Pain management

[Spring02]

I have a pain management appointment next week. The doctor put me forward for it because I have fibromyalgia.
Does anyone know what I can expect when I go?

Hi, OP. Who is it with - a Persistent Pain Service or Pain Management Programme of an NHS Trust? Or something else?

Hey, it's definitely through nhs but the letter doesn't say much at all. It just says clinic:chronic pain

I have this too. I went on a persistent pain management course (GP referred) It was six weeks long and quite invaluable. It explains about stress on the body and how it takes its toll. Cortisol causes a lot of havoc in the body and course discusses ways to manage it. It also explains about pacing yourself. Being kind to yourself and not putting yourself under pressure to do things when you don’t feel well. How to help better your sleep. Because we were in a group setting it helps to know that you’re not on your own and we offered each other a lot of support. Oh and have Epsom salts bath too - very beneficial. Try and google meditation and relaxation techniques. Lastly, keep as active as you can but stop and have sit downs regularly don’t push yourself. I hope you can find some relief from it. It’s a frustrating diagnosis.

When my GP referred me I went long not really knowing what to expect, too.

Turns out it was an assessment with a chronic/persistent pain specialist psychotherapist. We had x2 one hour sessions. The psychotherapist then offered me various options including more Talking Therapy. I actually opted for a 3 month pain management course which promotes mindfulness, the ACT model, safe movement and group therapy.

I am now waiting to start another NHS course of adapted movement & gentle exercise.

These types of pain management courses are becoming more prevalent in the NHS as a way of managing persistent pain, fibro, chronic fatigue and long covid.

It really didn't sound like my cup of tea at all, but I'd definitely now give it a thumbs up. The group work was especially encouraging. You really connect with people in the same boat. (Sorry for the all metaphors there!)

(NB: ACT = Acceptance and Compassion. You can find lots of resources online for this, mindfulness, basic Tai Chi etc.)

I can't believe/hope mindfulness is the only option.

This sounds like the Pain Service. It depends how bad your pain is as to whether you may find it helpful or not. For my don’t know where to put yourself want to chop my leg off pain their mental well being type approach was useless. My pain is not affected by “mindfulness”.
They can advise on pain meds too which can be good because gps can be reluctant to prescribe some of the more costly stuff without this but be aware that patients are frequently encouraged to think the pain is in their control.

I think its really important to go in with an open mind and really try everything suggested. There isn't a magic solution to chronic pain which will leave you pain free, and its about finding tactics that let you live with pain.
I have a 'cut my arm off' level of pain (though the issue is that cutting it off would almost undoubtedly leave me in more pain) and actually the mental side of pain management is vital as pain is there from nerves generating pain signal, then the brain reporting it. Certainly in my pain condition, the biggest strides in pain management have been using VR to retrain your brain to get out of the pain spiral where it reports more and more pain.

It's not the only option but it is really important part of it.
I have fibromyalgia and have done so over 30 years.
Though I never went on a pain management course I have learnt lots of techniques to make it manageable.
Deep relaxation, yoga, managing my stress, keeping my blood sugars balanced through diet, fighting for the pain and doing some cardio exercise regularly, acupuncture and massage have made my life much easier. Acceptance is also important if pain and insomnia. Being upset and woe is me is allowed every now and again in my head but in general I just crack on with it. I managed to work full time and have 3 kids. At times it is fucking hard but if I do all these things it improves.
There isn't a pill that helps (in fact I learnt the hard way they cause more issues) so came off them all and occasionally take a ibuprofen if I have to sit still for a long time as this is the worst

I'm due to go on a course. I already do almost the things mentioned, breathing, relaxing, I have plenty of time to myself.

I still feel that whilst mindfulness is a good technique it doesn't suit all. What about getting to the root cause of the problem. In fact I have read many many articles. In fact when I broke my back in 4 places, still not fully better a year later. I've done nothing else other than read literally every article I can find. See this one.

<a class="break-all" href="https://www.google.com/url?q=www.ncbi.nlm.nih.gov/pmc/articles/PMC4479890/&sa=U&sqi=2&ved=2ahUKEwjzmtWOtIyGAxWJXUEAHX0HCT4QFnoECBsQAQ&usg=AOvVaw2i9w3UK1U01mkg7DsV_1YU" rel="nofollow" target="_blank">mindfullnrss

Many say that whilst mindfulness has its place, it's not the answer to all. And many articles say more research is needed into the effectiveness of mindfulness. Not to rely on it to fix all.

In some respects it seems like it's the latest fad that has come over from Asia alongside yoga and breathing exercises and it seems to be the new age answer for everything.

but actually the more you read generally you realise many many areas of medicine, a lack of real answers, they just literally don't know what they're doing and they don't know what the answers are. and sometimes it comes down to money And other times it's a lack of progress.

And sometimes it just seems to be no easy answer. I mean honestly sometimes you look some things up like a herniated disc which can cause terrible pain in the spine and there's literally very little answers for it. One of the articles I saw said you keep moving and make sure you've given up smoking !!

