Spoon Theory: A useful metaphor for conceptualising the reality of chronic pain

Spoon Theory: A useful metaphor for conceptualising the reality of chronic pain

Spoon Theory was coined in 2010 by a college student living with lupus. Since then it has gained much attention from chronic pain sufferers and others living with illnesses or pain that is not immediately visible to others. On Facebook and Instagram, tags such as #Spoonie and #SpoonieLife are commonly used in relation to chronic pain experiences. So what is Spoon Theory? What is a Spoonie? And why are we talking about it?

Spoon Theory speaks directly to the amount of energy someone with an ‘invisible’ illness has and what the consequences are when energy is depleted. It allows those who do not experience chronic pain and empathetic insight into the realities of pain management and energy conservation. Spoon Theory draws on the metaphor that we all have a certain number of energy spoons to use each day. Perhaps you start with ten spoons and each activity costs a certain amount of spoons. For example, getting out of bed may cost one spoon, getting dressed another one, eating breakfast another one etc. Once the last spoon has been reached you can either rest or overdraw spoons of energy to allow you to meet plans or obligations made prior. When spoons have been overdrawn this can lead to side effects such as increased pain, exhaustion, mood swings, appetite/weight changes and sleep disturbance. The term Spoonie, then, is often used as a self-adopted descriptor that identifies a person who has to spend energy wisely in order to meet their obligations and achieve desired tasks and goals.

Living well with chronic pain requires a process of making sense of the pain and flexibly persisting in spite of the pain. Flexibly persisting means actively pursuing the things we value in life, whist understanding the necessity of managing energy levels (not using all your spoons at once), so as to avoid burnout and the Boom-Bust cycle. This may mean not pushing too hard on good days and on bad days being as active as reasonable without significantly increasing the pain. Without appropriate pacing people can fall into the Boom-Bust cycle, where the energy spent on the good days eat into the spoon bank and leaves them even worse off on the bad ones.

At Metro Pain Group, we work hard to help increase your ‘spoons’ and improve consistency of your energy levels so that you can pursue the things you love and “live better”. We do this through research, evidence-based interventions and personalised pain management plans from multidisciplinary perspectives.

How do you increase your “spoons”?  Metro Pain Group would like your help in compiling tips and advice to be shared within the chronic pain community. In 25 words or less, how do you manage your pain and live better? Send your tips to: livebetter@metropain.com.au




What is your “Live Better” tip?

What's your Liver Better tip?

Metro Pain Group are compiling a collection of helpful tips and advice to be shared within the chronic pain community. In 25 words or less, how do you manage your pain and live better? Send your tips to: livebetter@metropain.com.au

The tips you share will remain anonymous and can make an impact to those living in chronic pain.




Shoulder pain: What happens when it persists?

Shoulder pain is the third most common musculoskeletal complaint, with studies indicating that the prevalence of shoulder pain in the general population may be up to 67%.1  Shoulder pain has been reported to persist beyond a year in up to 40% of patients, following an acute attack.2 As chronic pain is defined as such when it persists beyond three months, the rates of people experiencing chronic shoulder pain are high. The prevalence of chronic shoulder pain makes this not only a problem for the individual, but for society more generally, due to the burdens of revenue loss and increased reliance on healthcare.

Chronic shoulder pain can originate due to injury or a number of other factors, however, the nature of the pain changes once it has persisted beyond the expected period of healing. Where there is not a precipitating injury or underlying disease process, it is thought that postural and and psychological stressors are a likely cause. Degenerative disc disease and the phenomenon of central sensitisation may also be contributing or causal factors. Furthermore, shoulder pain could be nociplastic in nature, meaning its biological cause is due to rewiring in the pain system itself and not caused by a precipitating event.

In treating chronic shoulder pain, the aim of treatment is to reduce the pain, increasing function and improve quality of life. The most common treatments for chronic neck pain are rehabilitation programs, physical therapy, epidural steroid injections and suprascapular nerve blocks. Anti-inflammatory medications may also play a role in managing chronic shoulder pain depending on its underlying mechanisms. However, in discussing treatment options we must remember that a one-size-fits-all approach does not work for chronic pain as each individual’s biopsychosocial factors mediate the effectiveness and appropriateness of treatments.

