Chronic pain management video resource - Brainman

A team from Hunter Integrated Pain Service (HIPS), University of South Australia, University of Washington and Hunter Medicare Local (Hunter ML) have developed a series of videos about chronic pain featuring Brainman.^1,2

These videos represent a change in direction. Chronic pain can change, it's not always an enduring disease or problem. The first thing still remains to get assessed and rule out anything dangerous then it's time to 'shift focus', get informed and manage pain from a broad, active perspective.

Understanding Pain in less than five minutes

This video will enable people with chronic pain access to a self-management tool that will help them manage the impacts of chronic pain on their functioning, emotions and interpersonal relationships and will help in the adherence to pain management plans.

Show transcript for Understanding Pain: Brainman chooses

Everyone agrees that pain is a universal human experience.

We now know that pain is 100% of the time produced by the brain. This includes all pain, no matter how it feels − sharp, dull, strong or mild − and no matter how long you've had it.

You might've had it for a few weeks or months. This is called acute pain and it's common with tissue damage – say from a back injury or ankle sprain - and generally you'll be encouraged to stay active and gradually get back to doing all your normal things, including work.

Or you might've had it for three months or more and this pain is generally called persistent or chronic because in this type of pain tissue damage is not the main issue.

What's less clear though when you're told you have chronic pain, is knowing what's best to do about it. Well, in Australia chronic pain is a really big problem, in fact 1 in 5 people have it.

Having a brain that keeps on producing pain even after the body tissues are restored and out of danger is no fun. Some people say it still feels like they must have something wrong.

But that's just it, once anything dangerous is ruled out health professionals can explain that most things in the body are healed as well as they can be by 3 to 6 months. So, ongoing pain being produced by the brain is less about structural changes in the body and more about the sensitivity of the nervous system. In other words, it's more complex.

So, to try and figure out what's going on, you need to retrain the brain and nervous system. To do this it's helpful to look at all the things that affect the nervous system and may be contributing to your individual pain experience.

What can help is to look at persistent pain from a broad perspective and by using a structured approach and a plan it's less likely that anything important will be missed.

Let's start with the medical side.

Firstly, taking medication can help but only to a limited extent. It is the more active approaches that are necessary to retrain the brain. So using medications to get going is OK, and then mostly they can be tapered and ceased. Some people also think surgery might be the answer, but when it comes to a complex problem like chronic pain, surgery may not be helpful. So, if you're thinking of surgery, it's best to get a second opinion and remember to consider all the things.

Next, it is helpful to consider how your thoughts and emotions are affecting your nervous system. Pain really impacts on people's lives and this can have a big effect on your mood and stress levels. All those thoughts and beliefs are brain impulses too. But you can learn ways to reduce stress and wind down the nervous system. This helps with emotional wellbeing and can reduce pain as well.

The third area to consider is the role of diet and lifestyle. Now it turns out that our modern lifestyle might not be so good for us. In fact what we eat and how we live may really be contributing to a sensitized nervous system. Looking at all the things like smoking, nutrition, alcohol and activity levels, and seeing if there are any issues is a good beginning, and these things can go on your plan.

Then there's often enormous value in exploring the deeper meaning of pain and the surrounding personal story. By stepping back and looking at all the things that were happening around the time the pain developed, many people with pain can make useful links between a worrying period of life and a worsening pain picture. For many, recognising deeper emotions can be part of the healing process.

Last, but by no means least, is physical activity and function. From the brain's perspective getting moving at comfortable levels, without fear, and where the brain does not 'protect by pain' is best, and you'll gradually restore your body's tissues.

So, to sum up pain: It comes from the brain and it can be retrained and when looked at from a 'whole person' or broad perspective gives you lots of opportunities to begin.

So, get a helping hand if you need it, set a goal, and begin.

The content in this video was a joint project between GP Access and the Hunter Integrated Pain Service.

Video URL:

• https://www.youtube.com/watch?v=5KrUL8tOaQs
• https://www.youtube.com/watch?v=OYOi1AD5mOk (English subtitles)

Understanding Pain: Brainman chooses

Decreasing pain starts with knowing about pain and choosing to work on sustainable strategies. Get assessed, rule out anything dangerous and get informed. Manage pain from a broad active perspective by addressing underlying depression or anxiety issues, reconnecting to life, finding positive support, sleeping, resting, health eating practices and establishing regular physical activity.

Show transcript for Understanding Pain: Brainman stops his opioids

Many people with long term pain don't feel believed and get trapped in a never-ending loop of suffering.

Changing direction brings hope. New ideas have revolutionised pain thinking and care.

The focus is more on the whole person and less on the body structures. Persistent pain can change. It's not always an enduring disease or problem.

First, getting assessed and ruling out anything dangerous is important.

Then it's time to shift focus. Get informed and manage pain from a broad active perspective.

Next, everyone can benefit from making the mind-body link.

Drawing a time line helps makes sense of the emotional impact of life events, before, during, and after the onset of pain.

Addressing underlying depression or anxiety early is critical to reducing pain over time.

People also say they feel isolated.

Reconnecting to life makes a real difference. Finding new purpose and positive ongoing support benefits the recovery process.

Sleep, rest and physical activity have its all impact on function [sic].

Taking practical steps towards improving sleep, limiting rest and establishing regular activity helps.

In time confidence builds.

And trusting that the body's rhythms and limits can change brings a renewed sense of well-being.

Last, good nutrition can't be ignored. Optimising our diets with plenty of natural food lets healthy gut bacteria thrive and brings less inflammation and pain.

This is not just new age thinking.

These discoveries have shifted the world's understanding of how best to treat pain.

Decreasing pain starts with knowing about pain and choosing to work on sustainable strategies.

Knowledge about pain now and less pain in the future?

Now that's a reward worth working for!

The content in this video was a joint project between Hunter Integrated Pain Service (HIPS), University of South Australia, University of Washington and Hunter Medicare Local (Hunter ML).

Video URL: https://www.youtube.com/watch?v=jIwn9rC3rOI

Understanding Pain: Brainman stops his opioids

We all accept medicine advances as knowledge grows. In treating chronic non cancer pain, there's been too much focus on opioid medication and not enough on the most effective ways to improve pain and wellbeing.

Show transcript for Understanding Pain: Brainman stops his opioids

We all accept medicine advances as knowledge grows.

In treating chronic, non-cancer pain, there's been too much focus on opioid medication and not enough on the most effective ways to improve pain and wellbeing.

Most people taking opioids experience early gains, but it doesn't last. Taking more may seem to help at first, but in fact it makes matters worse.

Along with well-known side-effects, scientists have also discovered that people taking opioids often develop other problems.

They're more likely to fall, have lower sex-drive, lower immune function, and poorer quality sleep. There is also an increased risk of accidental overdose and death. We now know that opioids can quickly sensitise the nervous system and actually increase pain.

Some people using opioids say that it gives them a little bit of comfort. But, that's not a reason to remain on them.

There are also those who develop addiction and this makes it very difficult to stop opioids despite the harms.

Knowledge changes. We now know that when it comes to chronic pain use of these drugs often makes matters worse.

Opioids are no longer recommended for chronic non-cancer pain. Instead get support, get an active recovery plan, and get started.

The content in this video was a joint project between Hunter Integrated Pain Service (HIPS), University of South Australia, University of Washington and Hunter Medicare Local (Hunter ML).

Video URL: https://www.youtube.com/watch?v=MI1myFQPdCE