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Behind the doors of a pain clinic.

corridor, doors, pain, clinic

My afternoon at a pain clinic.

Some of our patients attend pain management centres, but it wasn’t until last Friday that a friend of mine invited me to the Friends & Family Group Meeting at INPUT Pain Management, which is part of St.Thomas’ Hospital, opposite the Houses of Parliament.

My friend is a chronic pain sufferer coming to the end of the second week of a 4-week residential course there.  She had a hunch that I might be interested in coming along, as I am studying for an MSc in the Management of Chonic Pain and Headache Disorders. Well, she was right.

The background

This type of pain management centre represents the most up-to-date, evidence-based format for treating people with chronic pain of all types. It helps with not just the biological aspects of persistent pain, but also, and arguably more importantly, the psychological and social dimensions. This is known in the trade as the “biopsychosocial approach” to chronic pain management. Briefly, many good studies show that pain, which is the body’s way of alerting us to an actual or potential threat, is complex and very particular to each person.  In addition, the negative effect that persistent pain has on our relationships, our poor psychological state, together with a faulty belief that how much pain we’re in is an indication of the amount damage, can actually make our nervous system acutely alert to even the smallest threat – like a very sensitive car alarm that is set off by a falling leaf.

Current evidence shows that this approach to dealing with persistent pain is superior to the spiral of pain-killing medication, which is only effective up-to-a point, and which requires frequent trips to the G.P. and other specialists for medication reviews and further tests and investigations.  The idea is that with pain education and psychological tools, sufferers can play an active role in reducing the negative effects that pain has on their life.   This is far better than medication alone.  What it does not do is perpetuate the false hope that there is a therapy or scan or drug that will take the pain away permanently.  I imagine that accepting this crucial point is the biggest hurdle.

During the group session

There were about 10 participants on the programme, 9 of whom were women, all suffering with persistent pain.   A physiotherapist and an occupational therapist lead the group discussion, and I was struck by how seamlessly they wove their messages and learning points in to the exercises.  Even the ice-breaker was an opportunity to learn.  For this we had to pair up and tell another group member two facts about ourselves  – one true and the other a lie.  Our partner then had to uncover the lie by interrogation.  The point about this was to teach us how much harder it is to present a “false face” to the outside world, in other words, constantly telling people that you feel OK when you don’t.  It takes more energy to keep this falsely optimistic mask up than to interact with people in an authentic way.  My lie (that I was born in Uganda, of all places) went undetected – what does that say about me, I wonder?

Then the physiotherapist took us through an exercise which involved holding a finger in front of our face.  We then had to focus our attention on this finger.  She then asked us to notice what the background looked like – blurred, we all murmured. Next,  she asked us to change our focus to the other things that were in the room and asked us what the finger looked like – again, we all agreed that the finger now looked blurred. We then discussed how, if the finger represented pain, and if all we ever thought about, or “ruminated” on, was our pain, then this made this feeling stand out even more.  This would also be at the exclusion of everything else.   Making an effort to notice the world around us (also known as “being present”) could make the pain fade into the background more.  Try the exercise yourself, it really works!

Next, we were asked to play a game where each person in the group took a turn to make a particular movement.  Everyone else was then encouraged to follow this person’s movements. We were then asked to take note of how we copied the movements – whether exactly, which leg or arm we moved first, to what degree.  After most people had the chance to be copied, we then discussed the importance of being mindful about everything we do and also to judge for ourselves what our personal limits are with any activity. This introduced us to the concept of “pacing”.  So, we don’t have to do any activity at someone else’s pace or rate, it’s important to choose a way of doing things that we’re comfortable with.

Finally, the occupational therapist gave us a Post-It note and asked us to write down one thing that we wanted to achieve this year. He then asked us to write down all the barriers to achieving this goal.  We then paired up to discuss what we had written and to be encouraged by our partners to come up with some ways of overcoming these obstacles and achieving our goal.  This concept of “goal setting” is important because we learn that we don’t have to limit ourselves, and that by considering our goals and evaluating the obstacles we can then plan to achieve them – whether it’s riding a horse twice a week, walking for half an hour a day or swimming for 10 minutes at a time.

Phew! Quite a lot in a 90-minutes.

After the session

The participants had clearly built up a good rapport with one another, so much so that afterwards one of them told me that she felt so upset, that she had to leave the friends and family session, because she felt that the tight-knit group had been invaded. I quite understood, because to be able to share their experiences with other people living with persistent pain, to spend productive time on themselves and not feel like they were being a burden on their carers, family or friends, and to learn so many active and sustainable skills that they can practise over an extended period must be a very powerful and life-changing experience.

There are a number of residential pain management centres in the UK, however demand is very high.  This, of course, means that the patients have to wait for up to a year for a place which, studies show, leads to poorer outcomes in the treatment of persistent pain.  It’s a shame that because of the current 1-year waiting list for INPUT at St. Thomas’, they have just had to cut the residential programme to 3 weeks, instead of the usual 4, giving less opportunity for participants to practice what they have learnt under the guidance of the skilled pain management therapists.  It will be interesting to see whether this truncated programme is as effective at helping sufferers manage their pain better.

My friend said that since being on the course she has felt completely exhausted at home at the weekends, and that she even begun to feel more pain than when she had started the course, probably because she was she was asking a lot more of herself. However, she felt hopeful that, over time and with practise, she would be able to use these new concepts and techniques to feel more in control of her symptoms and have a better quality of life, despite the pain.

These types of pain management centres have been shown, over the longer-term, to reduce over-reliance on medication and lead to fewer G.P., specialist and hospital visits.  However, in the short-term, politics and the need to balance NHS budgets means that this type of care is in shorter supply than it ought to be, given the overwhelming evidence to support it.

It would be great to hear from anyone who has had experience of this type of pain management centre.  Has it helped in the long term? Feel free to leave a comment below.



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