Living with chronic conditions and pain

Chronic conditions

‘Acute’ conditions are those which come on quickly and can usually be treated with medications or maybe surgery.  Following a period of recovery, normal health returns. Examples of acute conditions include influenza, appendicitis or gall bladder inflammation.

Chronic conditions tend to come on more slowly, sometimes taking years before specialist attention is sought as people often adapt to the symptoms (e.g. annoying aches and pains in the joints with arthritis or shortness of breath with heart problems).

Chronic conditions include:

• arthritis
• back pain
• osteoporosis
• diabetes
• bronchitis
• asthma
• heart conditions
• related depression.

There are often no quick solutions to these conditions and rather than the illness itself, it is the associated problems of the condition which can have the greatest affect on daily life and personal relationships.

Chronic conditions can be accompanied by ongoing pain and tiredness that can lead to frustration and sometimes depression. Some people slow down or stop doing their routine tasks or activities, which in turn may lead to further disability.

Living with a chronic condition

Living with a chronic condition can be a challenge - but you are still in control of your life. Being able to ‘self-manage’ a chronic condition, in partnership with health professionals, family, friends and carers, can minimise the severity of your symptoms  and improve your quality of life. Self-management is about taking an active role in managing any long-term health condition. Self-management is not about going it alone.

As with acute conditions, the role of appropriate health professionals (general practitioners, specialists, physiotherapists etc.) is very important in managing any chronic health condition.

What do I need to do to effectively self-manage my chronic condition?

To gain the skills and confidence to take control of your condition, you can:

• learn all you can about your condition, its treatment and management;
• ask about and understand your medications;
• communicate your feelings with your health care providers;
• incorporate suitable activity and fitness sessions into your day;
• learn and practice relaxation techniques and problem-solving skills;
• maintain a healthy diet, eating from the five food groups everyday;
• deal with the fatigue, frustration and sometimes isolation that a chronic condition can bring with it;
• find out about community support groups in your area; and
• work out effective ways to manage your symptoms.

Chronic disease self-management courses

Chronic disease self-management courses teach you how to enhance your health and wellbeing, and take an active role in managing your chronic conditions.

A chronic disease self-management course will give you the tools to overcome the day to day challenges of living a healthy life with a chronic condition.

Attending a chronic disease self-management course can help you:

• reduce your pain, fatigue and health distress;
• increase your level of activity and exercise; and
• gain greater confidence to continue to self-manage your condition.

What is involved in a chronic disease self-management course?

Skills covered in chronic disease self-management courses, such as those run by Arthritis Australia can be readily applied to the management of many chronic conditions.

Topics covered include:

• dealing with frustration, fatigue, pain and isolation;
• appropriate use of medications;
• communicating effectively;
• nutrition and exercise;
• use of community resources;
• goal setting and problem solving;
• working with your doctor; and
• relaxation and symptom management.

You will experience benefits from trying new coping strategies and gain increased confidence in your ability to manage your condition, along with an increased sense of control over your health.

Arthritis

What is arthritis?

The word arthritis comes from Greek: arth meaning  joint and itis meaning inflammation.

Arthritis is a very common condition in Australia affecting people of all ages and from all walks of life.

Arthritis is not a single condition. There are over 150 types of arthritis, all of which affect one or more joints in the body. And although the derivation of the word means ‘inflammation of the joint’ some forms of arthritis don’t actually involve any inflammation.

The most common symptoms of arthritis are pain, swelling and stiffness in one or more joints, and fatigue.

Three common forms of arthritis are osteoarthritis, rheumatoid arthritis and gout.

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Osteoarthritis

Easily the most common form of arthritis, osteoarthritis mainly affects people over the age of 45. Osteoarthritis can affect any joint but usually occurs in large weight-bearing joints such as the hips, knees, shoulders and the lower spine.

In a healthy joint, the ends of the bones are covered by a smooth layer of cartilage. The cartilage stops the bones grating together and helps the joint move smoothly. In osteoarthritis, this cartilage breaks down.

Symptoms of osteoarthritis

Although symptoms vary from person to person, the most common signs are:

• tenderness;
• pain; and
• stiffness of the joints, including early morning stiffness.

Other symptoms include:

• swelling of the joints, caused by inflammation;
• muscle weakness, which causes the joints to feel unstable;
• a grinding sensation in the joints; and
• loss of mobility.

Rheumatoid arthritis

Rheumatoid arthritis is a disease that causes inflammation of the joints, usually in the hands, feet and knees. The tissue surrounding the joint becomes inflamed, leading to swelling, pain and stiffness.