For this reason, developing an individualised, multi-faceted management plan in conjunction with a pain physician can maximise treatment outcomes and help you Live Better.  If you would like your current pain management plan reviewed, or for more information, please fill out the form below:

References:

1 Luime, J. J., Koes, B. W., Hendriksen, I. J. M., Burdorf, A., Verhagen, A. P., Miedema, H. S., & Verhaar, J. A. N. (2004). Prevalence and incidence of shoulder pain in the general population; a systematic review. Scandinavian journal of rheumatology33(2), 73-81.

2 Kuppens, K., Hans, G., Roussel, N., Struyf, F., Fransen, E., Cras, P. & Nijs, J. (2018). Sensory processing and central pain modulation in patients with chronic shoulder pain: A case‐control study. Scandinavian journal of medicine & science in sports28(3), 1183-1192.

Request for Pain Management Review

  • DISCLAIMER

    At Metro Pain Group, we assess each patient’s condition individually. As leaders in pain intervention, we aim to provide advanced, innovative and evidence-based treatments tailored to suit the patient. The suitability of our procedures varies from patient to patient. If you would like to find out if this or other treatments are suitable for your specific condition, please speak to one of our doctors at the time of your consultation.

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New definition of pain

New pain definition validates left of centre experiences of chronic pain

Pain is way more complex than originally thought. It does not always follow a linear path where cause leads to effect. The pain experience does not necessarily result from an injury. The world of chronic pain research has recently defined a new classification of pain, which proves highly affirming and helpful for chronic pain sufferers.

Many chronic pain patients will be familiar with the stigma of living with chronic pain. Chronic pain often leads to stigma due to its perceived “deviance from expected behaviour, both in medical setting, where symptoms should be independently verifiable and curable, and in broader social settings, where adults are expected to be autonomous and productive until old age” (Williams 2016). Discrimination in both medical and social settings are widely reported, leading to significantly impacted wellbeing (De Ruddere and Kenneth 2016).

It may come as a relief to many, that conceptions of pain are broadening and medical science is beginning to find biological explanations for many unexplained chronic pain conditions. The recent introduction of a new categorisation of pain called nociplastic pain has been instrumental in giving medical practitioners a better understanding of their patients’ pain experiences.

In the past, pain was defined as either nociceptive or neuropathic. These terms sound complex but basically mean pain caused as a normal bodily reaction in the somatosensory system to harmful stimulus (nociceptive pain) or pain caused by disease or lesion (neuropathic pain). The common feature of these types of pain is that they have a measurable cause and effect and distinguishable biological origins. But what if pain arises and continues with no measurable cause or precipitating event?

Nociplastic pain is a category of pain introduced by the IASP in 2017. In this category, pain “arises from altered nociception, despite no clear evidence of actual or threatened tissue damage…or evidence for disease or lesion” (IASP taxonomy 2017). Nociception is the process through which the body takes harmful stimuli and encodes it into ‘pain signals’, thus nociplastic pain is an alteration in this process so that pain signals are activated outside of the normal cause and effect. Kosek et al., argue that this “altered nociceptive function (can) constitute a condition in itself” (2016: 1384).

This introduction of nociplastic pain is highly validating as it gives a biological explanation for unexplained chronic pain conditions. This challenges stigmas related to many nociplastic conditions such as fibromyalgia and Complex Regional Pain Syndrome type 1 (Kosek et al., 2016: 1382). In particular, this new categorisation gives both practitioners and patients a better model of thinking about and treating chronic pain when nociceptive and neuropathic origins cannot be found.

At Metro Pain Group, we understand that discrimination only leads to worse outcomes and that the only route to helping our patients live better begins with believing them.

