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Lower back injury? Joint pain management? Lumbar pain? Look no further. At MSK Pain we have a dedicated multidisciplinary team, led by Dr. Neels Du Toit. We understand that chronic pain treatment can be overwhelming, impacting various aspects of your life, including relationships, emotional well-being, and even sleep. But don’t lose hope – we believe in you and are committed to investigating the precise source of your pain and discussing available treatment options.

Managing the Full Impact of Chronic Pain

An important component of this management includes attending to the consequences of chronic pain, which in many people include anxiety, fear avoidance, relationship distress, and depression. Our goal is to manage the full impact of chronic pain sufficiently to allow you to return to a quality of life where you can pursue the things that bring you the most pleasure. Our team is dedicated and passionate about helping people recover from the full impact of pain conditions.

Chronic pain, defined as pain present every day for 3 months, is a totally different problem from acute pain. Acute pain is an evolutionary process that ensures we rest a part of our body when injured, allowing it to heal. However, chronic pain is a pathological process and has become designated as a disease by the World Health Organisation. Neurological pathways are set up that are maladaptive and serve no purpose or, worse, intensify our pain rather than aiding the healing process.

Chronic pain can be exhausting. The persistent concentration required to block pain can interfere with thinking, concentration, and memory. Night pain interfering with sleep exacerbates the problem further. When pain levels increase above 6/10 on the Visual Analogue Scale (VAS), chronic pain becomes extremely difficult to block and interferes with daily activities, hobbies, and employment.

It is not surprising that anxiety sets in when ourpain fails to settle as anticipated. We worry about when or if the pain will ever subside, and fear it may increase in intensity. Consequently, we may avoid movements that initiated the pain in the first place. This fear avoidance may contribute to musculoskeletal pain, as the muscles around the affected area start to waste or atrophy, providing less support to the affected site. To address this, we involve a highly skilled physiotherapist in chronic pain management, even recommending analgesia before sessions to encourage movement and rehabilitation.

The Complex Connection between Anxiety and Chronic Pain

Anxiety is a common complication of chronic pain, and since anxiety and chronic pain travel in similar neurological pathways to the brain, an increase in one can precipitate an increase in the other. The effect may even multiply rather than simply add to the problem.

Addressing Anxiety through Psychology

If your doctor or treating practitioner has recommended you visit a psychologist, they are not implying that the pain is purely in your head. Anxiety is a consequence of chronic pain, not the cause, and helping to reduce anxiety can also help decrease pain levels and make the overall treatment program more successful.

Holding On to Hope

If your pain syndrome has persisted for months or years with minimal improvement, you may eventually give up hope and believe that your neuropathic pain treatment is a lifelong sentence. Depression is common at this stage. Family and romantic relationships may be placed under considerable strain. 

If your pain conditions occurred at work, feelings of disappointment or outright anger that your employer has abandoned you may linger. Car accidents are another precipitator of chronic pain syndromes, and residual, understandable anger can persist for years if not recognised.

We Believe You – Never Give Up Hope
We do believe you. Please never give up hope. Our team is here to support you on your journey towards managing chronic pain and regaining your quality of life. Together, we will work towards a brighter and pain-free future. Contact us as your trusted pain specialists in Melbourne.

Is the popular saying “no pain, no gain” really true? Many wonder if experiencing pain during exercise is necessary to reap its benefits. This may include chronic pain, lumbar pain or musculoskeletal pain to name a few. The truth is, the level of discomfort during exercise varies depending on several factors.

Exercise often involves pushing your body beyond its comfort zone, leading to sensations of discomfort. This discomfort, referred to as muscle soreness or fatigue, is a natural response to physical exertion. It usually occurs during or after exercise and subsides within a few hours or days.

Understanding Discomfort During Exercise

Discomfort during exercise can stem from various factors like muscle fatigue, lactic acid build-up, and increased heart rate. These sensations are considered normal and even essential for progress in fitness endeavours. When you challenge your body’s limits, it adapts by becoming stronger, more flexible, and efficient.

Discomfort might manifest as burning sensations in muscles, shortness of breath, increased heart rate, or mental fatigue. However, it’s crucial to distinguish discomfort from pain. While some discomfort is expected during challenging workouts, it shouldn’t be debilitating or hinder your ability to perform exercises correctly.

Differentiating Discomfort from Pain

Pain during exercise should never be ignored or brushed off as a natural consequence of physical activity. It could be a sign of an underlying injury, improper form, or overexertion.

Managing Chronic Pain and Exercising

The Impact of Chronic Pain on Exercise

If you experience chronic pain, you’re not alone. Many individuals live with chronic pain and may fear that engaging in exercise will worsen their pain conditions. Finding a form of exercise that is entirely pain-free may not always be realistic. 

In fact, avoiding physical activity due to fear of increased pain can lead to a vicious cycle where muscles weaken, joints stiffen, and overall fitness decreases. Over time, this physical deconditioning can result in more pain.

