Clinical psychologist Dr Amanda  Williams explains how attitudes to pelvic pain are determined by gender.  Men often experience discomfort in discussing what is perceived as a ‘woman’s problem’. Communication can often be life-saving, and the importance of opening up, and in turn receiving the necessary support, is emphasised.

The importance of having support in dealing with pain is further exemplified by Phil and Sue O’Brien. Phil lives with cluster headaches, and the couple reveal how they have learnt to manage his pain together.

This edition has been enabled by an educational grant from Pfizer Ltd.

Click here to listen

A four-lead TENS unit

Dr Pete Gladwell specialises in clinical physiotherapy in the pain management service at Frenchay Hospital in Bristol. He tells us more about the effects and benefits of using TENS as part of your pain management regime. 

How does TENS work?

TENS stands for transcutaneous electrical nerve stimulation. The device has been around since the 1960s and helps pain management by delivering electrical impulses across the skin.

TENS machines are usually a small box with wires leading to self-adhesive pads. These pads are placed either side of the pain, on top of the pain or close to the painful area.

When switched on, the user gets a tingling sensation under the pads. The body produces its own natural painkillers, endorphins, in response to the electrical stimulation. My usual advice is to aim for a strong, but comfortable sensation; the right sensation is found using the controls on the TENS machine.

The TENS machine works through different mechanisms. Some research shows that the TENS machine operates through the pain-gate, a special system that helps to block pain messages going up through the spinal cord. Other evidence argues that the TENS machine stimulates some of the opioid systems, or natural pain killing systems, within the body. The third mechanism, which my research suggests as well, is the distraction mechanism; it may actually just take somebody’s mind off the pain.

Can TENS be useful to everyone?

For some people, using a TENS machine leads to pain relief. For others, the sensation just takes their mind off the pain for a while.

Unfortunately, for some people it is not helpful or they find the sensation too unpleasant. In our clinics we encourage people to change the sensation to suit them, but it may not work as people’s experience of pain is diverse.

As far as we can tell TENS machines can be used for all pain conditions, providing there are no preventative health reasons. However, it can be difficult for pain where there are many pain sites, or for more widespread pain like fibromyalgia syndrome. This is mainly because the pain can move and vary throughout the day; you end up chasing where the pain is with the TENS machine. In comparison to those people whose pain is reliable, people who suffer from widespread pain might find that after a while they stop using their TENS machine, as they are less likely to find value from use. However, people with widespread pain often also have another pain problem which can be helped through using a TENS machine.

Different Strategies

Through talking to people who had experience of using TENS, we asked them directly about the ways that they used their TENS machine, the benefits they got and how they overcame their problems. From this research, there seemed to be four main strategies that people had worked out to gain the most from their TENS machine.

The first strategy was to only use their TENS machine on a bad day or a flare up to help cope and get through the pain. Then there were those people who would use TENS intermittently during the day, either in a break or in combination with relaxation techniques. The third way was to use TENS for particular activities which would have been difficult because of pain and the fourth way was on and off all day for most daily activities. These different methods show the vast range of people that could find using a TENS machine beneficial.

When it comes to the benefits, people do talk about pain relief. However, some people also find the distraction from their pain really quite helpful. This is known as counter-stimulation; where a more pleasant sensation helps you to manage your pain. These people asserted that the distraction was a separate benefit from pain relief, as it can just provide a break.

So far, research conducted has not been conclusive. However, patient research has led to some better ideas about how to measure the benefits of TENS in future studies, as well as providing some ideas for patients and clinicians about who might benefit. We hope now to conduct research on the true benefits of TENS machines, in order to lead to an increased understanding.

Hints and Tips

• My advice is to use the machine at rest when in a comfortable position, when you are having a break or before sleep. This prevents the machine being such a cumbersome object, with daily activities being completed after use.

• The strength of the sensation is personal. There are some people who feel that the stronger the sensation, the more effective the TENS machine will be. However, other people just need to be aware of the sensation to know that it’s doing its job.

• Despite being hypo-allergenic, the pads can aggravate the skin. There is an old-fashioned rubber pad with carbon in, which is stuck to the body using a sticky gel. For some people using old-fashioned pads can help with the allergy. However, they’re not guaranteed to help and unfortunately some people do continually react to the pads. In this case, it is important to keep use to short crucial periods and also to change the position of the pads regularly to avoid the problem.