If you would like your current pain management plan reviewed, or for more information, please fill out the form below:

 

References:

De Ruddere, L. & Craig, K. D. (2016). Understanding stigma and chronic pain. PAIN, 157(8), 1607–1610. doi: 10.1097/j.pain.0000000000000512.
Williams, A. C. (2016). Defeating the stigma of chronic pain. PAIN, 157(8), 1581–1582. doi: 10.1097/j.pain.0000000000000530.
Kosek, E., Cohen, M., Baron, R., Gebhart, G. F., Mico, J., Rice, A. S., Rief, W. & Sluka, A. K. (2016). Do we need a third mechanistic descriptor for chronic pain states?. PAIN, 157(7), 1382–1386. doi: 10.1097/j.pain.0000000000000507.

Request for Pain Management Review

  • DISCLAIMER

    At Metro Pain Group, we assess each patient’s condition individually. As leaders in pain intervention, we aim to provide advanced, innovative and evidence-based treatments tailored to suit the patient. The suitability of our procedures varies from patient to patient. If you would like to find out if this or other treatments are suitable for your specific condition, please speak to one of our doctors at the time of your consultation.

  • This field is for validation purposes and should be left unchanged.




Beyond opioids: moving towards evidence-based interventions for chronic pain

During the late 1990’s the idea that pain was being undertreated gained traction, leading to the coining of pain as the 5th vital sign. [1] Alongside this new understanding, pain was given status as a human rights issue. This meant that the denial of pain medication became the denial of a person’s human rights. At the time, opioids had been prescribed for acute pain and cancer pain. However, one publication in a major medical journal stating opioids as safe for chronic pain patients (based on unverified research) changed prescriber attitudes.[2] Subsequently opioids were being prescribed to anyone in ‘pain’. To further lay the groundwork for an opioid crisis, governing agencies began to use patients’ pain control as a measure of the hospital’s success.2 The funding and government reimbursement of hospitals depended on their success and thus the pressure to prescribe opioids for pain was significant.

It is now 2019 and we have a definitive evidence-base proving that long-term opioid therapy has little to no benefits for chronic pain patients, instead being fraught with risks of misuse, dependency and overdose. While opioids can play a useful role in acute pain, cancer pain and in a palliative care setting, the evidence suggests that long-term opioid use decreases quality of life and provides unsustainable pain relief as the body becomes tolerant to the substance. Regardless of the undeniable harms of addiction, opioid use is an “independent risk factor for depression, and in some patients can paradoxically worsen pain”. [3] This worsening of pain is called opioid induced hyperalgesia. It is now understood that classical opioids (e.g. codeine, morphine, oxycodone, fentanyl) activate a neuro-immune response which amplifies the transmission of pain signals in the spinal cord and brain. These medicines can provide short-term relief whilst slowly making overall pain experience worse over time.

Furthermore, pain is now understood as a biopsychosocial experience, meaning it comprises of biological, psychological and social factors. To suggest a one-size-fits-all approach to managing pain is to neglect vital contributing factors to that person’s pain. Yet, chronic pain is still one of the most cited reasons for opioid prescriptions, reflecting a time-poor and overburdened medical system where pressures for quick fixes are strong. Alarmingly, the opioid crisis is growing in Australia, as the rates of opioid related deaths have almost doubled between 2007 and 2016 (from 3.3 to 6.6 per 100,000), with more than three-quarters of these deaths involving prescription drugs. [4]

Given the current opioid epidemic, it is critical that the medical field utilises opioid-sparing therapies that are effective and evidence-based for the long-term relief of chronic pain. At this time, many innovative and effective therapies are available at Metro Pain in alignment with each patients’ pain management plan. Our treating teams are multidisciplinary and can address and relieve pain from biological, psychological and social aspects to help our patients live better. Treatment options such as nerve blocks and neuromodulation (a therapy in which electrical currents interrupt pain signals) have been revolutionary in how we view and treat chronic pain globally.

While there are many novel and innovative treatments that are proven and more effective than opioids for long-term chronic pain relief, the epidemic is likely to continue for now. Unfortunately, until these treatments become affordable and accessible on a larger scale we will continue to see overburdened medical systems opting for quick-fix solutions to the long-term detriment of society and people suffering chronic pain.