Symptoms of rheumatoid arthritis

The early symptoms of rheumatoid arthritis vary, but the main signs are:

• tenderness;
• pain;
• early morning stiffness in the joints;
• swelling in the joints;
• tiredness;
• muscle weakness;
• weight loss; and
• loss of mobility.

Gout

Gout is a common and painful type of arthritis occurring when uric acid crystals are deposited in the joints. This causes irritation and tissue inflammation.

Uric acid is a waste product produced by the blood. The body disposes of it first by dissolving it in the blood, then filtering it through the kidneys, to be finally removed in the urine.  Some people, however, either produce higher than normal amounts of uric acid, or their bodies are unable to filter it out of the blood.

The first attack of gout usually happens between the ages of 40 and 50 years, normally affecting the big toe first, although it can go on to affect the knees, ankles and hands. Men are nine times more likely than women to get gout.

Unlike other types of arthritis, which develop slowly, an attack of gout can occur quickly, even overnight.

Most people from gout benefit from:

• drinking lots of fluid, helping to flush uric acid out of the body;
• limiting alcoholic drinks;
• avoiding certain foods – including liver, kidney, brains, anchovies and shellfish; and
• losing weight.

How to manage your arthritis

There is no cure for arthritis but there is a lot you can do to control it, manage the pain and live a full life with the condition, including:

• seeing your doctor immediately when you notice any symptoms;
• learning pain management techniques, like relaxation, yoga and using hot and cold packs;
• being physically active, especially doing water therapy and tai chi;
• getting rest – this will prevent swelling in the joints and prevent you from becoming fatigued;
• stopping smoking – as a smoker you are twice as likely to get rheumatoid arthritis as non-smokers;
• taking the medicines recommended by your doctor;
• seeking support from other people and support groups; and
• using mechanical aids such as walking frames and specially designed eating utensils.

Pain, stiffness and inflammation are hallmarks of arthritis. You may find exercise, physiotherapy, occupational therapy and rest can help, but medication may often be required under a doctor’s supervision.

There are many strategies and treatments to choose from if you live with arthritis and other musculoskeletal conditions, including:

Physiotherapy

Physiotherapists will use a broad range of treatments to treat your pain and stiffness, to increase muscle strength and maintain joint mobility. Physiotherapy treatments are often used in combination with an individual exercise program, massage, joint mobilisation and postural assessment.

Occupational therapy

Occupational therapists can advise you on how to best avoid over-stressing your arthritis-affected joints. They will look at aspects of your daily life, including activities around the home and leisure activities. By simplifying daily tasks you will be able to better protect your joints.

Chiropractic

Good results can be achieved by well-trained, experienced chiropractors who use manipulation as a common technique to treat mechanical and degenerative spinal disorders.

Podiatry

Podiatrists treat problems of the feet. They can also advise you on footwear that will provide extra support and comfort.

Acupuncture

Properly applied acupuncture has a role in the relief of pain, but it has not been established to be more effective than physiotherapy or anti-inflammatory medication.

Osteopathy

This treatment consists of a wide range of soft tissue stretching, massaging and relaxation techniques, as well as manipulative therapy for specific spinal joints and soft tissues.

Pain, stiffness and inflammation are hallmarks of arthritis. You may find exercise, physiotherapy, occupational therapy and rest can help, but medication may often be required under a doctor’s supervision.

There are many strategies and treatments to choose from if you live with arthritis and other musculoskeletal conditions, including:

Physiotherapy

Physiotherapists will use a broad range of treatments to treat your pain and stiffness, to increase muscle strength and maintain joint mobility. Physiotherapy treatments are often used in combination with an individual exercise program, massage, joint mobilisation and postural assessment.

Exercise

We all can benefit from regular exercise. If you are affected by arthritis, exercise is particularly important – even light exercise can help you maintain joint mobility and health.

Regular exercise helps by:

• decreasing the arthritis pain in your joints;
• preventing your joints from becoming stiff;
• maintaining and increasing the range of movement in your joints;
• strengthening muscles and bones – helping you to take the load off your joints and making them more stable;
• decreasing or relieving muscle tension – tension adds to the pain of arthritis and in the long-term can lead to poor posture and deformity; and
• improving your posture and balance – this will take weight off affected joints, and reduce your risk of falling.

Types of exercise

Not all forms of exercise are appropriate for every kind of arthritis. Before you start it is important to ask your doctor to help you develop a program that will suit your type of arthritis, physical health and lifestyle.

