I don’t think we talk enough about pain.

There is some sort of taboo or stigma against sharing about pain. Even physical, musculoskeletal pain. For most parts, we don’t share our pain experiences. For most parts, we don’t have anyone to process our pain with.

Because we don’t really talk about pain, most of us have very poor understanding of our pain. To address this, we have started a monthly community workshop series called Pain Schooled!.

Pain Schooled! at its core is about getting people to explore what it means to live in pain. We already know there are many components that contribute to a pain experience. The culture you grew up in, the people you hang out with, your psyche, your health status, your social life, your work life all contribute to your pain experience. At Pain Schooled! we discuss what pain means to you and how we can process pain with a biopsychosocial approach.

#1 Chronic pain is a disease

Most of us think of pain as a symptom. But what if that’s not just it?

Will your attitude towards your own pain change if chronic pain is a disease on its on right?

The European Federation of International Association for the Study of Pain (IASP) declared chronic pain as a disease on its own right in October 2001. That is almost 20 years ago!

Most of us still see pain as an indication of weakness. That pain is trivial. Pain will go away by itself. Well, no. Pain is a lot more than that.

Study: Chronic pain as a symptom or a disease (2019)

The IASP Working Group together with World Health Organisation is developing a new codes for the upcoming International Classification of Diseases to see chronic pain disorders such as fibromyalgia and nonspecific low-back pain as diseases in their own right. Chronic pain secondary to other pathology – i.e. cancer-associated pain – will still have pain addressed as a symptom.

Bottom line: chronic pain is a disease, get help

#2 Singaporeans work hard, live in pain, and do not seek pain treatment

Singaporeans work hard.

The Working Hours Survey conducted by Morgan McKinley found that 70 per cent of professionals based in Singapore work more hours (Asia One) than what they are contributed for. With the average Singaporean working 2,371.2 hours in 2016, Singaporeans work the longest hours in the WORLD (Asia One).

Sentosa Development Corporation did a survey of 600 Singaporeans and found a typical Singaporean only spends 2.8 hours of the week with family and friends (Today Singapore). Singaporeans also feel guilty for taking time off and wish they are doing something more productive when on breaks.

It makes sense for me to seek help if I am sick. It also makes sense to me to seek help if I am living in pain. But research shows Singaporeans don’t think that way.

The 2017 GSK Global Pain Index found almost half (42%) of Singaporeans suffer from weekly pain. Singaporeans also choose to avoid or delay seeking pain treatment. The resulting productivity losses is estimated to be at a whopping $8.4 billion!

That is a lot of money.

Our advice is that you should seek help if you are living in chronic pain. Research is telling us that chronic pain is a disease and there are tangible costs involved with delayed treatment.

Bottom line: Pain affects your work productivity in tangible ways, get help

#3 Research say it’s okay to take a break

I am not just telling you this from a mental or psychosocial health perspective.

A study published in 2018 found moderate-quality evidence that taking breaks have no detrimental effect on work productivity. There’s really no need to feel guilty about it.

Taking breaks were also found to improve low back pain and discomfort.

Bottom line: Please take a break if you need to!

#4 The number one contributor to years lived in illness is musculoskeletal disorders

When it comes to measuring health, one of the metrics used is YLDs (Years Lived with Disability). YLDs measures the years you lived with health loss (i.e. lived in illness).

Guess what is the biggest contributor to that? It’s musculoskeletal disorders such as back pain, shoulder pain, knee pain. Next up? Mental health disorders.

  1. Musculoskeletal disorders: 20.7%
  2. Mental health disorders: 17%
  3. Sense organ diseases: 6.3%
  4. Skin diseases: 5.1%
  5. Cardiovascular diseases: 4.7%

These figures are from the The Burden of Disease in Singapore, 1990–2017 published by the Singapore Ministry of Health on 2 April 2019.

To put that into context, eating less fit and exercises for cardiovascular health prevents you from dying early. True. But musculoskeletal disorders are four times more likely to cause you disability in the years you are alive.

If we are putting effort to keep ourselves alive through diet and exercises, why aren’t we putting any effort into living pain-free in good psychosocial health?

Do you want to live longer but in pain and misery? That’s my question for you.

Bottom line: Don’t suck it up because it’s a lose-lose situation for you 

#5 Multi-site pain and low back pain intensity are both linked to absenteeism

A study published earlier this month found the following to be linked with sick days:

  • Higher perceived physical exertion at work (not the same as higher physical exertion)
  • More time in manual work
  • Less social community at work
  • Less leisure-time physical activity
  • Smoking
  • Pain across multiple body sites
  • Low back pain intensity

Bottom line: Again, chronic pain is a disease, please seek help

#6 There are more than pain killers when it comes to pain management options

It’s common for most Singaporeans to intuitively pop a pill when they are in pain. Some Singaporeans choose to live in pain without treatment because they are unaware of non-pharmacologic pain management options.

Evidence supports education, exercise, and even cognitive behavioural therapy as effective pain management options (Pubmed).

Because now pain is seen as a disease in its own right, pain management has moved away from just addressing pain as a symptom. This mean we don’t address the “root causes” of your pain to make your pain go away. We address your pain to make your pain go away.

Pain is phenomenological. This means your experience of pain is unique to you alone only. No one can tell you your pain is not real and no one can tell you what your pain is. Interestingly enough, phenomenological research shows pain is an experience (understanding pain #6). This means your pain experience of pain is what it is because of the meaning you attributed to your pain.

If we can help people alter the meaning of their pain, we can improve your pain experience.

#7 Mindfulness may help with pain

Two major lower back pain guidelines (Lancet Low Back Pain series, joint guidelines from American College of Physicians and American Academy of Family Physicians) both endorse mindfulness as a treatment option for lower back pain.

The Lancet puts mindfulness as a second-line intervention. It is important to recognise this because mindfulness as an intervention for chronic pain is still fairly new.

While latest studies are reporting mindfulness to be favourable for pain relief, the quality of evidence remains low.

Study: Mindfulness Meditation for Chronic Pain (2017)

The systematic review and meta-analysis looked at 30 randomised controlled trials and found low quality evidence that mindfulness practice is associated with a small decrease in pain intensity. The authors concluded more research is needed before the efficacy of mindfulness practice for chronic pain can be determined.

Study: Brief Mindfulness-Based Interventions for Acute and Chronic Pain (2019)

The paper looked at 20 studies, including 13 studies where mindfulness practice was delivered via audio or video recordings, and found provider-delivered mindfulness medication to have some effect on acute pain. However, more research is needed before a recommendation for mindfulness mediation as first-line treatment can be made.

Bottom line: Mindfulness may help with chronic pain but evidence is still lacking

#8 There are free apps for mindfulness/mediation practice

I’ve personally attended a few brief mindfulness sessions but I have not given any of these apps a go. These apps are recommended by friends who are familiar with the mindfulness or mediation practice circle.

(More updates to come.)