These reasons amongst others, drive our passions at Metro Pain Group to find better ways than prescribing pills to help our patients suffer less, function more and live better.

If you would like your current pain management plan reviewed, or for more information, please fill out the form below:

 

References:

[1] Morone, N. E. and Weiner, D.K. 2013. Pain as the 5th vital sign: exposing the vital need for pain education. Clinical Therapeutics, 35(11), pp. 1728-1732.
[2] Rummans, T.A., Burton, C.M and Dawson, N. 2018. How good intentions contributed to bad outcomes: The opioid crisis. Mayo Clinic Proceedings, 93 (3), pp. 344-350.
[3] Juurlink, D.N. 2017. Rethinking “doing well” on chronic opioid therapy. Canadian Medical Association Journal, 189 (39), pp. E1222-3
[4] Roxburgh, A., Dobbins, T., Degenhardt, L and Peacock, A. 2018. Opioid-, amphetamine-, and cocaine-induced deaths in Australia: August 2018. Sydney: National Drug and Alcohol Research Centre.

 

Pain Management Inquiry

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    At Metro Pain Group, we assess each patient’s condition individually. As leaders in pain intervention, we aim to provide advanced, innovative and evidence-based treatments tailored to suit the patient. The suitability of our procedures varies from patient to patient. If you would like to find out if this or other treatments are suitable for your specific condition, please speak to one of our doctors at the time of your consultation.

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Pelvic Pain: You Don’t Have to Suffer in Silence

Chronic pelvic pain is pain felt below the navel which has been ongoing or intermittent for over six months. Pain can range from a dull ache to a sharp stabbing pain in this region. Individuals suffering from pelvic pain often experience other debilitating factors to their quality of life on top of their physical pain. They may experience signs of depression, anxiety, insomnia, as well as difficulty with work and relationship issues. 1

Some estimate pelvic pain to affect a staggering 1 in 5 women and 1 in 12 men during their lifetime. 2

Unfortunately many individuals suffer in silence, as pelvic pain is a multisystem disorder that often comprises of sexual, bowel and urinary, gynaecological and musculoskeletal symptoms 3. As a result of this complex nature, it can be difficult to diagnose.4 Unlike the visible pain of a broken leg, pain in the pelvic region is not easily seen, leaving sufferers feeling that the pain is simply all in their head or too embarrassed to speak up. 5

It’s important to recognise that pelvic pain is a very real condition with very real pain that can be treated.
At Metro Pain Group we assess each patient’s condition individually with advanced, innovative and evidence-based treatments tailored to suit the patient. Depending on your personal circumstances we can provide many treatment options to help manage pelvic pain including prolotherapy, hip joint injections, rehabilitation and more.
Our goal is to reduce your pain and improve your quality of life, enabling you to Live Better.

If you are looking for options to relieve your pain and would like more information please call 03 9595 6195 or please fill out the form below.

References:
1 Riegel, B., Bruenahl, C.A., Ahyai, S., Bingel, U., Fisch, M. and Löwe, B., 2014. Assessing psychological factors, social aspects and psychiatric co-morbidity associated with Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) in men—a systematic review. Journal of psychosomatic research, 77(5), pp.333-350.
2 Pelvic Pain Foundation. (2018). Pelvic Pain Foundation – Homepage. [online] Available at: https://www.pelvicpain.org.au/ [Accessed 11 Jan. 2019].
3 Baranowski, A.P., Lee, J., Price, C. and Hughes, J., 2014. Pelvic pain: a pathway for care developed for both men and women by the British Pain Society. British journal of anaesthesia, 112(3), pp.452-459.
4 Ahangari, A., 2014. Prevalence of chronic pelvic pain among women: an updated review. Pain physician, 17(2), pp.E141-E147.
5 Perry, C.P., 2001. Current concepts of pelvic congestion and chronic pelvic pain. JSLS: Journal of the Society of Laparoendoscopic Surgeons, 5(2), p.105.

