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 Living better with chronic pain

Living better with chronic pain

Self-management can be helpful for prolonged pain, says Dr. Anne Marie Pinard, an anesthesiologist who specializes in chronic pain. Here are the basics.

If you suffer from pain for more than three months, or if the pain persists even after the illness or injury that caused it has healed, you have chronic pain, which affects 20-25% of the population. The consequences for patients are enormous, both on a biological and psychological level: anxiety, sleep disturbances, reduced ability to concentrate, and reduced self-esteem. Everything changes," says Anne Marie Pinard, a lecturer at the Laval University School of Medicine and chair of the Chronic Pain Department.

These people can withdraw from social life and stop working. Chronic pain is therefore extremely costly. According to US figures, the cost amounts to USD 600 billion per year. Unlike acute pain, chronic pain is useless because the danger has usually passed, but the body's alarm system is still activated," explains the anesthesiologist who specializes in pain management.

Medicines that don't work

'People who come to our clinic for pain have experienced an unprecedented number of failures,' says Pinard. In fact, the effect of pharmacological treatments is often limited. In most cases, they only reduce pain by 30-40%.

According to the anesthesiologist, improvement is possible if one participates in the treatment and has good support. This is what he calls self-management. It is the ability to manage symptoms and treatments, as well as the physical and psychosocial effects of pain while making the necessary lifestyle changes to cope with daily life.

"It's like taking the bull by the horns and helping yourself, but it's not necessarily easy," Pinard acknowledges. People with chronic pain need support and guidance in this process. Within the health care network, however, waiting lists can limit access to appropriate resources.

An online program

"That's why we're working to develop tools that allow people to take charge of their lives when they feel competent," says the anesthesiologist. One of my Ph.D. students developed a self-management program in collaboration with patients. It has been validated by health professionals and will be available online within a year. As this is a research project, some analysis still needs to be done. The program will be published on the Managing My Pain website, which already contains many online resources for people with chronic pain.

The project includes several chapters dealing with different aspects of self-management. "The first question is whether the person is ready for self-management, says Pinard." Then we explain how to set goals. We also talk about activity levels, mental health, exercise, nutrition, and smoking. Participants are encouraged to participate, ask questions and choose strategies. They can take notes in a diary and record their progress.

Overcoming pain

One of the most important principles of self-management is to examine one's perception of pain. "People come to the clinic expecting an injection or a miracle pill," says the anesthetist. However, it's possible that improvements may not be immediate. If you suffer for 10 or 15 years, it takes several weeks for the pain to go away," he adds. 'It can take months or even years to get it back.

But pain shouldn't stop people from being active. "Many patients tell us they'll do this or that when they get rid of the pain," Pinard says. But you need to set attainable goals, even amid the pain. That's why he asks his patients to think about what they'd like to do. It may be something as trivial as sitting outside and drinking coffee, but these small gestures can gradually incorporate the positive back into daily life.

"People with chronic pain are very afraid to move, and we understand that," Pinard says. That fear has a name: Kinesiophobia. Trying to overcome that fear is part of self-management.

"The patients with the best outcomes are the ones who accept that they'll be in a little more pain at first, but that they'll be fine afterward," the anesthesiologist points out.

Prevention of chronic pain

It is useful for the treatment of chronic pain. It's better to prevent. "For acute pain, such as back pain, the doctor can use certain questionnaires to assess whether the person is at risk of developing chronic pain," Pinard explains. Although these risk factors are known, they are rarely assessed, the expert laments.

"If we identify high-risk patients first, we can refer them for rehabilitation immediately and try to prevent chronic pain," the anesthesiologist adds. But there is no means to do that, and that's a pity because we could save so many people from suffering from this problem.


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