Advice to rest and avoid pain has traditionally been given to people with chronic pain. However, research linking lower back pain in teens with work absenteeism as adults points to the need to tackle pain early, eliminating fear-avoidance behaviour later in life. During National Pain Week (23–29 July) the Australian Physiotherapy Association (APA) is highlighting the effectiveness of physiotherapy in pain management programs.
One in five Australians under the age of 65 is affected daily by chronic pain, rising to one in three for those over 651. Chronic pain is Australia’s third most costly health burden and the leading cause of early retirement and work absenteeism, costing the economy more than $34 billion per year.
New research from Curtin University, co-authored by APA physiotherapist Professor Peter O’Sullivan, has found that the likelihood of prolonged absenteeism due to chronic pain can be traced back to fear of pain in the earlier years of sufferers. Using data from a long-term study, the researchers found that taking time off school due to low-back or neck pain meant an individual was three times more likely to take sick days from work as a young adult2.
Dianne Wilson, chair of the APA Pain group, says “Pain is a protective mechanism. If our brain thinks that we are in danger it makes unpleasant feelings so that we change behaviour to protect ourselves. But pain is not always an accurate indicator of tissue damage. Contextual factors can play an important role; feelings of stress, anxiety or depression can heighten the perception of pain. As pain persists certain parts of the nervous and immune systems may become overactive. This overactivity or sensitivity means that we may experience longer-lasting and more frequent pain without ongoing tissue damage.
“It may seem counter-intuitive, but for most chronic pain sufferers, maintaining movement is the best thing they can do. Physiotherapists have the expertise to guide patients through an education and exercise program, pacing and grading their program to suit the patient’s individual needs.”
Chronic pain is a complex health issue. Though it is individuals who suffer the severe, debilitating symptoms, the burden extends across the whole of society. Physiotherapy has been proven effective in the early intervention and management of pain, leading to positive outcomes such as fewer sick days, shorter injury duration and decreased utilisation of the health care system3.
With an understanding of the biopsychosocial model of care (appreciating that experience is influenced by physical, psychological and social factors), physiotherapists are well placed to provide best-practice approaches to pain including education and the promotion of healthy movement.
Dianne Wilson is available for further comment or interview.
For a listing of physiotherapists in your local area visit www.choose.physio
1 Pain Australia 2018-2019 Pre-Budget Submission. December 2017. http://www.painaustralia.org.au/static/uploads/files/painaustralia-budget-submission-18-19-color-wfbralgwytgq.pdf
2 Coenen, P., Smith, A., Kent, P., Harris, M., Linton, SJ., Pransky, P., Beales, D., O’Sullivan, P., Straker, L. (2018). The association of adolescent spinal-pain-related absenteeism with early adulthood work absenteeism: A six-year follow-up data from a population-based cohort. Scand J Work Environ Health. http://www.sjweh.fi/show_abstract.php?abstract_id=3744 " show_abstract.php?abstract_id=3744
3 Hallegraeff JM Krijnen WP van der Schans CP et al. Expectations about recovery from acute non-specific low back pain predict absence from usual work due to chronic low back pain: a systematic review. Journal of Physiotherapy 2012;58:165–72.
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