How to talk to your doctor about chronic pain

Published July 2024 | 6 min read
Expert contributor Associate Professor Marc A Russo, a specialist pain physician
Words by Michelle Herbison

Finding the right pain relief can be a challenge, especially if you struggle to explain your pain to a doctor or feel you’re not being taken seriously. 

If you’re living with chronic pain, understanding as much as you can about it is often the first step in effective chronic pain management.

One in five Aussies over age 45 lives with chronic pain, but everyone experiences it differently and many find it hard to describe, explains Associate Professor Marc A Russo, a specialist pain physician.

“For any individual we have to listen to what they have to say about what they’re experiencing, but often patients don’t have a vocabulary to explain pain. Often, they merely focus on, ‘it’s horrible’, ‘it hurts’ or ‘it’s unpleasant’.”

Understanding pain and finding effective chronic pain treatments are important priorities, both on an individual and societal level. With 68% of chronic pain sufferers being of working age, the national burden of pain is expected to reach $215.6 billion by 2050.

What is chronic pain?

When your brain and nervous system react to your body’s experiences, it can cause sensations of pain, a response that has evolved to keep our bodies safe from harm.

While acute pain is a normal and often healthy response to an injury or medical condition, chronic pain is defined as persistent pain lasting more than three months.

Most chronic pain is caused by injury, and according to NSW Health, the back, leg, shoulder, arm and neck are the body parts most commonly affected.

There are two types of chronic pain:

Tissue pain (nociceptive pain)

Tissue pain includes muscle spasms, joint inflammation, chronic arthritis and unhealed fractures. This is the most common cause of pain, and often the original cause of the pain is known.

Nerve pain (neuropathic pain)

Nerve pain includes persistent shingles pain (an infection that causes a painful rash) and burning in the feet due to diabetes, sciatica or spinal nerve damage. Despite being a less common type of pain, Assoc Prof Russo says it’s commonly seen in pain clinics as these patients have often been unable to get a diagnosis for their pain elsewhere.

Why is chronic pain treatment complicated?

Most acute pain goes away when you treat the cause. For example, a cut on your finger or a bruise on your knee will hurt until it heals.

The problem is, when the pain lasts longer than three months, acute treatments like resting are no longer helpful, says Assoc Prof Russo, and pain starts causing serious problems with your sleep, mood, relationships and ability to work.

Living with chronic pain makes you five times more likely to be significantly limited in your daily activities.

“When pain proves persistent, many of those habits, techniques and behaviours we associate with acute pain turn out to actually hinder you having the best quality of life that you can,” Assoc Prof Russo explains.

Is pain worse and more common for women than for men?

Various studies have found women are more likely than men to experience physical pain and it more commonly has a negative effect on their mood.

Nurofen’s 2024 Gender Pain Gap Index Report found one in two women felt they had their pain ignored or dismissed, and 32% of those women felt their GP didn’t take their pain seriously.

Assoc Prof Russo says this difference between men and women is likely due to a mix of biological and cultural factors.

“I generally find minorities across the board tend to have more dismissing of their lived experience of pain by society and the medical profession, regardless of whether they’re female, elderly, speak a foreign language or are transgender,” he adds.

What to do if you're in pain

If you’re experiencing chronic pain, your GP should be your first port of call, as they can refer you to a pain specialist clinic. Rather than “making a body part magically heal”, a pain clinic will focus on empowering you with coping skills via a team of multidisciplinary experts over a period of six months or so, Assoc Prof Russo explains.

This could include pain specialist medicine physicians, nurses, physiotherapists, psychologists, dietitians and occupational therapists offering chronic pain treatments including:

• pain relief medications (e.g. paracetamol, ibuprofen, opioids, local anaesthetics)
• physical therapy (e.g. massage, exercise, hydrotherapy)
• psychological therapy (e.g. cognitive behavioural therapy, relaxation, meditation)
• other interventions (e.g. surgeries, injections, neuromodulation).

Nearly 70% of all GP visits for pain result in a medicine prescription but Assoc Prof Russo warns against heavy reliance on either prescription or over-the-counter medication.

“There isn’t a single drug on the planet that comes without side effects or complications for certain individuals,” he says.

