Most of the patients attending the pain clinic have had pain for more than six months. The pain has been difficult to treat, and you may have had treatment that has failed. We will fry to explain what is happening, and help if we can.
When you have been in pain for several months there will be changes in the body that can keep the pain going, even though an original injury has healed. It rarely takes more than six months for an injury or an operation to heal.
The sensation of pain is carried in the nerves. An injury excites the nerves, and causes pain. If the nerves are excited for a long time, then they become more sensitive, and can generate pain even when the injury heals.
The spinal cord and the brain also become more sensitive to pain if the pain lasts for a long time.
When we have pain the normal response is to avoid anything that makes it worse. Pain is often increased by movement, and we avoid those movements that make it worse. This can be harmful, because the muscles rapidly become weak and stiff when they are not used. The weak, stiff muscles become a new source of pain within a few days.
Sometimes we brace ourselves to prevent a painful movement, and the muscles may contract for a long time to hold us still. These muscles will ache, and can go on to develop cramps and spasms. The muscle pain can be worse than the original pain.
When a joint is moved or squeezed too much it can be painful. As we get older our joints can become arthritic, which might be a result of wear and tear.
Regular use seems to help the joints. the most pain comes from the stiff joint that has not been used much. The way in which the joints are being used can cause pain, and this is often the problem. Damage to the joints is less common, but obviously happens in accidents and illnesses like rheumatoid arthritis.
THOUGHTS AND FEELINGS
When the pain does not go away, our thoughts start to dwell on it. It can be very difficult to ignore the pain. If the pain stops us from doing what we enjoy, or stops us from doing what we need to do, then we often become frustrated, angry or depressed. These are normal reactions to a painful situation that will not go away: but make life even more difficult. Sometimes the pain is frightening, and the future can seem fuff of pain, with more and more problems.
Our bodies react to our emotions: the pulse races, we feel our face go red, the blood pressure increases. The muscles and nerves react: the muscles tense up, and the nerves become more sensitive, ready to do something. The stress from pain makes this happen, and the reaction of the nerves and muscles can increase the pain. The pain can then be even more frustrating, frightening and depressing — and cause even more stress to the nerves and muscles. The “vicious circle” runs round and round, and the pain gets out of control.
The importance of the way in which we react to pain is often forgotten. The effects of pain are too important to ignore and if we treat the body but ignore the thoughts and feelings that go with the pain then the “vicious circle” can bring the pain back.
WORK AND FAMILY
Pain makes it difficult to work normally: the pain can increase, and it can affect our ability to concentrate on the job. It can rob us of any energy or enthusiasm for our work. The pressures of work can make it more difficult to cope with the pain.
The difficulties of being out of work can affect the pain even more. Almost everyone has fewer problems with pain if they can continue to work: if you can keep a normal lifestyle, then it is easier to cope with the pain. Sometimes people have to change their work, but this is much better than giving up altogether.
Our families are also affected. We can become irritable, depressed and difficult to live with. We feel unable to take part in family life. The situation leads to the whole family being upset by the pain. Like work, the best way to cope is by trying to keep family life as normal as possible. Changing because of the pain can make the situation worse.
We know that pain can be helped. We also know that medical treatment, with drugs, injections and operations becomes less useful as the pain lasts longer. This is because of the changes that we make to cope with the pain.
Some people have had a lot of medical treatment, and may not need any more: if it has not worked in the past, then it will not work in the future. Other people may not have had all the treatments that can help, so we may start with pain-relieving drugs, injections or with asking a surgeon for advice.
It is helpful to took at how the body works, and we often use physiotherapy to treat stiffness, weakness and changes in the muscles and joints.
The thoughts and feelings we have about pain are important, and we can explore how they make it difficult to cope with pain. Clinical psychologists bring a special skill to this side of the pain. The way in which we react to pain can make things more difficult, and we are never really prepared for it. It is normal to feel upset, angry or depressed. We can learn ways to avoid some of these feelings.
We can learn ways to deal with both the physical and mental difficulties of longlasting pain. A pain management group can bring together patients with physiotherapists, nurses, psychologists and doctors, and teach new ways of avoiding the effects of long-tasting pain.
We know that some pain will never be cured. We also know that it can be helped, and that the best results come from working together to live normally even if some pain remains.