"You can help prevent getting a slip disc by regular exercise and quitting smoking".
and I was like you can't be serious. Is that the best answer that you've got? Smoking?

I was diagnosed as a diabetic 50 years ago and three doctors told my mum that they hoping they were hoping for a cure within 10 years. 50 years later they've achieved little cure wise.

It's also a bit like cancer, used to be one in five, then one and three, now it's one and two and despite years and years of research they've actually made very little progress.

and when you look up most health conditions on the Internet, it's very clear that the Medical world doesn't actually have very good answers for anything see above point about herniated disc. I haven't actually had a herniated disc but I know somebody who had the pain was absolutely terrible and the suggestion that things will get better and take a couple of paracetamol You read about being offered practically no pain relief for childbirth and you wonder if there's just not a bit of misogynistic treatment going on here anyway I'm going round and round in circles. It's just a part of me that feels a bit sceptical about it all I can't work out why better progress is not being made why people seem so blasé about pain and the terrible effects it can have on people And question this new view mindfulness really is the answer.

Yes I'm sure it does help a lot of people but I really don't think it's the latest answer and honestly believe the NHS who are so deprived of money and in such a state have kind of turned to it because they've got literally nothing else to offer.

And that very pessimistic and depressing and I don't want to think in a negative way but all the reading I've done hasn't come up with any other suggestions or any other way of looking at it.

I want to be open-minded and go on my new course, six weeks online with an open mind. But I'm starting to wonder is that really the best that they've got? Because if it is that's poor.

If you are in pain then that is the body's system telling you something is wrong. So why not try and fix the underlying cause. Say if you had .... Plantar fasciitis, you wouldn't want to pay take painkillers for the rest of your life. You'd actually want to address the root cause and do the exercises or physio or anything just stop the pain at the initial / root source.

I said that to one of my doctors, re not wanting to take painkillers for the next 40 years, rather wanting to address the root cause and he had no answers.

Is it that I'm not looking at the mindfulness course in the right way?

It's also a bit like cancer, used to be one in five, then one and three, now it's one and two and despite years and years of research they've actually made very little progress.

@Oblomov24 sorry, I don’t understand this sentence.

Isn’t that the statistics linked to cancer - the prognosis used to be that one in every three people would get it, now it’s one in every two people will get cancer.

TheOnlyLiving thank you.

Sorry, I was just speaking fast, getting everything off my chest! This is a sure argument, re cancer, not my main point.

My point is, cancer it's becoming more common . When I was younger, they would say that one in five people will get cancer. Then the stats moved to 1 in 3. Now it's 1 in 2. So more and more people are getting it. But the answers aren't any better.

And in the last 50 years, quite a lot of money has been spent on cancer research . But the fact is, they haven't actually made that much progress.

And that's just my point very little progress is being made generally .

And they have very little answers to a lot of medical issues. And when you look things up many of the answers are so generic they could apply to anything. I've honestly looked up quite a lot of back conditions thinking that it might be what I had and nearly everywhere they say eat well and move more. and you're like 1) physically I can't move so that's not very helpful. and if you feel like saying is that the best you've got?

you search and search about all back conditions. about osteoporosis and other back conditions and they actually have very little answers, other than keep yourself healthy , keep yourself active. Is that all the advice you've got? don't you think we already know that.

And I find some of their answers Dismissive and blasé. I don't know how much pain you've ever been in. I've never been in very much pain until this, but the suggestion of taking a couple of paracetamol. These people are on a different planet, they don't seem to realise how much pain I'm in.

And I find a lot of suggestions very very dismissive and that's just how I feel.

Thank you iblomov I understand now

If you are in pain then that is the body's system telling you something is wrong. So why not try and fix the underlying cause. Say if you had .... Plantar fasciitis, you wouldn't want to pay take painkillers for the rest of your life. You'd actually want to address the root cause and do the exercises or physio or anything just stop the pain at the initial / root source.

Actually no. With chronic pain your brain has got into a loop with thinking there is something wrong with your body. The underlying route cause isn’t an issue with your body and so fixating on physio exercises, for example, is counterproductive because you are reinforcing to your brain that there is something wrong with your body and therefore your brain ramps up the pain signals.

With chronic pain you need to reinforce messages of safety and that your body is ok so your nervous system can calm down and stop firing off the pain signals.

I've been trying. Reading up on neuroplastic pain treatment, ; different styles of breathing I've been practicing regularly. It's not working at all so far.

My sister is (from a very kind place) trying to get me to go on one of these courses and borrowed a book from the hospital she works in all about it.

I read it and wasn't convinced. It's a nice idea that you can do a bit of yoga and pace yourself etc but to me, that doesn't make sense. It seems to suggest the pain is imaginary and you can will it away.

My pain is caused by arthritis, labral tears and massive instability in my hips. That's not imaginary. I don't WANT to have this pain so why on earth would it be there if it wasn't real? To be honest, I just want to take loads of drugs so that the pain is dulled and I can try forget it. I don't want to lie on a mat and imagine myself on a beach.