 

Pelvic Pain Inquiry

  • DISCLAIMER

    At Metro Pain Group, we assess each patient’s condition individually. As leaders in pain intervention, we aim to provide advanced, innovative and evidence-based treatments tailored to suit the patient. The suitability of our procedures varies from patient to patient. If you would like to find out if this or other treatments are suitable for your specific condition, please speak to one of our doctors at the time of your consultation.

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Best Practices for Dorsal Root Ganglion Stimulation

drg stimulation

Dr Paul Verrills, in collaboration with other world leaders in neuromodulation, has recently published, The Neuromodulation Appropriateness Consensus Committee on Best Practices for Dorsal Root Ganglion Stimulation (DRG). The Neuromodulation Appropriateness Consensus Committee (NACC), which Dr Paul Verrills is a member of, reconvened to develop this article to provide other doctors worldwide with guidance for the best practice and use of DRG stimulation in the treatment of chronic pain syndromes.  Clinicians who choose to follow these recommendations may improve safety and treatment outcomes for patients living with chronic pain, where such treatments could prove beneficial.

Click here to view the abstract of the article.

 




World Arthritis Day

World Arthritis Day

Arthritis is a common chronic disease affecting people of all ages. In Australia alone, approximately 15% of the population have some form of arthritis, with osteoarthritis being the most common.

12 October marks World Arthritis Day. Help us raise awareness. If you are one of many who are affected by osteoarthritis, know that there may be options available.

For more information, please fill out the form below.

 

 


Osteoarthritis inquiry

  • DISCLAIMER

    At Metro Pain Group, we assess each patient’s condition individually. As leaders in pain intervention, we aim to provide advanced, innovative and evidence-based treatments tailored to suit the patient. The suitability of our procedures varies from patient to patient. If you would like to find out if this or other treatments are suitable for your specific condition, please speak to one of our doctors at the time of your consultation.

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Treatment for ongoing knee pain

treatment for ongoing knee pain

Do you experience knee pain that is worse in the morning, but improves as the day progresses?

 

Do you feel burning sensations, buzzing and numbness in your knees?

 

Do you experience severe pain that often wakes you up at night?

 

The knee is a complex joint. Ongoing knee pain from osteoarthritis can come from multiple sources. In 30% of cases, the pain does not actually come from the joint itself.1 The knee is surrounded by connective tissues, ligaments and bone which are all rich in nerves, and the likely source of pain. In some cases even nerves that well away from the knee area can also be common sources of pain.

At Metro Pain Group, we have a range of options available. With our unique approach, we offer treatment strategies for the long term reduction and management of pain.  Depending on the patient’s specific condition, we offer:

  • General advice
  • Medication management
  • Psychology and rehab
  • Delivery of injectables including steroids, hyaluron, PRP and stem cells
  • Recommendation of orthopaedic devices
  • Diagnostic procedures
  • Interventional treatments

 

If you are looking for options to relieve your pain and would like more information, please fill out the form below.

 

References:

1 Dieppe, P.A. and Lohmander, L.S., 2005. Pathogenesis and management of pain in osteoarthritis. The Lancet365(9463), pp.965-973.

 


Ongoing knee pain inquiry

  • DISCLAIMER

    At Metro Pain Group, we assess each patient’s condition individually. As leaders in pain intervention, we aim to provide advanced, innovative and evidence-based treatments tailored to suit the patient. The suitability of our procedures varies from patient to patient. If you would like to find out if this or other treatments are suitable for your specific condition, please speak to one of our doctors at the time of your consultation.

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September is Pain Awareness Month

Pain Awareness Month

Pain Awareness Month is a time when various organisations work together to raise public awareness of issues in the area of pain and pain management. The initiative was introduced by the American Chronic Pain Association under the Partners for Understanding Pain banner in 2001.

This year, the International Alliance of Patient Organizations and International Pain Management Network joins the initiative to bring pain to the forefront of the international community. Raise awareness by getting involved. Talk to your family, friends and healthcare team and help create greater understanding of pain.