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Chronic Pain

Summary

Chronic pain is a long-lasting pain that persists for more than three months, even after an injury has healed or due to an ongoing condition. It is one of the most common reasons people visit their doctor. Chronic pain can be classified based on its characteristics or affected body regions, including:

  • Musculoskeletal pain (e.g., arthritis, back pain)
  • Neuropathic pain (caused by nerve damage, often described as burning or tingling)
  • Fibromyalgia (widespread pain with fatigue and sleep issues)
  • Chronic headaches (such as migraines)

Chronic pain is especially common in older adults, affecting one in three people over 65. Conditions like arthritis, osteoporosis with fractures, and spinal stenosis can contribute to pain, but they are treatable and should not be considered a normal part of aging. If left untreated, chronic pain can lead to depression, reduced quality of life, and loss of independence.

Definition

Pain is considered acute when it occurs suddenly due to an injury or illness and resolves as healing takes place. If pain lasts longer than three months, it is classified as chronic pain. It may be linked to ongoing medical conditions such as arthritis, migraines, or nerve damage (neuropathy).

Neuropathic pain, in particular, involves changes in how the nervous system processes pain, leading to:

  • Allodynia: Pain from stimuli that are not usually painful (e.g., light touch).
  • Hyperalgesia: An exaggerated or prolonged pain response to something normally painful.

Chronic pain can fluctuate, with flare-ups triggered by activity, stress, or unknown factors.

Diagnosis and When to Seek Help

Seek medical attention if pain:

  • Lasts for more than three months.
  • Interferes with daily activities, sleep, or mood.
  • Worsens despite home treatments or medications.
  • Is associated with numbness, weakness, or unexplained weight loss.

A doctor may assess symptoms through physical exams, imaging tests, or nerve function studies to determine the cause and best treatment approach.

Management

A combination of treatments is often needed to effectively manage chronic pain, including:

  • Stretching and physical therapy: Improves mobility and reduces stiffness.
  • Relaxation techniques: Practices like meditation and deep breathing can help manage stress-related pain flares.
  • Medications:
    • Antidepressants and anticonvulsants can help with nerve-related pain.
    • Over-the-counter pain relievers (e.g., acetaminophen, ibuprofen) may be useful for mild to moderate pain.
    • Opioids are not recommended as first-line treatment due to risks of addiction, overdose, and side effects such as increased pain sensitivity over time.
  • Lifestyle adjustments: Regular exercise, maintaining a healthy weight, and managing stress can help reduce pain intensity.

Follow-Up and Monitoring

Chronic pain requires ongoing management. Patients should work closely with their doctor to adjust treatment plans as needed. Regular follow-ups help ensure pain is well-controlled while minimizing medication side effects and preventing complications.

History and Exam

Key diagnostic factor

  • presence of risk factors
  • duration of pain more than 3 months
  • physical comorbidity
  • psychological comorbidity

Other diagnostic factors

  • precipitating factors for chronic headache
  • duration of headache pain
  • radiating pain
  • morning stiffness in joints

Risk factors

  • age over 45 years
  • female sex
  • pregnancy
  • history of trauma or chronic pain

Diagnostic Investigations

Investigations to consider

  • plain x-rays of spine, bones, and/or joints
  • MRI of spine
  • electromyogram and nerve conduction studies

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      Social and emotional functioning refers to a child’s ability to understand, express, and manage their emotions, as well as to interact effectively with others. These skills are fundamental for building positive relationships, developing empathy, and coping with the everyday challenges of growing up.

      Children who experience difficulties in social and emotional functioning may struggle with recognizing their own feelings or those of others, regulating emotional responses, or responding appropriately in social situations. This can lead to challenges such as anxiety, low self-esteem, difficulty making friends, or misunderstandings with peers and adults.

      In the school environment, social and emotional difficulties can impact a child’s engagement, cooperation, and overall learning experience. Emotional distress may manifest as withdrawal, irritability, or disruptive behaviour, which can further affect academic progress and peer relationships.

      Assessment of social and emotional functioning as part of a neuropsychological evaluation typically includes behavioural observations, standardized rating scales, and information gathered from parents, teachers, and sometimes the child. This comprehensive approach helps identify strengths and areas for support in emotional regulation, social skills, and adaptive behaviours.

      Understanding a child’s social-emotional profile allows for the development of tailored strategies to enhance emotional wellbeing, build resilience, and improve social communication. Early intervention and supportive environments can empower children to navigate their emotions more effectively, fostering confidence and meaningful connections. 

      At Offspring Health, we aim to provide transparent information about the costs involved in neurodevelopmental and educational assessments.

      Neuropsychological assessments typically involve multiple sessions that usually take between 8 and 16 hours in total, depending on the complexity and individual needs. Our hourly rate is $260, so the total cost typically ranges between $2,300 and $4,230.

      Fees generally cover:

      • Initial consultation and history gathering
      • Testing sessions where your child will complete various fun and interactive tasks
      • Liaison with schools or health professionals as needed
      • Comprehensive case analysis and report preparation
      • Feedback sessions with families and, where applicable, educators or other professionals

      Please note that standard neuropsychological assessments are generally not covered by Medicare. However, some assessments and therapy services may be funded through the National Disability Insurance Scheme (NDIS) for eligible participants. We recommend discussing funding options with your NDIS planner or support coordinator prior to booking. Private health insurance may offer partial rebates depending on your level of coverage.

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