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Andrea* suffered from severe neck and back pain after a car accident. She used to be an active person so the pain affected many aspects of her daily life.

On ‘good’ days where she had less pain, she would overdo things to ‘make up’ for ‘bad’ days. But this aggravated her pain and forced her to rest. Over time, she could do less and less before the pain would flare up, and she ended up relying on higher dosages of medication to manage her pain.

To break out of this cycle, she started Cognitive Behavioural Therapy (CBT) sessions at SKH, which equipped her with skills to manage her pain. CBT is among the therapies offered at the SKH Pain Management Centre, which has a multi-disciplinary team of pain specialists, physiotherapists, psychologists, nurses, and doctors to help patients with chronic and disabling pain disorders. Here are some of the treatments offered:

Psychology: Tap into the power of the mind

For patients with pain, a psychologist can help by coming up with strategies to transform the way they relate to pain. One common therapy used is CBT which helps patients change how they view their pain, and learn coping strategies so that their mind and body respond better to it.

How does CBT work?
In Andrea’s case, the psychologist helped to identify the factors that contributed to her pain, such as activities she engages in, work and family stress. She was taught skills to manage her stress through relaxation and mindfulness practices. Goals were also set to allow her to gradually build up her activities. For example, she started off with daily five-minute walks for a week, then seven minutes the following week.

Andrea felt happier and more confident as she could do more over time. She is now able to manage her pain better, instead of feeling defeated by it, and has resumed a more active and fulfilling life.

What kind of pain can CBT treat?
CBT can treat chronic or persistent pain that is negatively affecting a person’s daily life. In some cases, undergoing CBT earlier can also prevent the onset of persistent pain and pain-related disability.

Who is suitable for CBT?
Those willing to explore alternatives to medical or surgical treatments, and be actively involved in their own care will likely benefit from CBT. “We usually tell patients that we are not here to reduce their pain. Instead, we encourage them to focus on what they can do – be more in the driver’s seat – to manage their pain,” shares Ms Evangeline Tan, Head of Psychology at SKH.

What are the benefits of CBT?
Patients who have undergone CBT have reported less pain and distress, increased activity, increased confidence in managing pain, and reduced healthcare visits and medication. These positive effects can last as long as they continue to use the strategies they have learned.

Acupuncture: An alternative therapy

Acupuncture can be applied to different types of pain, particularly those caused by musculoskeletal disorders and nerverelated pain. Pain conditions such as frozen shoulder, back pain, neck pain, osteoarthritis, ‘tennis elbow’ and sciatica (pain from the lower back down to the leg) respond well to acupuncture.

How long does it take to work?
The results differ with individuals and their conditions. Some patients have reported that they felt the pain relief immediately or the next day. For chronic pain with underlying diseases such as arthritis, ankylosing spondylitis or scoliosis, the pain relief effect may not last as long as compared to other types of pain. Regular sessions may be required to manage the pain in the long term.

Are there side effects?
Acupuncture is generally safe and care will be taken to minimise discomfort and complications, assures Ms Adele Lau, acupuncturist at SKH Pain Management Centre. Possible side effects include slight bleeding around the site of needling, mild ache or tingling sensation after removal of needles. Usually, these are mild, temporary and do not result in any permanent adverse effects.

Is there a minimum age for acupuncture?
There is no age limit but it is not recommended for infants and very young children as the needling sensation can be unpleasant for them. We usually recommend acupoint massage or tui na instead.

What other restrictions are there?
Before treatment, we will first assess the patient's suitability by reviewing his or her medical history. We particularly watch out for patients with bleeding disorders, infectious diseases, those who are taking blood thinners or are pregnant.

Physiotherapy: One step at a time

Physiotherapy helps people with pain to develop the skills to manage their conditions, increase participation in activities, and improve quality of life. Physiotherapists are able to tailor exercise routines that promote healing, strengthen muscles, and build fitness.

What kind of pain can physiotherapy treat?

Physiotherapy can help with most pain, but some pain is managed and not treated. This is especially true for chronic pain as it involves many factors and can contribute to disability, anxiety, depression, sleep disturbances, and poor quality of life. 

“We treat to improve function, rather than manage pain. The emphasis is to manage the condition, improve function and minimise its impact on your life rather than finding a cure,” explains Phoebe Ting, senior physiotherapist at SKH.

How long does it take to work?
Strength gains typically take at least six to eight weeks. For chronic pain, it tends to be an ongoing and fluctuating process where there will be good days and not-so-good days. Long-term positive effects are best felt if exercise is done regularly.

Any simple tips for people to follow on their own?
We have a saying “Motion is lotion, rest is rust”, so the best advice is to keep active. “As a rule of thumb, do 150 minutes of moderate activity weekly – these are activities that should make your heart beat a little faster, make you perspire and pant a little. Window shopping is not moderate activity though,” advises Ms Ting.

Everyday activities such as walking and gardening can help improve the general well-being of people with chronic pain. If you have chronic knee or heel pain, seek your doctor’s or physiotherapist’s advice on appropriate exercises.

*Not her real name.