Adopting a Systematic Approach

Approaching exercise in a systematic way, starting with low loads, durations, and repetitions, can help manage chronic pain during physical activity. It’s important to understand that chronic pain persists beyond the usual time of tissue healing, making it an unreliable indicator of the body’s condition. Factors like stress, past experiences, poor sleep, social losses, and mood can contribute to the perception of pain, going beyond tissue damage.

Even in cases of underlying structural, mechanical, or inflammatory problems, exercise can be beneficial when carefully progressed and started at low levels. Mild to moderate pain can often be accepted, as long as it settles within a reasonable time frame.

A Good Saying to Remember: “Hurt Doesn’t Equal Harm”

While you might not be causing actual damage, it’s essential to minimise pain flare-ups. Exercising parts of your body not affected by pain and pacing your exercise regimen carefully can help. Seeking advice from an exercise expert, such as a physiotherapist or exercise physiologist with pain management training, can guide you on your exercise journey.

Knowing When to Listen to Your Body

While moderate pain during exercise may be acceptable, pushing too hard and aggravating the pain is not advisable. Swelling, heat, and redness accompanying pain could indicate excessive exercise intensity. Pain can serve as a warning to avoid injury. Like how we instinctively withdraw our hand from a flame, exercise-induced pain can help us prevent muscle tears and disc bulges.

If discomfort during exercise intensifies, don’t ignore it. Stop and switch to a different activity. In group exercise classes, don’t feel pressured to do what everyone else is doing. Listen to your body and choose what’s right for you.

Safest Forms of Exercise

The Importance of Enjoyable Exercise

The safest exercise forms are the ones you enjoy and want to continue. If someone hates swimming, telling them it’s the best exercise won’t motivate them. Finding enjoyable ways to exercise, such as with a friend, listening to an audiobook while walking, or committing to set class times, can boost motivation.

Considerations for High-Impact Activities

Certain exercises may be harder on the body than others, but they can also bring benefits. Studies show that running doesn’t cause osteoarthritis in the lower limb joints as once believed; instead, it can improve bone density and joint health.

High-impact activities should be approached with caution. Prepare with strengthening and lower-impact exercises before progressing. Use proper technique, equipment, and build up gradually while considering existing joint or muscle issues.

Low-Impact Exercises for Chronic Pain

For those with chronic pain, consult a healthcare professional or physiotherapist for tailored exercise recommendations. Some low-impact exercises that may help include walking, swimming, yoga, strength training, pilates, cycling, and tai chi.

1. Walking: A gentle cardiovascular exercise that can be easily adjusted to your comfort level.
2. Swimming, hydrotherapy or water aerobics: The buoyancy of water reduces stress on your joints while providing resistance for muscle strengthening.
3. Yoga: Certain yoga poses and stretches can help improve flexibility, strengthen muscles, and promote relaxation.
4. Strength training: Strengthening exercises, such as light weightlifting or using resistance bands can build muscle strength and control and help support joints.
5. Pilates: Using specialised equipment or not, the focus is on core control, postural alignment and breath control to enhance strength, flexibility and overall body awareness.
6. Cycling: Whether indoors on a stationary bike or outdoors, cycling can be a low-impact exercise that is gentle on the joints.
7. Tai Chi: This mind-body practice combines gentle flowing movements, deep breathing, and meditation, which may help improve balance, flexibility, and reduce pain.

Embracing an Active Lifestyle

Start Small, Progress Gradually

Low-intensity exercise is an excellent starting point and may remain the best option for some. Others may progress to more intensive exercises. Regardless of the exercise chosen, even a 5-minute walk is a great start. Embrace an active lifestyle and discover its benefits.

Seeking Support for Chronic Pain

If chronic pain hinders your efforts, reach out for advice, support, and minimally invasive techniques. Our team will work with you to get you moving again.

Conclusion: Exercising Wisely for a Healthier You
In conclusion, “no pain no gain” isn’t always the right approach to exercise. Discomfort is normal, but debilitating pain should be addressed. As pain specialists in Melbourne, we recommend  a tailored and systematic approach to exercise which can help individuals with chronic pain engage in physical activity safely and reap the many benefits of an active lifestyle.

Living with Pain? Learn How to Manage Daily Activities to Minimise Discomfort

Dealing with chronic pain can be tough. However, some of our day to day activities may be exacerbating the problem. Meet Jim, who’s been nursing a small tendon tear in his shoulder for four months. He’s concerned that any activity causing pain could lead to further damage, so he’s stopped moving his arm altogether. This sedentary lifestyle has led to muscle weakness, making it harder to carry out basic tasks.

Sasha, on the other hand, has been living with low back pain for ten years. Although she takes pride in her housekeeping and gardening, the pain gets worse as the day progresses. This lower back injury and disc pain leaves her feeling upset and frustrated. 

Then there’s Eric, who’s now retired and determined to continue playing golf, despite being diagnosed with moderate osteoarthritis in his knee. He can barely walk after a game and spends the next day recuperating on the couch. Recently, he’s been forced to cut down on his golf games for joint pain management, as it takes him two days to recover after each round.

If you’re facing similar challenges, there are ways to manage your musculoskeletal pain and live a more fulfilling life. Learn how to optimise your daily routine to minimise pain conditions and get back to doing the things you love.  

