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Alexandra has been in pain for eight years. New treatment is helping her cope

Though the number of Australians suffering from pain is rising, there are still no effective treatments available. However, according to the authors of a study published this week, a new approach could transform a person’s experience of pain.

By some estimates, chronic pain – pain that persists for more than three months – affects about 30 per cent of people globally, and it is the leading cause of disability worldwide. Age is a factor, and chronic pain disproportionately affects women, but little else is known about why some people are affected.

One of the issues with treating chronic pain is that it’s not curable – rather it is a condition that can be managed – and experts are still trying to understand the underlying mechanisms. Current treatment typically involves a combination of medication, lifestyle advice like exercise and cognitive behavioural therapy (CBT).

“None of these treatments is a cure nor do they work for everyone and medication – which only relieves pain in a small percentage of people – can come with nasty side effects,” says Neuroscience Research Australia and UNSW chronic pain expert, Professor Sylvia Gustin.

In their combined 28 years working in chronic pain research and treatment, Gustin and her colleague clinical researcher Nell Norman-Nott realised that current approaches tend to overlook an important factor: the emotional experience of pain.

“You give pain medication and the people still suffer emotionally,” Gustin says.

By some estimates, 85 per cent of people with chronic pain also suffer anxiety and depression.

In previous research, Gustin and her team scanned the brains of 48 people – half of whom had chronic pain. They found that among those with chronic pain there was a decrease in the main inhibitory neurotransmitter of the central nervous system, which is called GABA.

According to Gustin, GABA has a calming effect on our brains and helps us regulate emotions, so a decrease means all feelings are amplified. “It really results in an increase in overwhelming negative emotions.”

Along with physical changes in the brain, constant pain can cause negative emotions too.

“Your pain worsens your mood and then when you’re in a worse mood, you perceive your pain to be more intense,” says Alexandra Green, a Sydney-based statistician who has suffered chronic pain for eight years. “It’s a vicious cycle.”

An increasing number of studies have attempted to address the oversight and examine howemotional-focused skills to manage stress, anxiety and low mood can affect pain perception and life quality.

In the new paper, the first systematic review and meta-analysis of its kind, Gustin and Norman-Nott found that by learning to regulate emotions, patients experienced sustained reduction in pain levels, reporting a clinically significant improvement of 10 points on a 100-point pain intensity scale.

“Through certain skills in emotion regulation, things like mindfulness, you can utilise neuroplasticity to instigate the reversal of some of the changes that we see in the brains of people with chronic pain,” says Norman-Nott.

“We are not saying that we can decrease the pain to zero,” Gustin adds. “It’s more that you have something to work on daily to increase your quality of life. It’s the missing link that is needed because people are suffering.”

Last year, Green participated in the online-based Emotional Recovery Program for Chronic Pain, facilitated by Gustin and Norman-Nott. She had a spinal fusion at age 12 to treat severe scoliosis. It led to osteoarthritis and, seemingly out of the blue, pain flared in her early 20s and never went away.

Until then, Green had an independent life, travelling the world by herself and completing a PhD. It was a shock to have to rely on others to do basic tasks like carry groceries and do household chores. The pain limited her capacity to socialise and over-exertion could leave her bedridden for days.

Appointments with numerous specialists and doctors, some of whom suggested the pain was all in her head, left her thousands of dollars out of pocket, while some treatments she was prescribed ultimately made her pain worse. Last year, she finally found help.

A combination of medication, a surgical treatment called radiofrequency ablation, daily gentle exercise, heat packs and massage therapy have provided some relief, Green says. The skills she learned via the program with Gustin and Norman-Nott have also improved her perception of the pain and allowed her to manage it.

“Before, if I was in a pain flare up, I would freak out, and I’d get really stressed, which would then make the pain worse,” she explains. “Now I’m able to calm myself down.”

It’s more effective than CBT (which is more focused on thought-patterns), she says, because it acknowledges the emotions that exist alongside pain and provides strategies for managing them, including mindfulness, acceptance, learning the triggers, managing the expression of negative emotions and using distraction.

“The power of the brain is just incredible,” says Green. “So while it might not remove your pain entirely, it’ll help you cope with it a lot better.”

The University of Adelaide’s Professor Mark Hutchinson, chair of the steering committee for the Australian Pain Solutions Research Alliance, says the findings are interesting, but believes “much more” is still needed as people continue to experience unacceptable levels of pain.

“What this study does do very nicely is highlight the power of acknowledging and treating the biopsychosocial complexity that is the lived experience of pain,” Hutchinson says.

“As such, a convergence of interventions that enhances the resilience of the mind and body in an evidence-based manner is a good thing.”

For Green, it may not be a cure but it’s a step towards reclaiming her life from pain.

“When you’re in chronic pain, you feel so helpless and there’s just nothing that can be done,” she says. “But there are options for people.”

Article originally published in the Sydney Morning Herald.


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