Helping you understand what to expect from treatment

When your body is injured, your body activates protections:

1. Pain – to limit activity
2. Posture or movement restriction – like limping, to prevent further harm
3. Wariness or anxiety – to keep you alert and cautious

Other systems may also respond, including:

• Autonomic changes (e.g., sweating, swelling, colour or temperature changes)
• Stress hormone shifts (like increased or depleted cortisol)
• Immune system activity linked to past injuries or current threats

These responses are normal and help the body to heal and avoid further injury.  When protections persist longer than they are needed, these persistent protections become chronic pain.  So, pain is an experience that comes into consciousness as one the protections that the body raises against threat.

Even after an injury heals, the pain of injury can remain. Here’s how:

• The danger signals from an injury (called nociception) travel through the nervous system to your brain.
• In the early stages, the signals from the injury are strong and the body responds with appropriate strong protections.
• Over time, the original injury improves, and the signals from the injury are reduced.  The body can amplify the reduced signals as the signals travel to the brain to be assessed, continuing to present a high level of danger signal to the brain.
• The body assesses the amplified signals as indicating continuing severe danger—even when the injury has reduced in severity.

Amplification of danger signals can be influenced by many factors, including:

• Your beliefs about the severity of your injury
• Your past experiences with pain or trauma
• Your emotional state, like depression, anxiety, or hopelessness
• loss of your normal fitness after a long period of inactivity.
• Avoidance of activity, intended to reduce pain but making pain worse
• Persistent stress, for example from complex compensation or legal processes

The pain is always real, but the cause may no longer be physical damage alone. Other factors take on a bigger role.

Complex Regional Pain Syndrome (CRPS) is a challenging pain condition that can develop after an injury or surgery, usually affecting a hand, foot, arm, or leg. The pain is  more intense or persistent than expected based on the original injury.

CRPS may  involve:

• Changes in skin colour or temperature
• Swelling and sweating in the affected area
• Increased sensitivity or pain to touch
• Stiffness, weakness, and loss of movement

While many people recover well, others can experience long-term pain and reduced function. Early, coordinated care is beneficial.

A Comprehensive and Caring Approach

At Adelaide Chronic Pain Clinic, we start with a thorough assessment to understand your situation. From there, we build a treatment plan that may include:

• Pain education to help you understand what’s happening in your body.
• Medication to manage symptoms.
• Physiotherapy to restore safe movement and function.
• Occupational therapy to support daily tasks and independence.
• Psychological support to manage stress, fear, and the emotional impact of pain.

Advocacy and coordination to help you access the right care at the right time.

Some people can reduce opioids without difficulty.  Most people who have used opioids for a long time can manage 10% dose reduction per month. Some people need slower reduction and smaller increments, for example 5%  every two months. The usual experience with long term opioid reduction is that with each dose reduction there is a small increase in pain for one or two weeks with each dose reduction.  The pain then usual settles to its pre-reduction level.  With each reduction there is a temporary pain increase and then a matching pain reduction.  

The reason for this increase then decrease of pain is that in long term opioid use, pain is maintained by a balance between two opposing forces within the nervous system: hyperalgesia (which tends to increase the pain), and analgesia (which tends to reduce the pain).  With opioid reduction, there is an immediate reduction of analgesia and pain increases. This is why the dose reduction should be small enough to tolerate.  Hyperalgesia reduces more slowly, so that usually within 2 to 3 weeks, the pain has returned to the pre-reduction level, as the hyperalgesia and analgesia balance each other again. After about a month, most people are ready to make another reduction. 

With opioid reduction over time, pain stays the same or less than it was before reduction started. The difficulty is not in the long term – in the long term things are typically the same or better—the difficulty is getting through the temporary pain increases that accompany each small reduction.  Opioids are more dangerous when combined with other sedative drugs (for example benzodiazepines like Valium) so it is an important for safety to reduce other drugs while opioids remain at a moderate level.

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