Aside from the well-documented issues with drug addiction, Assoc Prof Russo sees many patients suffering from "a misappropriation of the experience” [or a misunderstanding] of their pain, with and without drugs.

“They note that every time they stop taking them, their pain seems to return – so they assume the drugs are helping the pain – but what they don’t realise is part of the withdraw effect in a chronic pain patient is for the pain to get worse,” he explains.

This is especially true when it comes to opioid use. Opioids are a strong medicine which doctors commonly prescribe for short-term treatment of severe pain, such as after a surgery, or for patients undergoing cancer treatment.

When reducing this kind of pain relief, patients may experience different types of pain as part of the withdrawal symptoms, including joint, bone and muscle pain and headaches.

When reducing the amount of strong pain medication, it’s recommended to speak to your doctor about a tapering-off plan to reduce these symptoms. Any tapering-off plan will depend on how quickly you need to withdraw from pain medication use, as well as how long you’ve been taking the medication.

How to prepare for your doctor’s visit

Before your visit to speak with your doctor about your pain experience, get ready to answer questions about your pain and medical history, how pain is impacting your lifestyle and what you’re hoping to achieve, Assoc Prof Russo says.

Questions may include:

• what makes the pain better?
• what makes it worse/radiate/decrease?
• what have you tried before?
• what has worked and what has failed?
• what would be a meaningful shift forward for you?

Try to use accurate descriptive words like ‘burning’, ‘shooting’, ‘stabbing’, ‘aching’, ‘throbbing’ or ‘twisting’. You might find it helpful to document your experiences in a pain diary. This can be done either in a notebook or on your phone using a pain diary app.

Before prescribing treatment, your doctor should spend a lot of time explaining to you their understanding of the situation, Assoc Prof Russo says.

“It reduces stress and anxiety for a patient to have a deep understanding of what’s going on with them,” he explains. “The more somebody can accept the situation they’re in rather than rage against it, the less stress they have and the better they can engage in therapy.”

This Way Up^* provide evidence-based online programs developed by experienced psychiatrists and psychologists, including a Chronic Pain Program. You can ask your clinician to prescribe you the Chronic Pain Program for free, designed to teach you proven strategies for managing pain and lessen its impact on your overall wellbeing and quality of life.

What it’s like to have your chronic pain dismissed

Chasca experienced severe pain for many years, but it was always dismissed as ‘normal period pain’ and ‘just what women go through’.

“It would become so severe that I would have to walk out of school, get on the bus home in agony, get straight into a hot shower, take painkillers and just be in bed,” she recalls. “I knew that my friends weren't experiencing that, so I knew something wasn’t right. But I didn't necessarily talk to friends, teachers or my mum about it because I felt like there was a lot of shame around the menstrual cycle.”

Chasca says the only remedy she was offered by doctors was birth control, which “really didn’t agree with me”, and she felt the male doctors she was seeing couldn’t relate to her circumstances.

“It was intimidating to talk to them about it and it was really deflating being condescended and silenced and given a solution that wasn't even a solution. After two or three GPs, I stopped searching and just put up with the pain for 10 years.”

It wasn’t until her late 20s that Chasca had a “very big penny-drop moment” when a friend told her about endometriosis. She’d never heard of it before but looked into it and immediately recognised her symptoms.

But when she asked an older male doctor to get tested, he immediately shut her down.

“He was like, ‘Whoa, whoa, whoa, let's not jump to any conclusions’ and he wouldn’t send me for any tests.”

Deflated, she tried again with a female doctor, who agreed Chasca’s experience ticked the boxes for endometriosis, and referred her for a laparoscopy to confirm her suspicions.

For anyone in a similar situation, Chasca recommends not giving up hope. Keep looking for a GP aligned with your values, specialising in your area of pain if possible.

“Do not disqualify your feelings or your pain if you don't get the answers that you're looking for from a particular doctor,” she says.

You can read more stories of women living with chronic conditions and managing their wellbeing in our women’s health hub.

A GP at your fingertips

Need help with your pain? Speak to your GP as your first port of call. If you prefer a telehealth consultation, we have a partnership with GP2U, an online video GP service, that provides telehealth services. All HCF members with health cover can access a standard GP consultation (up to 10 minutes) for a fee of $50.