Generally you will need to do a mix of three types of activities:
• mobility exercises;
• strengthening exercises; and
• fitness (aerobic) exercises.

Chronic Pain

Pain is described as chronic when it lasts for more than three months, despite appropriate investigations and treatment. Chronic pain often has no concrete explanation and no tangible diagnosis. This does not mean that chronic pain is not real.

People living with pain find it has a major impact on the quality of their lives

Chronic pain is a pain that many people have to ‘learn to live with’. The question then is, how do you do that?

10 steps to healthy living with chronic pain

1. Accept the pain – understand that there may be no current cure and accept that you will need to deal with the reality of pain in your life. Accepting that the pain you have is chronic and has no ‘quick fix’ is the first step to living with your pain.
2. Get involved – take an active role in your own recovery. Follow your doctor’s advice and find out what you can do to move from a passive role into one of partnership in your own health care.
3. Communication – good communication with your health care providers is vital to getting the help you need to live well in spite of your pain.
4. Stop seeking more treatment – this may increase the risk of making things worse for you, keeping your focus on pain and raising unrealistic hopes. Each time a new treatment fails you may be left feeling a little more helpless. A better use of your time and energy may be finding things that you can do to improve the quality of your life.
5. Use as little medication as possible – pain killers may take the edge off the pain but they will not cure it.  Expecting medication to solve the problems of chronic pain is unrealistic. If medication is not helping then it is better not to continue taking it.
6. Learn ways to lead a normal life despite the pain – avoidance of activities you expect will worsen pain can result in a very restricted life. It is likely that you will have some limits, but letting pain determine what you do risks allowing pain to run your life. You may need to do things differently, like taking short breaks and taking longer to do things. Look beyond your pain to the things that are important in your life. Set priorities for the things that you would like to do.
7. Keep as fit as possible – if you lead as healthy a lifestyle as possible, your pain will be less of a problem. This means keeping active regularly, getting a good sleep, eating a balanced diet and finding a balance between work and leisure activities.
8. Deal with depression – feeling depressed makes living with pain that much harder. Seeking help from a psychiatrist or clinical psychologist may be useful. Medication is often not needed; talking things over and learning better ways of dealing with your pain is often more effective.
9. Learn to relax – pain increases in times of stress. Relaxation exercises are one way of reclaiming control of your body. Deep breathing, visualisation and other relaxation techniques can help you to better manage the pain you live with.
10. See the total picture – as you learn to set priorities, reach goals, deal with your feelings, relax and regain control of your body, you will see that pain does not need to be the centre of your life. You can choose to focus on your abilities, not your disabilities. You will grow stronger in your belief that you can live a normal life in spite of chronic pain.

Remember - your attitude and actions are the key to winning the battle with chronic pain.

Back pain

Back pain is not a disease itself – it is a symptom of injury to the back. And like most musculo-skeletal injuries, providing the back itself is structurally sound and healthy, in most cases, people with back pain recover well. But in a small percentage of people, it can become chronic and disabling.

Chronic back pain usually arises because there is an underlying condition such as arthritis or osteoporosis, or because the injury was severe – a fractured vertebra for instance.

Unfortunately chronic back pain is much harder to cure, because the injury is so severe or because the underlying condition is a degenerative one that cannot be reversed.

Seek expert advice when back pain:

• is severe, persistent (longer than a few weeks) or recurring (bouts come and go);
• is associated with a fall or an injury;
• doesn’t respond to simple treatments;
• interferes with your normal activities or work for a prolonged period of time;
• completely immobilises you;
• causes you to take pain killers continuously for more than a few days; or
• is associated with distinct symptoms such as weight loss, pins and needles, numbness in the legs or feet, fever, sweats or chills, or difficulty with controlling your bowel or bladder.

Self-care

Taking the following precautions to protect your back may be all that is required to avoid or prevent further attacks of back pain.

• Sit, walk and stand with a balanced, relaxed posture.
• Improve your footwear.
• Avoid sudden forceful movements.
• Bend and lift properly. Bend your knees. Take care not to twist when lifting. Avoid lifting heavy objects.
• Choose mattresses, chairs and cars with seats that give good physical support.
• Maintain a healthy body weight.
• Avoid lying on your stomach when you sleep.
• Exercise regularly – flexibility and strengthening exercises are especially important.
• Avoid staying in the same position, especially sitting, for too long. Stand, stretch and walk a little every half hour.

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