Chronic pain is when your pain persists for longer than six months, in spite of the original injury having healed. The condition has been shown to affect 35 per cent of Irish adults and it often has a significant impact on many areas of life including relationships, sleep, work and hobbies.
The cost of treating persistent pain is estimated to exceed the combined costs of treating both cancer and diabetes. With healthcare costs rising, and an ageing population, there is a strong need for evidence-based, cost-effective methods of treating chronic pain.
Why do some people develop persistent pain?
It is unclear why some people develop persistent pain and others do not. Persistent pain can affect people of any age, though it does tend to become more common with age. It can be related to physical injury, or it can develop as part of a variety of medical conditions. For some people there is no known cause.
What types of treatment are available?
There is a wide variety of treatments for chronic pain, including medication, injections and manual therapies. Most of these treatments tend to focus on one aspect of pain, namely the physical sensations, and, therefore, success can be limited or short term.
Sometimes the benefits of these treatments can also come at a cost, as when medication causes sedation or other undesirable side effects, or when drugs become addictive and thus cause other problems.
A common issue faced by people who experience persistent pain is that treating the physical sensations becomes the primary focus. In many ways this is understandable, but over time this narrowing of focus can become part of the problem, making chronic pain a complex condition requiring a broader approach.
In professional circles, we often refer to this as “the bio-psycho-social approach”. This approach benefits from different professions working as part of a team to treat the varying needs of individuals attending the clinic. This ethos underpins the success of an innovative treatment offered at the Mater Misericordiae University Hospital, in Dublin.
The Mater Act Pain Programme (Mapp)
Participants attend the programme one day a week over two months. It is a group intervention, with a typical group comprising 10 people. We also like junior staff members to sit in on groups, as part of their training. The main focus of the Mater Act Pain Programme (Mapp) is on improving function and quality of life. The aim of the programme is not specifically to decrease pain but to provide strategies to help manage people’s pain more effectively, so they can live more positive lives.
Psychology sessions are based on acceptance and commitment therapy (Act), which seeks to increase “psychological flexibility”. The core messages of Act involve accepting what is beyond your personal control, fostering a healthy relationship with your “self” and committing to action that improves and enriches your life. Mindfulness practices and peer-support also form part of the psychology sessions.
Physiotherapy includes hydrotherapy and gym-based activities that help to improve physical flexibility and strength, and encourage more natural movement. Participants are also given pedometers for the eight weeks to help track physical activity patterns.
Additional education sessions, delivered by different team members, cover topics such as understanding pain, activity pacing, sleep hygiene, stress control and medication management.
What are the results?
Our team is committed to ongoing evaluation of Mapp and we measure the short-term and long-term impacts of the programme through questionnaires, interviews and pedometer readings.
So far, our results show that participants end up experiencing less psychological distress; they report increases in acceptance of their pain; they say it interferes less with their daily life; and they report more confidence in engaging in activity and in managing their own condition.
These outcomes are consistent with the overall aim of Mapp, which is to enhance psychological flexibility, so that despite pain symptoms, people can still lead fulfilling and active lives. The results also add to a growing evidence base for Act as an effective approach for those with chronic pain, which we feel is enhanced by a combined activity session.
What next?
We continue to gather feedback from our patients to make Mapp a better programme. After all, it is the patients themselves whose lives we are trying to improve. If you are reading this, and you live with chronic pain and want to improve your situation, perhaps you should consider taking part in Act.
We’ll leave the last word to one of our recent participants: “Prior to the course I wasn’t sure anyone took my chronic pain seriously. During the course this was never in question, and it helped me to accept that I would have to live with the pain but that I could make the pain more tolerable by employing various skills including my thought processes.”
Dr Damien Lowry is a senior counselling psychologist and Máire-Bríd Casey is a senior physiotherapist; both work at the Mater Misericordiae University Hospital Pain Clinic in Dublin.
