PAIN MANAGEMENT - A NEW LEASE OF LIFE

TWO PEOPLE DESCRIBE THE DIFFERENCE MADE TO THEIR LIVES BY TAKING PART IN A PAIN MANAGEMENT PROGRAMME

Judith Benton attended a programme at Astley Ainslie Hospital

YOU WOULD surely think, that someone who had had back pain for twenty years would have learned to live with it efficiently. In fact, for the first ten years or so, encouraged by my GP, I took the painkillers and ignored the problem as much as possible. In those days, however much my back ached by the evening, I would be better, except for stiffness, in the morning. Nothing I did or didn’t do in the daytime seemed to affect the outcome much. Gradually, as the years went by, the pain began to dominate my days as well as evenings. Like most people with chronic pain I did a lot of fairly fruitless hunting around for help, but with the aid of physiotherapy, yoga and, especially, Alexander Technique, I began to make progress. I learned to get through the day without aggravating the pain as much. The level of the pain became lower and more predictable. I had less bad spells and spent less time recovering from them. I gained confidence and started to job hunt. Then we moved house.

Somehow the move left my back in what seemed a permanently irritated state. (I had NOT moved furniture around or carried heavy boxes.) I seemed to have lost all the progress I had made and I felt so tense and frustrated that inevitably I was making the problem worse. Pain Concern told me about the pain management programme at our local hospital, my GP was willing to refer me and I joined one of the programmes.

The Astley Ainslie Pain Management Programme is an outpatient version, twelve half-days over ten weeks, run by clinical psychologists and physiotherapists with a team which includes a nurse and an occupational therapist.

There is a further medical screening before patients are admitted to the programme – a last check that there is no magic cure and that the future lies with managing your problem as well as possible and seeking to prevent any further deterioration.

KEY ELEMENTS IN THE PROGRAMME

1.  
2. A carefully graded and self-monitored series of exercises to help people regain flexibility and fitness, especially those who had been afraid that exercise would cause further damage.
3. Pacing and goal-setting to enable people to maintain or increase their level of activity without causing flare-ups of pain.
4. Relaxation training, cognitive anti-stress and depression techniques to help cope with the stress and frustration of living with chronic pain and reduce the tension which aggravates it.
5. Reducing dependence on long-term medication.

There was also basic education about the structure of the body and the effects of different postural habits and lifting methods.

It was accepted that we would not avoid flare-ups of pain entirely so we discussed the management of flare-ups. The last lesson of the programme focused on the future, maintaining our progress and working towards longer-term goals.

It seemed to me particularly effective that the main elements in the course ran in parallel so that success in one area fed success in another. Conversely if one were not having much success in one area, success in another was encouraging. The staff were very supportive and the bringing together of different professional backgrounds was invaluable, both in the content of the programme and in the differing perspectives offered during discussions.

I still have chronic pain; in fact, I think I still have the same amount of chronic pain. But I FEEL much better. The significance of this may easily be overlooked by those who are totally focused on finding or providing a cure. But if you are going to live with your chronic pain, most probably for the rest of your life, then the way you feel about it is crucial. I feel better because the programme provided a lot of information, a safe environment in which to explore our limits and the opportunity to think out a policy appropriate to a long-term problem. If you are going to have pain every day you need to plan for it, not just react after it has started.

You live surrounded by other people who are always urging you to do more or do less, according to their personalities and the needs of the moment. You also have your own fears and bouts of impatience with the need to treat your injury with respect. It helps to have a very clear idea of what you can do and what you cannot do.

I do have the odd criticism. The programme was rather rushed and probably needed at least two more sessions. It was a bit loaded towards the needs of those who had given up a lot of activities because of fear of setting off the pain. After the programme there is, at present, no organized follow-up, no opportunities to take some of the ideas further and no refresher courses for those who, under the pressure of everyday living, find their pain management skills getting rusty. Yes, I know funding for non-acute services is very scarce.

Studies of results of pain management programmes both in UK and in the USA (where the idea seems to have originated) have shown a consistent pattern. People come off the programmes without any significant reduction in the level of pain but able to do more (sometimes much more), without causing flare-ups of pain and with a greatly reduced dependence on medication. They feel fitter, more confident, more optimistic about the future and in control. Comments I have heard from people who have attended programmes follow a remarkably similar theme: “I feel as if I can control my pain now instead of it controlling me”, “It feels like a new lease of life”, and even, “It saved my life”.

John Solomon also took part in a pain management programme

MY TALE is probably much the same as that of thousands of other people who have suffered chronic pain. The visits to the local GP, referral to a Physio Department, and then to a consultant surgeon; the operation, the recovery, and the realization that all is not well. The surgical aftercare, more physiotherapy, and the prescription of a range of pills all intended to approach the problem from a different angle, and all with side effects.


At this point, my chronicle of pain becomes more individualistic. A final and totally different type of treatment is offered, I perceive it to be the end of the line, and approach it in a highly motivated and positive state of mind. It is a pain management programme at a nearby hospital.

I should, at this stage, mention that acceptance onto the programme was subject to an interview with a clinical psychologist. As far as I could tell, this was to confirm suitability, and to discover to what extent my life had been affected by chronic pain. Since I am fortunate enough to be in employment, it was also necessary for me to obtain approval by my employers to be released from work for twelve half-day sessions.

As far as the course itself is concerned, I found the staff to be very professional, supportive and approachable. My lifestyle was bombarded with new habits, attitudes and exercises. I was furnished with more understanding and knowledge of how I could help myself, and why, up to that point, I was my own worst enemy. By the sixth week, I was considerably more comfortable, with improved levels of stamina and elasticity, and had, by that time, started a programme of pill reduction which, within a few months, cut my pill intake from sixteen per day to zero.

I have changed from being a person whose life was controlled by pain to being merely influenced by it. My work record is now “normal”, and I can take on a long drive with confidence. In case I have given an incorrect impression, none of this was achieved easily, and the hardest part will be maintaining my new habits for the rest of my life. However, all of this would not have been possible without the expertise, hard work and dedication of the pain management team, and the love and support of my wife and daughter.

For information about pain clinics and pain management programmes write to The British Pain Society, 3rd Floor, Churchill House, 35 Red Lion Square, London WC1R 4SG, or visit http://www.britishpainsociety.org
http://www.britishpainsociety.org/patient_publications.htm - gives a direct link to the British Pain Society's most up to date publications.

Pain Management © Judith Benton & John Solomon. All Rights Reserved.