One in four people or 25% of Irish households has a chronic pain sufferer in the home,” says Dr Paul Murphy, consultant pain specialist at St Vincent’s Hospital, Dublin, “so that’s a significant number of people.”

So, how is chronic pain defined?

“Chronic pain is pain that is present for more than three months,” he says.

“On average, it lasts for about seven years, so it’s a very long-lasting illness, but a European Federation EPIC study showed that the number of people with pain for in excess of 20 years is about 22-23%.

“Some people would have it treated and it would resolve over time, but a quarter of those who’ve had an episode of chronic pain will have it for all of their life.”

Major causes

So, what are the major causes of chronic pain in Ireland?

“Back pain is the biggest one,” Dr Murphy says. “It can be due to mechanical issues or to nerve damage. Chronic back pain is the most common. It can be a combination of two types of pain. The first one is nociceptive pain, which is a mechanical type pain which results from injury or damage to body tissues and is often described as a sharp or stabbing-type of pain or as an ache.

“The second is neuropathic pain, which is caused by damage to or dysfunction of nerves. It is often described as a burning, stabbing, stinging, numbing or tingling type of pain. Back pain can be a combination of both. Diabetes is the second biggest cause of chronic pain. 48% of people with diabetes will present with nerve pain and speak of burning, stabbing or electric shock-type pain around their feet. They may say they have to hang their feet outside bed because they are burning so much.

“Strokes, MS and spinal cord injuries would be the third, but the other big cause of chronic pain that we’re seeing is shingles.”

Shingles - see GP within 72 hours

By itself, shingles isn’t too bad – but you can end up with post-traumatic neuralgia, he says.

“This is chronic, permanent burning nerve pain and it’s one of the most difficult to treat.

“One of the messages we’re trying to get out to anyone who has shingles is to see their GP very quickly. There is a small window to prevent this becoming chronic.

“Patients need to start viral treatment and medication to treat the pain within 72 hours of the rash starting. If you don’t treat it early, the chances of it becoming permanent pretty much depend on your age. If you get it in your 20s, there would be a 4% to 5% risk. In your 70s, that risk would rise to 95%.”

Chronic pain - a disease in its own right

Chronic pain almost becomes a disease in its own right, he says.

“There are a whole range of these conditions that will all cause chronic pain, but something causes the nervous system to become damaged or deranged. It then becomes a chronic disease in its own right. The Medical Council of Ireland has also now acknowledged that pain management is a whole new medical specialty,” he says.

Not 'all in my head'

Doctors often see people with pain having investigations like MRIs, CAT scans and x-rays but very often the images won’t show any abnormality whatsoever, he says.

“This can be very frustrating for those people who want to know what’s going on. They often ask if it’s all in their head – but it’s not. People often have awful symptoms but totally normal scans. The converse is true too – that people have dreadful scans and have no pain. We are trying to increase awareness that chronic pain is a disease in its own right and that there are treatments available. If things aren’t resolving, it is appropriate to seek early referral on to specialist services.”

Treatments available

There are a lot of interventional approaches that can be used to try and reset the nervous system, he says.

“Advanced therapies like spinal stimulation, for example. We also link with rehabilitation services – physiotherapy, occupational therapy and clinical psychology because chronic pain can have a very serious psychological impact on the individual – it’s the fact that you can’t escape from it.

“This can have an impact on emotion and mood, so we always engage the services of a clinical psychologist to help with that. Cognitive Behavioural Therapy (CBT) is a big part of the service that’s provided, along with medication.”

Describing your pain helps doctors

Many people find it difficult to describe their symptoms, he adds.

“This can have a negative impact on their care. The mypainfeelslike…questionnaire, available on www.mypainfeelslike.ie, will help patients describe their pain when talking to their doctors, which will ultimately improve their quality of care.”

The series of images used to describe pain was developed by artist David Schwen.

For more general information and support related to chronic pain, see www.chronicpain.ie

Ivan Yates’ story

“I’m faced with the situation of having to manage back pain all the time,” he says.

“Although I had fusion surgery in 2011, I am still experiencing pain every day. It’s a case of avoiding situations where I am seated in a conventional upright chair. I either stand or kneel while radio broadcasting or working because sitting is a big aggravator of pain for me.

“On TV I have to sit, but as soon as we go to an ad break I stand up. I have to lie in the back of a car, for example, and simple things like going to the cinema or the theatre are difficult for me and often I have to leave events early.”

Ivan takes medication every day – anti-inflammatories and analgesics (painkillers) – but there is only so many you can take in a 24-hour period, he says. He explains why he got involved in the mypainfeelslike… campaign.

“I was remiss back in 2003 in the sense that I simply ignored back pain for a long time, then I woke up one day and could not move. I ended up on crutches for several weeks and I had done permanent damage. My message is to go to your doctor as soon as possible because pain is your body’s way of communicating with you that there is something wrong. It shouldn’t be a case of grin and bear it, it should be a case of early diagnosis. Permanent damage was done to my left leg by my ignoring the problem. I’ve no feeling in my toes now as I let it go too far.

“The second reason is that I know that articulating your pain can be difficult. One in four people is suffering from chronic pain, but it can be hard to describe. Is it a stinging pain, a stabbing pain, a burning pain, an electric shock pain and so on?

“If you can describe it well, clinicians can find it easier to diagnose. The idea of having sketches to refer to, to help you identify the type of pain, is a good one. More awareness about how people can manage their pain better is important, too.”

Not all pain is fixable

“Back pain is very prevalent and you have to remember that not all pain is fixable. If you suffer from rheumatism, arthritis, MS or Parkinson’s disease, and there is no cure, it is simply a case of managing the pain. One of the affiliate organisations involved in this campaign is Chronic Pain Ireland. It has 2,500 members who can tell horrible stories about how their quality of life is being impaired by the nature and persistent atrocious levels of pain.”

Ivan tries to think positive about his pain.

“I say, look, there are so many conditions you could have – a heart condition, a terminal illness. Everyone is going to draw some bad cards in life and I think, therefore, it could be worse and I try to be positive about it. If there is greater awareness of chronic pain, it can actually make you more positive in your approach to it. You have to learn to live with your pain and adjust your lifestyle accordingly.”

As a former farmer who lifted sheep and fertiliser bags in his youth, he has no doubt that farming is an occupation that puts strain on the lower back.

“The message is: Don’t take your back for granted. Mind it.”

See www.mypainfeelslike.ie for more information

The campaign

The mypainfeelslike… campaign is a collaboration between Grunenthal Pharma Ltd and Chronic Pain Ireland and is supported by Multiple Sclerosis Ireland and The Parkinson’s Association of Ireland. See www.mypainfeelslike.ie