Chronic pain affects 17% of males and 20% of females in NSW and in a significant proportion of these people, it will impact their daily lives. Major advances have been made in our understanding of pain in the last 40 years.

It is now widely accepted that pain is a multi-dimensional experience. Major advances have revealed that not only are afferent nerve impulses modulated in the spinal cord but by regions of the brain that regulate attention, emotion, and memory. In essence, this means that the traditional biomedical model of pain has been replaced by the biopsychosocial model of pain. Pain cannot always be explained or equaled to underlying pathology. The brain has plasticity, which means that it changes in response to stimuli. Pain can be modulated (inhibited or excited) in response to the brain’s interpretation of a painful event. For example, someone may be given a heat stimulus (40 degrees). They are then given a second stimulus, which is the same, but told it is 45 degrees. The brain has modulated the pain in response to expectation.

Some people are more prone to amplified pain responses than others, putting them at risk of developing chronic pain. Early identification of risk factors and patient education can minimize the risk of transition from acute to chronic pain. If a chronic pain state is identified, an appropriate management plan can then be put into place. The approach will need to be multidimensional, taking into account the many different aspects which may be contributing to pain and functional disability. It is advantageous that health professionals dealing with a particular case have an understanding of the nature of chronic pain to avoid a purely biomedical approach. Patients often spend time and money on unnecessary medical investigations with resultant positive findings that may then be attributed to the patient’s pain when in reality, they may have little clinical significance. This can also be a source of frustration for the patient and clinician.

There is still enormous progress to be made in the area of chronic pain. But the bottom line is that the management of patients in chronic pain states needs to be multidisciplinary, including pharmacological, psychological, physical, and must include patient education. Exercise and education should underline any effective pain management program.


knowledge … self-management … prevention