Unfortunately, many people fall into one of three counterproductive patterns, as demonstrated by Jim, Sasha, and Eric.

• Underactivity: Avoiding activities altogether, often out of fear of triggering pain. This sedentary lifestyle leads to muscle weakness and other health issues.
• Overactivity: Excessively pushing through the pain, either in the moment or later. This approach often leads to further damage and a worsening of symptoms.
• Overactivity/Underactivity: The boom-bust cycle, which involves periods of intense activity, leading to flare-ups of pain, followed by prolonged periods of rest to “recover.” This approach disrupts your ability to engage in meaningful activities and can lead to feelings of frustration and depression.

By identifying and avoiding these common pitfalls, you can manage your lumbar pain and musculoskeletal pain more effectively and get back to doing the things you love.

Living with chronic pain conditions can be challenging, but avoiding activity altogether or overdoing it can make the situation worse. Both underactivity and overactivity can perpetuate pain, leading to psychological distress and a loss of control over one’s life.

The boom-bust cycle, characterised by periods of intense activity followed by prolonged periods of rest, is also counterproductive, leading to progressively less activity over time.

Activity pacing, or “pacing up,” is a method of gradually building functional levels and regaining control over your life. By systematically managing your activities, you can reduce disc pain, pain conditions and improve your quality of life. A healthcare professional trained in pain management can guide you through this process and help you problem-solve along the way.

It’s also important to manage the expectations of others and recognise the pressure we put on ourselves. The focus should be on achieving goals, building strength and endurance, and improving functionality, rather than eliminating musculoskeletal pain altogether. With the support of family and friends and a structured plan, you can regain control over your pain and get back to the things you love.

Learn how to effectively manage your lower back injury or lumbar pain through activity pacing with this simple guide:

• Choose an activity that you want to do, like walking, cycling, or gardening. This method can also be used for more sedentary tasks like sitting at a desk.
• Establish your baseline by measuring the maximum amount of time you can perform the activity over three to five days before your pain level increases. Take the average of these times. For example, if you walked for 8, 12, and 10 minutes over three days, your average maximum would be 10 minutes.
• Begin at 80% of your maximum level to ensure that it is achievable. If you’re starting with walking and your maximum is 10 minutes, begin with 8 minutes. You can do the activity once a day, or twice a day if you recover quickly.
• Maintain this level on most days of the next week, even if you experience more pain than usual. The goal is to keep your activity level consistent and to slowly build tolerance over time to prevent flare-ups.
• Increase your activity level by around 10% each week. In our walking example, you would increase from 8 minutes to almost 9 minutes. Maintain this new level for one week before increasing again.
• Stay in control during flare-ups by reducing the activity level, but don’t revert right back to your baseline level. Gradually build up again.

Tracking your progress in an activity diary is a great way to monitor your progress over time. Remember, activity pacing requires patience and dedication but can significantly improve your quality of life. Learn more about musculoskeletal pain by researching joint pain management, pain treatment or pain conditions. 

Welcome to the first blog of MSK Pain. In this post, we’ll be discussing the difference between good and bad pain and how it relates to chronic musculoskeletal pain. 

Patients often wonder if the pain they’re experiencing is a sign of worsening pathology. The truth is, there’s good pain and bad pain. Good pain acts as a warning mechanism, alerting you to potential danger and prompting you to take action. Bad pain, on the other hand, persists for longer than three months and provides little protective benefit.

When you experience pain, it activates various responses in your body, including emotional, cardiovascular, and muscle activation. Chronic musculoskeletal pain can keep your body in a protective state for extended periods, leading to fear avoidance behavior and reduced movement. This type of pain is characterised by constant discomfort that interferes with even minor day-to-day activities.

To manage chronic musculoskeletal pain, it’s essential to break the muscle activation and fear avoidance cycle. Psychological support can help patients understand the absence of worsening structural pathology and introduce relaxing strategies to counter the fear avoidance and muscle activation cycle. Physical treatments, such as soft tissue measures and exercise therapy, can reduce abnormal muscle activation and encourage patients to move into the painful range of movement.

One of the key pillars of pain management is minimal invasive interventions, such as radiofrequency denervation, which can reduce pain from painful structures, specifically facet joints. This reduces protective muscle activation and fear behavior, allowing patients to move more freely and improve their overall wellbeing.

Over the next few months, we’ll be exploring these specific treatment strategies, including physical, psychological, pharmacological, and interventions, to help manage chronic musculoskeletal pain in the long term. 

Thanks for reading, and stay tuned for more.

Pharmacological (medication): Medication can play an important role in the management of chronic pain. If you are currently taking opioid containing medications, do not feel guilty. At some point in the past a medical professional thought that this type of medication might be the best way to manage your pain. Long-term opioid use however has significant negative effects on your overall health and function, and in some instances can cause or make pain worse – we call this opioid induced hypersensitivity. We would support you weaning off opioid medication or reducing the dose. Some medications acting as a neuromodulator can be helpful to manage certain types of chronic neuropathic pain. For example, Amitriptyline taken at a low dose at night time can reduce nerve sensitivity type pain and improve sleep.