• Be persistent! Sometimes patients have to plug away at a problem for two or three months before they feel sure that they are getting the correct benefits. Changing the settings and changing tack can help you work out whether TENS is working for you as an individual.

See also:

Clinical Nurse Specialist Sue Hepworth on TENS

Frenchay Pain Clinic website

Listen to:

Airing Pain 9: Pain Nurse Kathryn Nur on TENS and acupuncture

PREPARE

Writing down the things that you feel are important for you to discuss is a great idea. When you are in a situation it is easy to forget things or be sidetracked by just one issue. Put the things that are the most important to you at the top as it isn’t always possible to get through everything in one appointment.

YOUR MEDICATION

It is always a good idea to take a list of your current medicines with you. Don’t rely on the doctor having that information, it isn’t always sent when you are referred. This list can save a lot of time and give you more time to ask questions and get information. Remember, your last repeat prescription may not be up to date so check before you go.

YOUR APPOINTMENT

The appointment is for you to voice your concerns/issues and for the doctor to get a good clear understanding of where things are with you. If you are uncomfortable with other people being present, such as medical students, it is perfectly acceptable for you to ask them to go. They will not mind at all and may be glad to get a coffee!

Don’t get aggressive, that will upset you and you won’t be able to get your points across and your health professional may not concentrate on what you are saying but how you are saying it. Assertiveness techniques such as the ‘scratched record’ are very helpful in these circumstances. Stick to what you want. Don’t be put off but try and remain calm and polite, even if those around you may be a little brusque!

DO YOU NEED MORE TIME?

Arranging double appointments is often possible especially for GP appointments and can stop you feeling harassed at the short time you have for all the things you need to discuss. It is an option to consider, but remember that getting two appointments together may mean you have to wait longer to get to see your GP.

TAKE A FRIEND

Having someone else there with you can often help as they can remind you of what you want to discuss. Afterwards they often remember things which you have been told but not taken in. Make sure they are someone who isn’t going to take over YOUR appointment though and they are someone you trust.

WRITTEN INFORMATION

If you don’t have someone there with you who could note things down, ask the health professional to make a note of things – this can include changes to medication, different treatments, names of diagnoses, or other professionals. Many clinics now do provide written information on your plan of treatment for you to take home with you.

Make your own notes just to remind you of what has been said .This is a good way of remembering your previous appointment before you go to a new one, especially when it may have been months since your last consultation and lots may have changed. It can remind you of what you discussed and you can then update them quickly of any changes, allowing more time to discuss the important points.
Pain clinics especially, are notorious for asking you to complete lots of questionnaires! Although it can often feel that these are time consuming and sometimes it is difficult to see their relevance, they often provide vital information for the health professionals and a quick glance can give them information that will allow them to direct your consultation appropriately. This information is also used for research purposes enabling us all to gain a better understanding of chronic pain and its effects. So although sometimes difficult to complete please persevere.

Occasionally at clinics things do not always run smoothly. Notes may not be available, clinics run late for example. It is important to remember that this is equally as frustrating for the health professionals at the clinics and not always as a result of something that is within their control.

It is really important to remember that different doctors have different specialities and so feeling that they ignored or discounted something that was very important to you may just mean that it is not their area or field of expertise and so don’t feel able to give you advice on that issue. Also medicine in general does have its limitations and the health professional may be an expert in that field but there are many things that can’t be resolved or solved and they may not have the answer. It is not that they are keeping information from you. It is simply that they don’t have that information.

Listen to an interview with Jacquelyn Watson on Airing Pain Programme 32, available from www.audioboo.fm

Listen to an article on effective communication between health professionals and patients on Airing Pain Programme 15, available from www.painconcern.org.uk and www.ableradio.com

The programme’s clinical lead, consultant clinical psychologist Martin Dunbar, discusses the main aims and objectives of the values and acceptance based programme. In turn those partaking reveal their own experiences: how they came to be referred, and the impact it has had on their daily life.

To provide further insight into how pain management programmes operate, Lynn Watson, the nurse at the Glasgow Pain Management programme, explains what her role entails and shares advice on how to make the most out of medical appointments. Vera Elders, assistant psychologist, clarifies how mindfulness can be of use to those who live with pain.

All involved illustrate the far-reaching benefits of taking part, and emphasise the importance of putting yourself, and not your pain, in control.

