Written By
Rachelle McCabe
College
College of Healthcare Sciences
Publish Date
19 July 2024
Related Study Areas
Pain: a pervasive and misunderstood challenge
More than 3 million Australians suffer from chronic pain every day. Pain, in particular chronic pain, can be debilitating with treatments often hit and miss.
July 22-28 marks National Pain Week, the country’s annual awareness week for chronic pain, recognising those in our community who live with pain and; aiming to reduce social and other barriers related to managing chronic pain.
JCU Physiotherapy lecturer Dr Carol Flavell is a pain expert. She’s had decades of clinical experience helping people who are experiencing all kinds of pain. She is also a researcher working at the forefront of effective pain management.
According to Dr Flavell, there are no signs that the population’s experience of pain is in decline, largely thanks to the nuances of modern life and the state of the nation’s health. However, she says there are exciting developments in research into the treatment of pain, offering hope for those who live in pain every day.
Dr Flavell’s physiotherapy career kicked off in the 1980s in the United Kingdom. She worked as a clinical physiotherapist for 20 years, eventually finding her way to Australia, the country in which her passion for research took hold.
“I was always interested in doing my own research after graduating, but life can get in the way. I moved countries a couple of times, and I had young children who needed me,” she says.
Finding a path to physio research
Eventually the time was right for research, with Dr Flavell enrolling in a master’s degree, which began her transition into research. Soon after, she followed this up with a PhD at JCU after she was offered a lecturing position at the university. More than a decade later, she continues to lecture in physiotherapy at JCU and is involved in many local and international research projects.
“The focus of my PhD was on validating an examination process for physiotherapists to utilise on patients with persistent lower back pain. It involved a physical hands-on examination as well as clinical and technological tools like real-time ultrasound,” she says. “If we don’t examine people with persistent back pain correctly and appropriately, we can't treat them correctly.”
Dr Flavell says her PhD project revealed that taking a multidisciplinary approach to persistent pain by utilising a team of experts; including doctors, physiotherapists and mental health professionals who work collaboratively was key to achieving the best results for the patient.
Dr Flavell is currently involved in an international research project looking at effective pain management strategies for patients with HIV, who commonly experience episodic bouts of pain and illness that can lead to increasing disability.
“Managing health conditions that present with episodic disability requires a different approach to that of other conditions. HIV is one of the conditions where there is a stigma that makes rehabilitation more challenging, particularly if we think about group rehabilitation.”
“HIV, like multiple sclerosis and rheumatoid arthritis, is a chronic condition that's episodic. Patients might catch an opportunistic infection, become unwell, spend some time in hospital and then afterwards, need rehabilitation because they have become a deconditioned, they are weaker, they've lost muscle mass for example. The ups and the downs of those conditions are of a particular interest for me.”
Pain reduction through teamwork and movement
Want to know how to eliminate or at least reduce pain? Dr Flavell says people experiencing pain need to move their bodies and assemble a team of health professionals to help them.
“As a physiotherapist, I know I can't treat someone with persistent pain in isolation because it is multifactorial,” she says.
Her top tip? Be as active as possible for as long as possible.
“We know that being active key to a lot of positive things, but it's certainly key in terms of managing pain. When we exercise or move and do activities that we enjoy, it stimulates feel good hormones,” Dr Flavell explains.
“But not just that – it's also about moving muscles and joints which improves circulation generally, improves blood flow to muscles and ligaments, the joint surface or cartilage in the joint, and that then helps to reduce pain.”
Correct posture also key to pain reduction
“If we hold ourselves really tense we cause our muscles to contract. When muscles have been contracting continually they become fatigued and that causes chemical changes which your brain perceives as pain. It's an inflammatory type of change,” Dr Flavell says.
“It's really important that we pause regularly. If we're working on a computer or reading a book, just get up, move around, get those muscles and joints moving. Take care with how much you’re loading your joints. If you've got hip or knee pain, wear good footwear that is supportive, that will help to reduce the loading on the joint. Body weight comes into the picture here too.”
But Dr Flavell urges people experiencing pain to pace themselves when it comes to increasing activity, as physios often see patients who have taken on too much, too soon.
“Don't do what we call the boom or bust. We often see people who tried to do everything – they’ve mowed the lawn, then gone for a 10km run, then cleaned the windows, and of course it’s too much and they are laid up for days,” she says. “It's about pacing and that's not easy to do. I'm not saying just telling somebody to pace themselves is helpful because I don't think it is. I think we have to guide people specifically on how they conduct that pacing.
“Psychology also plays a big part in what we do. If a patient is in a mental cycle where they feel that they are not achieving or progressing that sends them back into that downward spiral of I'm no good, my back is never going to get better, this is hopeless. That’s not where we want our patients to be.”
Aiming for a pain-free future
Considering the challenges to come
When it comes to pain in the future, there are a number of challenges – from stooped postures, the rise of technology, obesity, and the prevalence of sitting for long periods, to name a few. But Dr Flavell says there is also hope.
“The new generation of physios are going to see a different profile of patients, they will be treating more posture related pain then I was when I was practising clinically,” she says.
“Obesity, from my perspective, will be a challenge in terms of pain because we know obesity predisposes people to high joint loading. High joint loading leads to the progression of osteo arthritis and joint disease.
“Posture is another issue, how many young people do you see who already have a very stooped posture? As physios we always observe people and I see it all the time, it's almost an epidemic. If we're sitting in a poor position, it causes the chin to poke forwards, this causes neck problems and back problems.”
However, Dr Flavell says medical leaders are starting to recognise the value of a multi-disciplinary approach to pain management, with some good facilities already operating in Townsville.
“It became quite clear throughout my PhD that multidisciplinary persistent pain management centres are the best way to manage patients with persistent pain. There is a high need, yet we have a lack of these centres in Australia and around the world.”
Innovation can drive progress
New research and improvements in medical imagery were also positives for people in pain, Dr Flavell notes.
“There is some fantastic work being done by researchers in Australia and around the world on trying to understand the link between the brain and what is perceived in the body in terms of a person's perception of pain, and how pain progresses from that acute phase through to becoming persistent, and why it affects one person and not another,” she says.
“I'm very hopeful. From a purely medical perspective we have improved neuro imaging and technologies that are helping us to understand what's going on with each patient.”
Want to know more about managing pain and not sure where to start? Chronic Pain Australia site offers a wealth of information about the latest treatments, events and research into pain, giving hope to those living with pain.
Find out more about how you can help people manage their pain and pursue a career as a physio by exploring our Bachelor of Physiotherapy couse page.