PPG Meeting on Pain and Persistent Pain Management

Wincanton's Patient Participation Group again organised an extremely interesting and relevant Open Meeting on Monday 7th June in the Memorial Hall where we had two excellent speakers to talk about pain. These were Jonathan Thurlow, Clinical Specialist Physiotherapist working for Somerset Community Health, and Louise Tarrant, Clinical Psychologist at Yeovil Hospital. Both specialise in Persistent Pain Management.

They quickly showed us that understanding pain, what causes it and how it can be dealt with can be quite complicated. Much of the pain we experience is acute, like toothache or twisting an ankle. The body is telling us that something dangerous or damaging is happening. Then there is pain which is much more persistent and while it is just as unpleasant as the acute type, it is not always an indication that tissues are in danger and for a significant number of people it can become chronic. It is not something that is going to go away.

This is where the art and science of persistent pain management comes in. In fact it has been practised by NHS for a couple of decades and during this time many hospitals and community teams have employed a range of skilled professionals using a variety of pain management techniques.

The Pain Clinic at Yeovil District Hospital has been running for approximately 20 years. There, a number of different professionals work as part of the Pain Team. Patients referred are assessed and then offered the most effective mode of intervention to suit them. This may include medication, physiotherapy, a TENS trial, a group Pain Management Programme and individual advice and support. Pain Management techniques include pacing activities, using relaxation, managing negative thoughts and moods, learning how to use exercise and stretch routines, etc.

The aim of any persistent pain management is always to learn about persistent pain, and to practice techniques which work within individuals 'real lives' in order to enhance their quality of life despite the pain continuing.
 
After they both had spoken the rather small group who had attended asked a series of extremely searching questions and it was clear that several were themselves sufferers of persistent pain.

This was a really encouraging and interesting meeting and at the end of it Louise Tarrant handed out a useful sheet of explanation and advice (which is attached and summarises the points they made).

It was also announced that the topic for the next PPG meeting is how to deal with Parkinson's Disease, a topic which is of interest not only to sufferers, but to their carers and families. These meetings are a real breakthrough and we hope will attract more people.

Nurse Practitioner Sarah Stephen,
General Practitioner Helena Smith,
Clinical Specialist Physiotherapist Jonathan Thurlow
and Clinical Psychologist Louise Tarrant.

John Baxter

Persistent Pain Management - Notes by:

Jonathan Thurlow (Clinical Specialist Physiotherapist; Somerset Community Health)
Dr Louise Tarrant (Clinical Psychologist; Yeovil District Hospital NHS Foundation Trust)

Making Sense of Persistent Pain

Persistent (ongoing) pain is a very complicated problem. It is important to have an understanding of pain and the healing process to know the differences between acute and persistent pain. This will also help you to explore the different ways of managing your pain and the reasons why these are so effective.

Types of Pain

Acute Pain:

This is pain that lasts for less than 3 months. Sometimes pain can go away as soon as the 'irritant' stops, e.g. when you prick your finger with a pin. Sometimes pain will last for a few weeks and this is an indication of 'trauma' where the tissues have been damaged, e.g. hitting your thumb with a hammer or spraining your ankle. Sometimes pain will last for a few months after a great deal of 'trauma' has occurred, e.g. after a joint replacement or a fracture.

Acute pain is when the body is telling you that something dangerous or damaging has or is happening. It is a helpful guide to make you behave differently while your body heals. For example, it reminds you to limp when you have sprained your ankle, and it tells you to move your hand quickly when you accidentally touch something very hot.

Acute pain will only hurt while the tissues are still healing. Once they have healed and the damage or danger is over the pain will subside.

Persistent Pain:

This is pain that lasts for more than 3 months. It is continued or recurrent pain that goes on for longer than the normal tissue healing process time. Persistent pain is not an indication of tissues being in danger or of damage happening now. Persistent pain hurts just as much as acute pain and, although it is not due to damage or danger it is no less distressing or real than acute pain.

Reasons for Persistent Pain

Many people suffer from ongoing pain. One of the most commonly asked questions is why? This is a very complicated and difficult question to answer. There appear to be three main reasons for persistent pain with most people having a combination of all three causing their symptoms:

• There is a physical source for the pain.
• Deconditioning has occurred.
• Changes in how the pain pathways work.

In other words, the original injury has healed but unfortunately due to the altered nature of your nervous system, pain signals continue to be produced. With ongoing pain the pain you feel is not related to ongoing injury or damage.

Pain Gate Theory

This theory was discovered by Melzack and Wall in the 1960s. The theory is that there are nerve gates in the spinal cord that can open or close to filter the messages from the nerves to the brain and from the brain back to the body.

Various things are recognised to open the pain gates and hence aggravate pain, these include:

• Overdoing things – pushing through pain
• Focussing on the pain, thinking about and talking about it lots
• Fear
• Tension
• Depression and low mood
• Stress, worry and anxiety
• Tiredness
• Poor posture
• Inactivity – doing as little as possible and avoiding lots of things

Various things are also recognised to close the pain gates and hence reduce pain. Many of these work on encouraging the body's natural pain relief (endorphins) to be produced. These things are important to know about to assist in filtering pain messages when the nervous system is on high alert and sending excessive pain messages (as in Persistent Pain).

Things that close the pain gates include:

• Exercise and movement
• Pacing activities - finding the balance between doing too much and too little
• Relaxation
• Laughter and doing things that bring you pleasure
• Distraction
• Good posture
• Challenging and balancing negative thoughts and feelings
• TENS
• Heat and/or cold
• Setting achievable goals

The strategies covered in Persistent Pain Management help you to manage your pain symptoms by influencing the pain gates. Ideally people are given information on what techniques can be helpful, and are supported in practicing these and then incorporating these into their daily life. In other words, having a quality of life despite pain.

If you are experiencing persistent pain then here's what should you do. Basically we suggest the place to start is to see your GP who may be able to help you develop your ability to manage pain better. Your GP may then also refer you to the Expert Patient Programme which means becoming part of a group consisting of others who have developed their own skills in dealing with their persistent pain, or your GP may decide that you should be referred to a Pain Clinic.

Comments

Posts: 1

Pain Management
Reply #1 on : Fri June 18, 2010, 14:09:01

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Since undergoing two knee replacements, my mother has never really recovered from the pain following the operations. It's so much a part of her life that she expects to have to live with it for the rest of her life. I will show her this article and hope that I can encourage her to talk to her GP about managing her pain in a positive way.

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