Both in acute and chronic pain, the treatment of the underlying condition that causes the pain and the treatment of the symptom is mutually important.

If your doctor merely treats the pain with therapy or medication and does not investigate and find, very specifically, what is causing the pain, then you may miss dangerous conditions and your health may be in danger.

For instance, in acute pain the following scenario may play out:

A 15-year-old boy with sudden and severe stomach ache is brought to the doctor. He may have among others constipation, irritable bowel syndrome, food poisoning or appendicitis. Making the wrong diagnosis and just treating the pain could end in him becoming extremely ill and even passing away.

In chronic pain, similarly, the following may play out:

A 42-year-old home maker presents with chronic headaches. There are many causes for headaches, for instance she may have a problem with her teeth, her jaw, her eyes, the joints of her neck vertebrae, or she (in very rare instances) may have brain cancer. Just treating the headache could have disastrous consequences for her.

When you have chronic pain, there is an underlying condition that is causing your pain. You require and interdisciplinary team to investigate the cause of your pain, advise you on what lifestyle modifications you should be making and helping you work out a strategy for self management of your chronic condition while helping with the symptoms through therapy, medication and neuromodulation of your pain-system with patient specific pain procedures.

What is the most likely diagnosis of your chronic pain?

Osteoarthritis is one of the most common diseases that causes chronic pain. Osteoarthritis describes a long-term, normally progressive condition, affecting all or some of the moveable joints of the body, particularly the joints carrying your weight such as your spine, hips and knees. Some people are genetically more prone to osteoarthritis than others. 

Inflammation of the joints, stiffness, and changes to the surface and edges of the joints causes pain. 

But there is good news! Early and accurate diagnosis of osteoarthritis means access to the right treatment. 

It is possible to treat the pain from osteoarthritis effectively, but it is very important to also treat the underlying disease.

This is done with lifestyle interventions to ensure bone and joint health, and decrease inflammation. 


dietitian is a registered healthcare professional who specializes in nutrition and dietary management. They are trained to provide evidence-based advice on nutrition, healthy eating habits, and how food plays a vital role In health and wellness. They apply their knowledge of food science and how the body works to assess your nutritional needs and develop an individualised dietary plan. ​

They can also help you with personalised meal plans that promote health and manage chronic inflammation or conditions such as diabetes mellitus, heart disease, and obesity. ​

It is not just about losing weight!​

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Headaches are some of the most common causes of chronic pain and there are several types of headaches, making diagnosis difficult in some people.

Migraine is the best-known chronic headache, and it causes a severe, pulsating (throbbing) headache that is usually on one side of the head. Persons who suffer migraine attacks frequently see visual hallucinations, are hyper-sensitive to light and noise, are nauseous and frequently vomit. The attack can go on for hours or days and is frequently incapacitating. There may be warning symptoms before the attack, and these are called auras. This can include visual hallucinations, pins and needles and even difficulty speaking.

Medications can help prevent some migraines and make them less painful. The right medicines, combined with self-help remedies and lifestyle changes, might help.

Migraine Symptoms

Migraines, which affect children and teenagers as well as adults, can progress through four stages:

Prodrome, aura, attack and post-drome. Not everyone who has migraines goes through all stages.


One or two days before a migraine, you might notice subtle changes that warn of an upcoming migraine, including:


Mood changes, from depression to euphoria

Food cravings

Neck stiffness

Increased urination

Fluid retention

Frequent yawning


For some people, an aura might occur before or during migraines. Auras are reversible symptoms of the nervous system. They're usually visual but can also include other disturbances. Each symptom usually begins gradually, builds up over several minutes and can last up to 60 minutes.

Examples of migraine auras include:

Visual phenomena, such as seeing various shapes, bright spots or flashes of light

Vision loss

Pins and needles sensations in an arm or leg

Weakness or numbness in the face or one side of the body

Difficulty speaking


A migraine usually lasts from 4 to 72 hours if untreated. How often migraines occur varies from person to person. Migraines might occur rarely or strike several times a month.

During a migraine, you might have:

Pain usually on one side of your head, but often on both sides

Pain that throbs or pulses

Sensitivity to light, sound, and sometimes smell and touch

Nausea and vomiting


After a migraine attack, you might feel drained, confused and washed out for up to a day. Some people report feeling elated. Sudden head movement might bring on the pain again briefly.

When to see a doctor?

Migraines are often undiagnosed and untreated. If you regularly have signs and symptoms of migraine, keep a record of your attacks and how you treated them. Then make an appointment with your doctor to discuss your headaches.

Even if you have a history of headaches, see your doctor if the pattern changes or your headaches suddenly feel different.

