Online pain doctor: Can telehealth consultations help?

Summary: Chronic pain affects up to half of adults and can impact daily life, mood, and wellbeing. While there’s no single cure, treatments include lifestyle changes, therapy, physiotherapy, and specialist care. GPs can help manage symptoms and help you achieve better quality of life.

It is believed that 30-50% of adults currently have or have had a persistent pain lasting for more than 3 months. This is a chronic condition which is often secondary to an underlying health condition (for example, arthritis), but it is also common for the cause of the pain to be uncertain (the cause has not revealed itself on investigations such as blood tests or scans).

What is chronic pain?

Chronic pain is often difficult to live with, as it can disrupt an individual’s ability to perform their activities of daily living. As a result, it can cause considerable disruption to daily life, and this ongoing distress has the potential to seriously affect a person’s quality of life. It is usual for there to be associated symptoms with the chronic pain such as; a feeling of generally being unwell, fatigued, “brain fog”, depressed mood and/or anxiety.

When to seek medical help for chronic pain

To help make decisions about how to tackle the pain, you may need to consider what matters most to you – what would you like to prioritise in your care? What are the benefits and risks of treatments available? What is the likely long-term outlook for your pain? It will be difficult to think about these without the support of your GP. You should expect your GP to recognise and treat your chronic pain as valid and recognise that everybody feels pain differently (past and present life experiences, such as emotional trauma, can affect how pain is felt). The GP should try to gain a deep understanding of how the pain affects your day-to-day life (including your career, your relationships and your sleep) and in turn how your activity of daily living affects the pain.

Also read: Can telehealth help with chronic pain & body ache? | Hola Health

Chronic pain treatment options

Chronic pain can be difficult to treat because there is no simple fix & there is not one particular treatment that works well for everyone. It may be unrealistic to expect pain to be resolved completely, but there are steps which can be taken to help you live well with pain (and its associated issues) and be able to perform activities of daily living.  

Medications for chronic pain

The GP may discuss antidepressant medications, which affect chemicals in the brain that are involved in the sensation of pain, as well as mood and emotions. Medical research indicates that these medications can help some people who have chronic pain, even in people who do not have depression and/or anxiety.

There is a misconception that painkiller medication such as opioids (for example, codeine, tramadol, tapentadol and/or oxycodone) and other drugs such as gabapentin/pregablin are mainstays of treatment for chronic pain. This is because they were used a lot in the past for chronic pain but are no longer recommended as medical research shows that overall, there is no benefit on an individual’s chronic pain, but the risk of harm and serious side-effects are very high. If you are already on these medications, it is important that you discuss this with your GP.

Multidisciplinary support for chronic pain

It is very likely that the GP will need the support of specialists and other allied health practitioners to support you. For example:

Physiotherapy and exercise

A physiotherapist and/or exercise physiologist can tailor an individualised treatment plan for you to maintain as physically active as possible and keep fit. This may involve moving around your home and walking more, or it may include group physical activity with an instructor. It is important for you to listen to your body and how it feels, going at a pace which feels right for you. The risk of harm of physical activity is very low, but the overall benefits to your physical and mental wellbeing can be great.

Psychological support

Chronic pain may well have an impact on how you think, feel and behave. In turn, your thoughts and overall mood can affect how you feel pain. This does not mean that your symptoms are “all in the mind”. Cognitive Behavioural Therapy (CBT) and/or Acceptance and Commitment Therapy (ACT) are talking therapies which a psychologist can use to help you manage your pain and associated symptoms, ultimately reducing the impact on your activities of daily living.

Acupuncture for chronic pain

Seeing an acupuncturist. Despite this involving needle, the risk of long term / serious harm is very low, and medical research indicates that it can help some people’s pain for up to 3 months.

Support groups and community resources

The GP may signpost you to various support groups or organisations. These may help get you in touch with other individuals with chronic pain, allowing you to share experiences and advise each other on how to manage your chronic pain and associated symptoms.

Also read: Natural remedies that may relieve chronic pain

When to consider a specialist for your chronic pain?

If your chronic pain and associated symptoms are not managed with the above methods, the GP will consider referral to a specialist pain management clinic to help ascertain if a specific intervention, assessment or specialist treatment is required for your pain. If the GP suspects a particular underlying cause which cannot be managed in the community a referral to a particular specialist may also be warranted.

The role of telehealth in chronic pain care

For some patients, the pain may affect their ability to get out of the house and travel to appointments with their health practitioners. Many clinicians, including GPs are able to perform virtual doctor consultations (via phone or video calls). With any chronic health condition, it is important to have a strong foundation of trust with your health professionals, and it may be more difficult to develop rapport and build a strong clinician-patient relationship when appointments are done virtually