How do you apply to get into a Pain Management Programme?

Theres two ways. You can either be referred by your GP or you can be referred by the Consultant at the hospital, that can be an orthopaedic consultant or the pain doctor, the rheumatologist, or neurologist, the people that do the neuro, or the neurosurgeon, but you have to be referred by either one of those and the Pain Management Programmes are up and down the country.

Now, theres two, a lot of GPs they get mixed up, they think a pain clinic and a Pain Management Programme are the same thing. A pain clinic is where they’ll give you medication, injections, all sorts of you know interventions I suppose. Whereas a Pain Management Programme won’t give you that, any medication. Their main primary purpose is to help you take more control of your pain. They accept the fact, they’re not saying they’re disbelieving you, but on the Pain Management Programme therell be a pain doctor, an anaesthetist who specialises in pain management, clinical psychologist and a physiotherapist.

They’re the three main criteria for running a pain management… to call your self a Pain Management Programme. And it’s not, when you say… when I say to people theres a clinical psychologist they immediately think ‘I ain’t mad but it, that’s not like that. Because pain has a psychological effect on you as well, like your thoughts and feelings, you need someone like that, with that professionalism to actually take you through that, to say ‘Well hang on a minute, perhaps you need to change your thoughts here a bit. So, but a lot of GPs, I was at a pain meeting the other night and a lot of GPs in the audience didn’t understand the word pain management. They all thought a pain management was a pain clinic.

So, yeah even the health’, some healthcare professionals get it wrong as well. But to be referred onto a programme, you need to be referred by your GP, the pain consultant, rheumatologist, an orthopaedic consultant or surgeon or the neurosurgeon, a healthcare professional. Physiotherapy can’t do it, or occupational therapy, it’s got to be someone like a doctor type bod.

Well the process to go through the pain clinic is just, you get a referral from your doctor and the doctor would then… the pain clinic would actually get in touch with you and you go for an interview, the initial interview, and with a psychologist, I think it was. And they assess you. If your, think they’d be, get a benefit out of the programme and they get back in touch with you and you go for a second interview, I think I went for a second interview, and they tell you when the programmes going to start and the programme lasts for I think it was 12 weeks and the actual programme itself it’s like a group therapy session.

I wouldn’t say group therapy but it’s a group session, a group discussion and it was always done things in a group and there was psychologists, physiotherapists, medical profession and they’ve all got something to say and they get feedback from you and you go through various parts of programmes like exercises. How to do the exercises properly, how long to do them for, when to do them, relaxation. I think that was a big factor that didn’t really work for me. I’ve got my own way of relaxing so relaxation tapes just did not work for me.

I had to use music tapes to relax and that went on for 12 weeks. Psychologists talking to you, understanding things, lots of form filling in and that was it. And one interview, well one meeting, about a month after the programme had finished just to see how we were getting on with things, see how we were coping. I’d say my mobility because of the advice I had got from the programme, I’d say it went up by another 20-30% so I’m quite happy about that. I’m actually being able to get on with my life to a certain extent. Well, I’m not as near as what I want it to be but a lot better than what I was before.

When I went to pain management, one of the first things they do is video you walking up and down the corridor – front and back views. After the third week, they do another video of you walking up and down the same corridor and they show you the results of the videos, before and after, and the difference is unbelievable, wouldn’t believe it, the difference in your walk, theres so much difference.

As I say about the girl with the crutches was the most, was… since she was on crutches the first day and after three weeks she was walking up and down the passageway without them. All right, she could only walk up once and back and then she had to put on the crutches, but she actually walked up and down that passageway with no crutches and it was great, it was a great thing… Should have more of them.

What else did they do? Did they ask you any other questions about your pain?

Mostly about tablets, what sort of medication we was on. They’re quite hard on that, they try to get you to cut down on your tablets and they succeeded in I’d say 99% of the cases. Everyone that I knew cut down on their tablets and I think this is the sort of thing that it should, you’d come when you first had the accident, before anything else, if someone has an accident at work or at home and they’ve injured their self and get in this sort of position, this should be one of the first things they go to, a Pain Management Clinic. Not leave it ten years before you go. They should have these up and running, straight in. It’d make life a lot easier.

Anyhow there were a group of us. I think there were about eight people and one was a lady who’d had a leg amputated and had phantom pain. There was a nurse who had a… she had something similar to me. There was a postie who’d broken his neck and had pain all down his body and we were just a random group of people from all over England and we One was a policeman who’d had a hernia operation go wrong, left him in chronic pain.

And we just sort of… because of the common element of sort of hopelessness and pain we just gelled. There was one lady who didn’t fit in. There was a girl who quit, couldn’t cope with it. She was a victim of a motorcycle accident. But the rest of us sort of stuck together and we went gradually through this programme. And first of all they educated us.

They told us how the pain systems in the body worked. They told us what happens to the body when people get chronic pain and stop moving, all the tendons, ligaments and that seize up, you get muscle guarding and all these things and so that gradually movement becomes more and more painful, not because of the original illness or disease but because you’re seizing up. And so through a very gradual, a very careful process of exercise they taught us to limber up.

