include physiotherapy and supervised exercises routines, and psychological counselling and support. There are also pain management clinics and pain support groups. It is really important not to isolate from others. 

As chronic pain can impact on all aspects of life and wellbeing even small changes may make a difference. Adequate sleep, nutrition, social interaction, and meditation may be beneficial.

Why not read some of our articles on staying healthy that may help with chronic pain management:

• Exercise
• Sleep
• Healthy eating
• Mindfulness

Our service provides free and confidential support 24/7, to nurses, midwives and students Australia wide. If you would like to speak to someone call 1800 667 877, or you can request support via email.

If you would like to know a bit more about the service before getting in contact — take a look through accessing support.

Australian Institute of Health and Welfare (AIHW) 2016a. Australian Burden of Disease Study: Impact and causes of illness and death in Australia 2011. Australian Burden of Disease Study series no. 3. BOD 4. Canberra: AIHW.

AIHW 2016b. Australian Burden of Disease Study: Impact and causes of illness and death in Australia 2011—summary report. Australian Burden of Disease Study series no. 4. BOD 5. Canberra: AIHW.