Pain Management Centres are the heavy-duty work-horse for chronic pain management. They’re also a bit scarce – but if you do get lucky enough to be referred, and get in to see an interdisciplinary team for your pain, they’re worth knowing a bit about.
When should you get referred? Preferably as early as possible – if your pain isn’t settling, and you’re feeling upset, distressed and find it hard to do everyday things because pain is getting in the way, any time from three months on is good.
Why should you get referred? One of the main reasons is to get a clear diagnosis. There are specialists for every part of the body, but when the problem is pain that won’t go away, the problem is the pain system, not the body part! So don’t settle for an orthopaedic surgeon, a musculoskeletal physician, a rheumatologist or even a neurologist, aim higher! See a pain physician. Their specialty is understanding and diagnosing chronic pain. BUT don’t settle for just seeing a medical practitioner. They’re fabulous, we can’t work without them, but they don’t know everything or do everything when you have chronic pain. Because with chronic pain the chances are pretty high that a medical approach through medications, injections, or other procedures, won’t completely remove your pain. Some of the treatments can cause problems themselves – side effects, injury and so on.
So another reason for being referred is to understand your chronic pain, to get to know what influences it better. Then you have a chance to do something about it.
What should be included in an assessment?
- You should complete a set of questionnaires. This isn’t to read your mind, but to help give the team a wider and deeper understanding of what it’s like to be you, with your pain.
- You should have a physical examination. This is to check any underlying pathology that might be adding to your pain.
- Your health history should be reviewed, and your old clinical notes. This is to uncover any contributing factors that might have been thought unimportant, but could play a role in why your pain is bothering you so much.
- You should have time to talk to someone about what it feels like to have your pain, the effect on your emotions, your sleep, your relationships, and what sense you’ve been able to make of your pain. After all, you’re the only person who is living with and feeling your pain! The person you talk to may be an occupational therapist, a psychologist, a nurse, a social worker. They shouldn’t tell you what is going on at this stage, because it’s only once the whole team meet that they can pull together all the bits and pieces that could be involved.
- You should also have an opportunity to do some physical activities such as walking, sitting, lifting, going up stairs etc. Depending on where your pain is bothering you, you may be asked to do some hand function tests, or some general fitness tests. And you should be asked about all those everyday occupations, or activities, that pain interferes with. Like opening bottles, hanging out clothing, driving, using a computer. Go through your day with this person, who may be an occupational therapist, physiotherapist, exercise physiologist or similar.
- Finally, you should be asked what you want if the pain is less of a problem for you. How would you know they’d helped you? What would you be doing that you can’t do now?
- At the end of the assessment, the team should meet before they begin recommending anything. This is because they need to all be on the same page about the importance of various factors involved. What’s the point in having a medication that might change your pain, but make you so sleepy you can’t function – especially when going back to work is your main goal!
What treatments are available?
This is variable, depending on the centre you’ve gone to. There is no standard treatment for chronic pain, even if the treatments are called the same thing! But you should have your medications reviewed – sometimes we take medications that are not working because we don’t know it’s OK to stop them.
You should have some sort of exercise or activity programme – maybe a gym programme, maybe walking, maybe swimming. The kind of exercise isn’t as important as the purpose – it’s to release endorphins, your own pain medicine from your own brain. But it should be graded and tailored to you and your goals, not some “off the shelf” package. Ask why you’ve been given the exercises you have, and especially ask how it’s going to help you with the things you want to do in your daily life.
You should have some information about chronic pain. It’s a process of discovery – so you should find out about your pain system, and how the various factors you experience contribute to how you’re dealing with your pain. This provides you with more information about what you can do to live with your pain.
You may see a psychologist – it depends on the facility, but whatever, it does not mean your pain is imaginary! It just means that a psychologist is a team member with skills to help you learn to cope with the pain.
You may also see a social worker – mainly to talk about your family and relationships and the systems you interact with.
You could see an occupational therapist – to discuss the important occupations you want or need to do. Things like managing your household, driving your car, coping with work, organising your day, being a good parent. You’ll then be helped to begin to do these things again, little by little.
What you won’t get
Probably you won’t get a complete cure for your pain. We’re not holding out on you, there just isn’t very much out there to get rid of chronic pain. In fact, the best medications we use today are old fashioned ones that were available from the 1930’s or earlier! Be cautious about opioids – the side effects are not nice, and there are no long-term studies showing their effectiveness over years.
You won’t get told it’s in your head. It’s not imaginary, and (hopefully) you’re not faking. I can’t tell if you are, or you’re not. Pain is pain and only you can feel it.
You won’t get a “get out of work free” card either. Working is good for your health, not working is lousy for it. But hopefully you’ll be supported and encouraged to return to work
I’ll write some more about how to go about working with a pain management team, but I think this should get you started.
Don’t forget – questions and comments are very welcome, even if you don’t agree with me.