This show was funded by Pain Concern’s supporters and friends.

Click to listen to show 32

Paul Harvard Evans talks to Professor Karen Davies from
University of Toronto and Dr Yves De Koninck from the Quebec Pain Research
Network in Canada. They discuss the benefits that research into brain imaging
and pain networks can bring to pain prevention and treatment.

De Koninck adds, which will only fuel this controversial
argument, that chronic pain is in fact a disease in itself. He says that people
living with pain have lost their body’s ability to control the pain sensation
and repress it.  He also discusses the
perception of pain, which Davies says emotions play a significant part in.

This show focuses on the psychology and neuroscience of
pain, which may help those living with the condition understand what is
happening to them.

Those interviewed include:

Professor Karen Davies, Neuroscience at University of
Toronto, Canada.

Dr Yves De Koninck, Director of the Quebec Pain Research
network in Canada

This show was funded by Pain Concern’s friends and supporters.

Click to listen to show 31.

SUCCESS – Service Users with Chronic Conditions Enabling Sensible Solutions – is a group of patients, carers and former patients with experience of chronic conditions. They work towards making research better and in turn contributing to policy change within the health service.

David Rae, from Swansea University, adds that there is a new tradition of involving patients in the research process. This involvement, rather than participation in the research itself, can include identifying research needs; helping design the research; applying for funding; and recruiting
participants.

Mostyn Toghill, who lives with type one diabetes, highlights the need for patient involvement and the significance of groups like SUCCESS. For instance, discussing personal experiences with service providers, can highlight the need for research into the uniformity off services throughout
different health boards.

By working with groups like SUCCESS, it is clear that research will become much more relevant and results will become increasingly reliable and valid. You can contact SUCCESS at successinreseach@swansea.ac.uk.

• Angela Evans – Research officer at Swansea University
• David Rae – College of Human & Health Science at Swansea University
• Members of SUCCESS including Mostyn Togill, John Flynn, Angela Evans & Jill Edge.

This show was funded by Pain Concern’s supporters and friends.

Click to listen to show 30.

For more information on Fibromyalgia go to http://www.ukfibromyalgia.com/

This show was funded by Pain Concerns supporters and friends.

Click to listen to show 29

It is Brain Awareness week from the 12^th until the 18^th of March. Brain Awareness Week (BAW) is the global campaign to increase public awareness of the progress and benefits of brain research.  For more information about the events taking place in the UK,  check out the calendar of events offered around the country -  click here.

Brain Awareness Week is concerned with lobbying for the continued development of the NHS Healthcare. On Wednesday 14 March a Scottish Parliament Event is being held, hosted by Jamie Hepburn, MSP for Cumbernauld and Kilsyth, the main aims are to:
-Continue to raise the profile of the impact for living with a neurological condition
-Continue to campaign for further improvements in services for people living with a neurological condition

If you suffer from a neurological condition then you may find the following episodes of Airing Pain useful. Click on the links below for the full synopsis and a link to the podcast.

Show 25:  A Heads Up On Migraines

Show 17: Primary Care and Pain in the Brain

Show14: Complex regional Pain Syndome, Phantom limbs and the Importance of Sleep

Show 2: Neuropathic Pain

Jill Davies and Herbie Roley are workshop leaders for Challenging Pain and relate how they aid and encourage those who take part. The workshop runs over two half day sessions, yet the effects are felt far beyond this time period. Rachel Gondwe, Training Services coordinator with Arthritis Care, describes how its success and effectiveness has been assessed.

Utilising self-management changes the role of both those with chronic pain, and their health professionals. It is explained how the relationship can change, and why it is essential that self-management is considered as part of the treatment process, and not merely as an ‘extra’.

Interviews with:

• Rachel Gondwe, Training Services coordinator with Arthritis Care
• Jill Davies, workshop leader at Challenging Pain
• Herbie Roley, workshop leader at Challenging Pain
• Kirstine MacDowall, volunteer tutor at Arthritis Care
• Toyin Onasanya, Arthritis Care’s South England training administrator

For more information on Challenging Pain go to www.arthritiscare.org.uk

This show was funded by Pain Concern’s supporters and friends.

Click on the link below and email to media@painconcern.org.uk.

Media Volunteer Information

Your information will not be given to an external source or used in our magazine, Pain Matters, without your prior consent.