Chronic pain affects one in five Canadians. It costs more than cancer, heart disease and HIV combined. Direct health care costs for chronic pain in Canada are estimated at more than $6 billion per year, and productivity costs related to job loss and sick days are at $37 billion per year. Moreover, the cost to human lives due to suicide and opioid related deaths is incalculable.

Chronic pain is defined as pain that lasts more than is reasonably expected. The typical understanding of chronic pain is that it is due to a disease of the body or a malfunction of the nervous system. These are causes that are outside of the person-in- pain's control, so it puts them at the mercy of whatever healthcare provider or TV ad that gives them any hope of relief. But there is a great deal of power that a person-in- pain has over their pain.

Appropriate care begins with an assessment of the degree to which pathology, physical functioning, psychological functioning and interpersonal dynamics contributes to pain.

Then, after any disease process has been adequately addressed, the next key step is to help the person-in- pain become more aware of the aspects of their lives that affect their pain. Examples of approaches that can improve physical and mental awareness include meditation, breathing exercises, biofeedback, proprioceptive taping of muscles and joints, controlled movements such as Yoga and Tai Chi and of course, education about pain. The methods used should be chosen based on the individual's aptitudes and preferences.

Awareness itself, however, will not create any changes in a person's life. Understanding and altering the factors that perpetuate pain is required to ensure lasting relief from it. The factors that can predispose a person to pain and/or perpetuate pain include: 1) Improper use of the body (this includes how you move it, how much rest you give it and how you nourish it); 2) Improper regulation of thoughts and feelings; 3) Unhealthy interactions with others around you.

Unfortunately, the development of awareness may not even be possible for individuals who have experienced physical or psychological trauma. Physical trauma causes scar tissue formation which restricts your body from proper movement and affects your proprioceptive system (this is the system that senses the body's position in space). Psychological trauma causes a person to relive past events or to completely shut down - both effects cause a disconnect between the person and an awareness of the present moment. There are various therapeutic approaches that can be used to help the person-in- pain break free of the physical and psychological scars.

Because there are many factors that can cause and perpetuate chronic pain, there is no single treatment that is effective for everyone. To truly understand and care for a person-in- pain, a
team approach is vital and assessment/treatment must be tailored to the person as an individual. This will help focus treatment on therapies that are beneficial and avoid therapies that are unnecessary or even harmful.