See your doctor immediately or go to the emergency room if you have any of the following signs and symptoms, which could indicate a more serious medical problem:

An abrupt, severe headache like a thunderclap

Headache with fever, stiff neck, confusion, seizures, double vision, numbness or weakness in any part of the body, which could be a sign of a stroke

Headache after a head injury

A chronic headache that is worse after coughing, exertion, straining or a sudden movement

New headache pain after age 50

Cancer-related pain

Nerve damage – related pain

RheumatoidArthritis (RA)

Rheumatoid arthritis, or RA, is an autoimmune and inflammatory disease. Your immune system mistakenly attack your own body cells and this cases inflammation in certain body parts. It specifically attacks joints of the hands, wrists and knees. The process of joint damage is caused by inflammation of the lining of the joint. Some persons with RA develop deformed joints. RA can also attack the lungs, heart and eyes.

Because it is a disease of inflammation there are cycles of flares (when the inflammation becomes worse) and remissions (when the inflammation lowers) and the symptoms include pain and stiffness of joints, swelling of the joints. It is usually the same on both sides of the body and persons with this disease can show effects of a chronic illness with weakness, fatigue, weight-loss and sometimes fevers.

It is not clear what causes RA, but the following are risk factors: genetic predisposition, cigarette smoking, obesity, advancing age and female sex.

RA is diagnosed with clinical history taking, physical examination, blood tests and imaging studies like X-rays.

The treatment of RA should be driven by your rheumatologist working from within an interdisciplinary team that will focus on both the lifestyle adaptations and self-help strategies that you require to manage your condition.

The corner stones of the management are:

Dietary and nutritional strategies – ensuring that you diet ensure optimal joint health is paramount, read about the anti-inflammatory diet here.

Physical activity – physical activity and movement actively combats the disease and the symptoms of the disease. See more about movement programs here.

Obesity – being overweight causes systemic disease, inflammation and puts strain on your joints. See more about healthy eating here.

Self-management programs – all chronic diseases require active participation of the people who
suffer from the disease, and you require a tailor-made self-management program. Read more about self-management here.

Group therapy – for patient who live in chronic pain, group therapy is an excellent tool to help with coping strategies and it complements self management programs. Read more about it here.

Medication - Treatment for RA usually includes the use of medications that slow disease and prevent joint deformity, and these are called disease-modifying antirheumatic drugs. Biological response modifiers are medications that are an effective second-line treatment.


Gout is a common form of arthritis that predominantly affects men and is usually present in one joint only and most frequently the big toe. Just as rheumatoid arthritis and osteoarthritis , there are periods that the symptoms worsen and these are called flares and periods here the symptoms die down, called remission. Repeated episodes of gout can lead to a progressive kind of arthritis.

Gout cannot be cured and must be treated as part of an interdisciplinary team with multimodal therapy.

Patients with gout usually present with a severely painful, inflamed and warm joint and the condition is caused too much uric acid in your body. The uric acids is formed from the breakdown of purines which are found in the food we eat.

The following are risk factors for the development of gout: Being male, overweight, systemic disease like high blood pressure, heart failure, diabetes, poor kidney function contribute and eating foods rich in purines like red meat and certain types of seafood. Drinking alcohol has a direct correlation with the development of gout and the more you drink the  higher the chance is of developing gout.

A physical examination, blood tests and X-rays are used to diagnose gout.

Gout must be managed with a multi-modal approach through an interdisciplinary team and the following are important:

Dietary and nutritional strategies -  obesity and a diet rich in inflammatory foods and purines contribute significantly to disease progression and pain. Understanding how to eat for your condition is important as this is the pillar of the management of this condition. Read more about it here

Movement – during a flare up movement can become difficult and rest is often sensible, however during periods of remission movement programs and walking significantly aid general health and joint mobility. Read more about it here.

Medication -  during the remission phase drugs that lower the uric acid levels in the blood is used, like allopurinol. In the flare phase, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, steroids, and the anti-inflammatory drug colchicine, are used.

Self – Management – each person with must gather an interdisciplinary team around them to advise them on a personal maintenance program designed specifically with them in mind. Aspects would include nutrition, movement, adaptations in the activities of daily living (ADL), and pain neuroscience education. Read more about self-management here.

Chronic pain syndrome (Fibromyalgia)

Fibromyalgia causes pain all over the body fatigue, sleep problems, fatigue, and frequently emotional and mental distress. People with fibromyalgia are also more sensitive to painful stimuli. It is unclear what the cause is, but there are effective treatment modalities.

The most common symptoms of fibromyalgia are:

Pain and stiffness all over the body


Anxiety and depression

Insomnia or difficulty sleeping

Pain that is in the face or jaw region

Problems with thinking clearly – some people refer to it as a ‘fuzzy feeling’

Memory loss

Difficulty with concentration


‘Pins and needles’ in hands and feet

Gastro-intestinal complaints, such as stomach ache, bloating, constipation, and irritable bowel syndrome