However, I read a magazine, and this guy had been on the Pain Management Programme and I just sort of read this story and I thought ‘Yeah, that’s going to be me. I’m going, I’m going to do that’ and it wasn’t as easy as I thought, it was in ’92 and it, when I got on the programme it was ’94, it took me quite a long time to actually even locate a Pain Management Programme.

It was National Health. But the one that I wanted to do wasn’t in my area and it involved, you know, Department of Health. My doctor, actually… it was fantastic because shed had a back operation herself and she knew that I really, really wanted to get my life back and she believed me because that was the biggest problem I had was that, you know, even though I’d had these operations some people still didn’t really believe me.

But anyway she, she was absolutely brilliant. I wrote to my MP, I did this, I did that. Anyway to cut a long story short, I did get onto the programme and at that time in ’94, I went into a hospital over three weeks and I cried for three weeks. I didn’t really think that I was that emotional but I obviously must be but I didn’t cry emotionally. I cried because I was in pain because I’d never, apart from after that last operation I’d never exercised in my life and I was now 54 and to go into a sort of exercise routine from never, you know, doing exercise. It had never been part of my life. I found it excruciatingly painful.

But because I’d been so screened by physiotherapy, psychologists and everything like that, they knew that in spite of the surgery I’d had and in spite of the pain that I was getting, it was safe for me to do this. And I, even to this day I don’t know why, but I just felt safe in their company and I don’t, I don’t know whether it was because I’d just read this story of this guy, you know, got his life back. I thought ‘Yes. This is going to happen to me. Even as much as I believed them and I felt safe in their company, I still went in there thinking I was going to be cured.

And the turning, that’s why it was a turning point in my life, because after 3 weeks you come out. You get a programme to practice exercises. I mean there were lots of psychology and stuff like that. It wasn’t just simple. It was quite hard actually. You talked about drugs and things like that but you just learned to live by different rules and they’re really simple rules and then that, theres nothing earth shattering about it.

When anyone ever goes on a Pain Management Programme, they always say the same thing, you know, ‘Why didn’t I think about that?’ You know instead of sort of standing there doing ironing for like 3 hours. Why don’t you just do it for 10 minutes and take a break and it’s all silly things like that, you know, simple things that one pushes themselves to the limit thinking that if I just do that and then I can sit down and I’ll be okay instead of making your pain worse by stopping it probably helps it.

And it’s all silly things like that and also exercising which for me was the biggest revelation because now I can’t live without exercising. You know, it’s simple but that’s part of my life.

And so it was arranged that I went into the pain management course and I was very reluctant to do the things that I was being asked to do. Like exercise. When I… every movement produced cramps and spasms, to suggest that I did exercise was completely beyond the pale.

And I was very angry and the first week, I think I just was sitting there, well sitting there for a few minutes at a time then wandering round and then coming back and sitting down again and reluctantly doing perhaps one attempt at each of the exercises that we were given, physiotherapy exercises.

I enjoyed the relaxation that we had, that was good. And I enjoyed the sessions with the psychologist. And at the end of the first week I was beginning to feel well I might have got something out of it but I wasn’t quite so sure whether it was for me. But I was enjoying the whole process of people together sharing their experiences. What was good was seeing that there were other people like myself who had got pain and were struggling and were going through, were in various stages of coping.

What was good, I found, was that they were people who’d started their four week session and were now in their third and fourth weeks when I was in my first. And hearing from them, that they had been like myself when they started, and I could see these people doing tremendous physical exercise, being very positive, that was, I think the biggest thing that convinced me that there was something about the pain management approach that was for me.

I was living in digs in [city]. I went over to [city]. Lived in digs just about 100 yards from the hospital to make getting there a bit easy. And so I went home on the Friday, after the first week, and it was quite interesting that I got the idea into my head that, by then that, well perhaps things should change.

I’d been in this situation of not being able to sit through a meal, and so I went home and decided I would sit in a different chair for a meal, family meal. This happened to by my youngest son’s chair. I think I chose him because he was least likely to object, or he was the least powerful member of the family!

But I sat in his chair and sat through the meal and this became a family joke, that change does something. And I felt as though I’d achieved something absolutely miraculous and major, that I’d actually sat through a meal, simply by changing my chair. So I went back full of enthusiasm for the course on the Monday and I started to make a lot of progress.

Back to the Pain Management Clinic… Their programme of exercises I think again I pretty well knew what to do but I think I got myself into a cycle of progressively doing less and less, getting stiffer and stiffer and it was difficult to say which was, what was pain caused by an injury or whatever or what was stiffness, that any use was going to cause me pain.

So I managed to get myself moving a bit more and I think an awful lot was caused by stiffness. And also that however much I rationalise to myself that exercise wouldn’t hurt me, there was the belief there that it’s going to hurt me. I think finding out in a safe environment that it didn’t hurt me and it was actually beneficial was very good as well.

They also spent quite a lot of time with me trying to persuade me to pace myself because if I take something on that I like to finish it, come what may, and I come from the sort of old school ‘Oh anyway if it’s a bit sore never mind get on with it’ kind of thing. Which was all very well because I was getting on with it and then days on end I was paying for it, so he taught me to sort of do things in little bits and build up to things so again I think that was a very helpful discipline and to have people there. The group there and also the psychologist and the physiotherapists to sort of, if you like, chivvy me on was, was good and to sort of check things out, try things out and get back to them and they would adjust things so’