Tuesday, October 26, 2010

In pain? Don't let your GP fob you off with pill... | Mail Online

Twenty years after Ian Semmons was badly injured trying to prevent a robbery, he is still in pain. Thrown down a flight of stairs, he'd shattered his back and ankles.

Despite two-and-a-half years of operations and rehabilitation — and strong painkillers — he lived in constant agony from his shoulders to his ankles.

'At its worst, it was like having big, sharp needles thrust into your body,' recalls the former risk management consultant.

Ian is one of nearly 10 million Britons who ­suffer from chronic pain, which is defined as continuous, long-term pain of more than 12 weeks.

Worryingly, a new survey has found that people in the UK wait, on average, three years for a diagnosis of what's causing their pain, and a further three years before the pain is adequately managed.

In many cases, chronic pain affects sufferers' ability to work: four in 10 are unable to work at all, according to the Pain Proposal European Consensus Report funded by Pfizer. Pain is a natural response to injury.

Rather like sending a telegram, the damaged nerves transmit tiny messengers called neurotransmitters to the spinal cord — the body's superhighway — and then to the brain, which decides how to respond.

As the injury heals, the messages become less intense and less frequent, and finally stop. But this mechanism can go awry. Like a broken record, it keeps repeating itself, re-sending the messages of pain long after the reason for stimuli has passed.

A quarter of people affected by chronic pain suffer from depression, and many feel their pain is so bad that at times they want to die.

Yet sufferers are very much neglected in the UK, because GPs are uninformed about chronic pain and designated pain clinics, says Dr Beverley Collett, a consultant in pain medicine at the University Hospitals of Leicester and chair of the Chronic Pain Policy Coalition.

'Many healthcare professionals don't know enough about chronic pain,' she says.

'During their five to six years of medical school, doctors spend just 13 hours on pain. Nurses spend just 10 hours, and physiotherapists manage to clock up 35 hours.

'But this is simply not enough time to understand this complex problem.'

Yet there is more reason than ever for young medics to take this part of their training seriously, she says, as experts are at last discovering that chronic pain is not just the body failing to heal, or, worse, a ­psychosomatic 'cry for help'.

'For a long time, patients who complained of chronic pain were labelled with depression,' says Dr Collett. 'Now, we are realising they may be suffering what we call a hyper-excitable response within their bodies.

'This means that nerves in the area of original damage have become so sensitive to stimulus they keep reporting sensations back to the brain — even when nothing is going on to warrant a message. In turn, the brain interprets that message as pain.'

Once activated, this has a knock- on effect, causing other nerves to fire off pain messages, too. 

In many cases, chronic pain affects sufferers' ability to work: four in 10 are unable to work at all

How well chronic pain is managed depends very much on how well your GP understands the condition — and whether you live close to one of the UK's few chronic pain clinics.

Like many patients, it was three years after the initial incident before anyone recognised that Ian's acute condition had become a long-term pain problem. He'd been effectively left to manage, with his GP prescribing the strongest pain­killers month after month.

By the time he was referred to a pain clinic, after changing GPs, the active fortysomething man had become angry and frustrated — unable to work or even to play with his then five-year-old daughter Becky.

His marriage had broken down, as his wife was unable to cope with the change to her husband.

'It was only when I got to see a consultant in pain medicine that anyone explained to me that I was going to be in pain for the rest of my life. Ironically, this was more of a mental boost than it sounds, as he told me I had to accept that I was not going to "recover" in the accepted sense, and that I had to get on with my life again.'

But the real improvement came 14 months later, when Ian was referred to a psychiatrist. 'I had reached rock bottom by the time I saw him. I had even taken to hiding a pack of very strong painkillers so that I could end my life if it all got too much.

'But the counselling helped me to move forward and finally to reduce the amount of medication I took, which itself was making me moody and physically uncomfortable.'
Side-effects of strong painkillers include constipation, insomnia and nausea — and Ian had suffered the whole range.

'With counselling, I started to focus on what I could do, not what I couldn't. My daughter motivated me, too. I didn't want her to miss out on having a dad.'

A crucial part of his recovery probably can't be replicated by most patients: he married his former physio, 47-year-old Judith, and the couple now have a 12-year-old son, Thomas.

But Ian, now 60, admits that 20 years on from the original incident, he is still in pain every day — and knows he always will be.

'I still need regular operations to relieve scar tissue, and I have rotten arthritis, too. But I mostly only use a stick these days, not crutches, and rarely take more than paracetamol.'

Ian went on to found the country's largest general pain charity, Action On Pain, and now campaigns for better service. 'Over 90  per cent of callers to our helpline don't even know pain clinics exist,' he says.

Dr Collett says it's essential patients see a pain specialist in conjunction with other experts.

'In Leicester, we are well equipped with a wide multi-disciplinary team, from anaesthetists to physiotherapists, as well as specialist pain nurses and consultants, but that is just not true everywhere.'


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