KEEP CALM AND CARRY ON. AN INTERVIEW WITH ALISON SIM
Alison Sim is an osteopath with a further Masters degree in pain management. Alison works predominantly in the area of chronic pain and runs education courses on different topics about pain. She has also presented at international conferences.
Sudi – Is chronic pain becoming more prevalent?
Alison – No, it is not becoming more prevalent. I think it is picking up more attention due to the rise in opioid use and the focus that health systems and the media have been paying to this issue. It is just increasing the awareness – which is a great thing! Chronic pain rates still sit at around that 20% of the population mark, whether that’s in the West or in the East. 1 in 5 people, or 1 in 4 people, depending on how you look at it and how you define chronic pain.
Sudi – For people who are in acute pain (new pain), what is the message to them to help them prevent developing chronic pain?
Alison – Seeing a good health professional who is up to date with pain science is really an important first step. If they can assess you and reassure that you are likely to recover, you will feel much more relaxed about having an injury or pain. Knowledge is power. Then the trick is to keep calm and carry on. If you are not as worried about it you are less likely to be checking in on it. This seems to be an important part of the recovery process – knowing that you are you are safe. Once you have this in mind, it is important to stay active, get back to work, hang out with your mates, keep doing stuff. Negative beliefs, worrying thoughts, anxiety, stress, activity avoidance are some of the main risk factors. The best thing we can do as practitioners is look at people’s beliefs and help them come to a better understanding of their pain that fits more with a more modern, scientific understanding of pain. If we can help people to understand that pain is multifactorial, and not always just due to tissue damage (without them just thinking we are saying it’s all in their head), it tends to relax things.
Sudi – For people that do have persistent pain, and have come to an understanding that it is not due to tissue damage, what pathways do you recommend to help them move forward?
Alison – That is a tough one Sudi! Maybe that is the key message. There is no ‘go-to’ and it is very individual. There is not one, easy pathway. For some people it might be that they need to move more. For others, it may be they need to see a psychologist to treat underlying, long-standing depression. A medication review could be part of the process for some. For others, it might be putting 3 or 4 strategies together.
Sudi – Prognosis-wise, what’s the good news and what’s the bad news for people in chronic pain?
Alison – That is a really good question. When you are trying to tell people this message, that they need to step off the merry-go-round, that they need to stop looking for that quick fix, that they probably need to embrace a bigger picture approach which involves meditation, exercise, not being so focused on their pain – it can be such a confronting message and people might have trouble relating to that idea.
Prognosis-wise, I don’t talk about what the stats say, and I don’t talk about whether people are likely to get ‘better’. I focus more on what do they want to do, goals and function, rather than getting pain-free. Getting rid of the pain should not be the goal, although that may be a by-product. It is more about accepting, and living well. Pain or no pain. People are used to fighting pain. And it is society’s way as well… ‘pain is wrong and we have to do something about it’. So it is a hard message to get across.
It is about how we define success. This is really important, and it’s a conversation we need to have. Set our expectations. What are we looking for? If we establish that someone’s goal is to get rid of the pain, we have work to do to change their mindset and expectations- to help them to focus on getting back to doing the things that are important to them.
Sudi – Pain is a protective response. Fatigue is a protective response. From your understanding, could chronic pain and chronic fatigue be similar in their physiological causes?
Alison – From my research and my understanding, that is what I have arrived at. From a neurological and social understanding there are some profound similarities. Unfortunately, the fatigue community is about 20 years behind the pain community. Instead of coming to a multi-disciplinary and multi-modal approach, people have gone looking for a medical ‘cure’. In the pain community, we have accepted that there is no biomedical cure, as we cannot necessarily identify it. So we focus on function. The fatigue patient groups seem to be really disappointed that the gold standard treatment is symptomatic treatment, meaning trying to gradually increase exercise and load tolerance. The impression that they can give is that they see this approach as not good enough because symptomatic treatment is not fixing the cause. They are still at the stage of ‘if we can find what’s wrong then we can use a medication to fix it’. It is such a debilitating and frustrating condition that it is totally understandable how this situation has come about. You can understand how someone would be really focused on wanting to find a cure. Unfortunately though, at this stage, these symptomatic interventions are the best that we have and they can be really effective for some people. Like treating people with chronic pain, it is really important that people understand that there will be times in the treatment process that they will have times that they are worse and that it is a slow process with ups and downs. If people can be well supported with this understanding and also supported and reassured in those bad days or “flare ups” it can help them to stick with the approach and get back to having more energy to live their life.
But yes, it is a really interesting area, and there are many similarities between the two conditions.