Making gains on pain
For many stroke survivors, dealing with chronic pain is a major part of life after stroke. Stroke survivors may have to deal with injury pain, nerve pain, or both.
Pain becomes chronic when it lasts three months or more. Anyone who has been through it, or lives with someone who has, knows how debilitating it can be. In chronic pain, the focus is on management rather than cure. Self-management of pain is about taking control: becoming the expert, and focusing on being as well as possible.
The first step in self-managing your pain is to investigate its causes and contributors. This is also important if anything changes with your health or pain and at regular points when chronic pain continues over many years. Medication reviews are a fundamental part of self-management, as is having a knowledgeable, supportive and proactive general practitioner.
Beyond that there is good evidence to show having multiple chronic pain treatment strategies is the most effective approach. Things to consider include:
Medication. For injury pain, anti-inflammatories, paracetamol and opioids may be prescribed. For nerve pain, anti-depressants may be prescribed to reduce pain messages in the brain. Anti-epileptics, which reduce excess electrical activity in the brain, may also be used. The NPS MedicineWise website has comprehensive information on pain management, including pain medications.
Psychological treatment. Cognitive behavioural therapy (CBT) has the most evidence as an effective treatment for chronic pain. CBT is a form of talk therapy that helps you identify negative thoughts and behaviours and develop the skills to change them. Other psychological treatments with evidence for their effectiveness include hypnosis, biofeedback and relaxation techniques. If you decide to pursue this treatment, see a psychologist with expertise and experience in chronic pain treatment.
Physical activity. Physical activity releases endorphins in your body and helps reduce pain naturally. Find something that makes you feel good and you’ll not only get the benefits, you’ll be more likely to stick with it. Pacing and planning activities to get things done within your pain tolerance is important too,
Equipment. Adaptive equipment and modifications can help you avoid exacerbating your pain while getting things done. The Clinical Guidelines note that electrical stimulation can be useful for shoulder subluxation pain.
Nutrition. While the usual advice around eating a wide variety of nutritious foods from the five food groups applies, there is some advice from the Pain Management Network website about foods to consider avoiding and including if you are living with chronic pain.
Connect with others: Chronic pain can be difficult to understand unless you’ve been through it. The Pain Management Network homepage leads on to some fantastic resources, bringing together expert advice with the experiences of people living it day to day. The Pain Link telephone helpline (1300 340 357) is staffed by volunteers who themselves live with chronic pain and are available to provide support, advice or even just listen.
Tell us about your experiences in managing chronic pain: what works, what life is like now and what you’ve learnt? Leave a comment below!
More resources
Stroke Foundation fact sheet: https://enableme.org.au/Resources/Pain-Management
Stroke Foundation blog on getting services and support for chronic pain: https://strokefoundation.org.au/Blog/2015/05/20/Chronic-pain-do-not-go-it-alone