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FAQs

1. What is pain?

2. In what way can the British Pain Society help patients?

3. Which is the most effective “over-the-counter” painkiller?

4. Is there any medication that may help my condition?

5. What else besides medication might help me?

6. How long is the waiting list for a pain clinic?

7. Are pain clinics NHS or private?

8. What is the best pain clinic to attend?

9. My GP has refused to refer me to a pain clinic, what can I do?

10. Where else can I seek help/information about my condition?

11. Can I talk to someone who has experienced severe, long-term pain themselves and understands what I am going through?

12. What is the Expert Patients' Programme? How can I find out if there is one running in my area?

13. Why have I been prescribed anti-depressants for my pain?

14. Should I have an X-ray or MRI scan?

15. Where can I find help with depression?

16. What is musculoskeletal pain?

17. What is nociceptive pain?

18. What is neuropathic pain?

19. What is referred pain?

20. What is an epidural steroid injection?

21. What is spinal cord stimulation?

22. How do I find out about funding that may be available to help me?

1. What is pain?
Often the cause of pain is obvious, a broken leg, or a bruise. But there are times when the source of pain is unseen, for example a slipped disc. Occasionally it is very difficult to find the exact cause of a person’s pain.

Health professionals use different terms for different types of pain.

  • Short-term pain is called Acute Pain. An example is a sprained ankle.
  • Long-term is called Persistent or Chronic Pain. Back trouble or arthritis are examples.
  • Pain that comes and goes is called Recurrent or Intermittent Pain. A tooth ache could be one.

Many acute pains are like an alarm telling us something is wrong. Most minor ones are easy to treat; others may be a sign of something more serious. For example the pain of a broken leg will make us rest the leg until it heals. Here the pain is helping.

Persistent pain often serves no useful purpose. The messages from the warning system linked to long-term conditions like arthritis or back pain are not needed - just annoying. Over time, it may affect what we can do, our ability to work, our sleep patterns. It can have a strong negative effect on our family and friends too.

Pain signals use the spinal cord and specialised nerve fibres to travel to our brain. This involves our whole body. It is more than just a network of wires. These fibres also work to process the pain signals. All together they work like a very powerful computer.

Sometimes this computer system can go wrong. The messages get confused and the brain cannot understand the signals properly. It can lead to chronic or persistent pain, which can be very hard to repair. Unfortunately, we cannot just re-boot the system.

Part of this process is linked directly with the emotional centres in the brain. This means how we are feeling has an effect on our pain. If we feel angry, depressed or anxious, our pain will be worse.

The opposite is also true. If we are feeling positive and happy, our pain can seem to be less. We are able to cope much better.

It shows that pain is never "just in the mind" or “just in the body” - it is a complex mix involving our whole being and how our brain interpretation the signals. This mix can change from one day to the next.

Sometimes, pain can begin very small. But the signals quickly jump along the network. It is like a football crowd. It takes only one person to start a chant or a song, but very quickly the whole stand has joined in.

This is called ‘wind- up’ and is one of the reasons why chronic pain does not go away easily. The ‘chant’ can last for hours, days or even years. This can lead to a long term, distressing problem which requires skill, time and patience to improve.

The way a pain signal jumps along the system is by the release of a chemical. These are called Neurotransmitters, and over one hundred types have been discovered. The amount of chemical released is extremely small.

There are good neurotransmitters and there are bad neurotransmitters. The bad ones make the pain worse; the good ones can help block the pain.

Again, the way we feel, our emotions are involved. But doing something we enjoy, having a good laugh or exercising, we can strengthen our ‘good’ neurotransmitters and so limit our pain.

However, if we are depressed or moody, lack motivation and are not active we strengthen our bad neurotransmitters and our pain gets worse.

Pain killers and other drugs can also strengthen these ‘good’ neurotransmitters.

Many of the modern techniques used by medical people have helped us to understand and treat pain better. But there is still a lot that needs to be learned.

Now-a-days, pain doctors realise that our personal circumstances make a great difference to how we feel pain. Only the person in pain can really say how painful something is. As a result, they are far more likely to listen to the patient and want to work together to improve the situation.

This can still be quite a challenge. Patients must be able to explain their situation to the healthcare professional. They in their turn must try to understand and help us in the best way for us.

2. In what way can the British Pain Society help patients?
The British Pain Society provides general inforation about pain. These include

3. Which is the most effective “over-the-counter” painkiller?
The best way to find the most effective painkiller for you is to talk to your doctor, pain nurse or pharmacist. They can give you individual and detailed advice. A leaflet about using over-the-counter painkillers to manage pain is available to view here.

4. Is there any medication that may help my condition?
There is a range of medication that may help you. The best thing to do is to talk to your doctor, nurse or pharmacist. Healthcare professionals can give you individual and detailed advice.

5. What else besides medication might help me?
There are a number of techniques that can help with managing your pain. Some are:

  • deep breathing
  • relaxation
  • positive imagery
  • thought distraction
  • heat or cold compresses (or a combination of the two)
  • reducing stress in your life
  • remaining positive
  • exercise

There are a range of products available designed to help epople. Although the British Pain Society cannot recommend any products, there is more information in the Society's Understanding and Managing Pain: Information for patients. Further information can also be found on our website under suggested reading.

6. How long is the waiting list for a pain clinic?
If a GP refers you, waiting times should be about 13 weeks. If you are referred to a specialist or a consultant, then waiting times can be longer.

7. Are pain clinics NHS or private?
Pain services can be accessed through the NHS, some of these are provided by the NHS, others may be provided by companies acting on behalf of the NHS. You may opt to see someone privately; this can be arranged through your GP.

8. What is the best pain clinic to attend?

The Society does not give ratings for individual pain clinics. Your local Primary Care Trust (PCT) can give you details about your nearest pain clinic. If you need help in finding the details, please conact us.

9. My GP has refused to refer me to a pain clinic, what can I do?
Generall you cannot receive NHS hospital treatment without being referred by your GP, unless its an emergency or a specialised clinic. You have no right to see a particular doctor although this can be requested. You can ask your GP to arrange a second opinion either from a specialist or another GP, but this is at the GP's discretion.

10. Where else can I seek help/information about my condition?
There are a number of voluntary organisations that may be able to help with your condition; see our useful addresses section for details. Some areas do have self-help groups, but it is fair to say that there are not that many; again, you can look at our 'Useful addresses' section. Your local council or library may also have a list of local organisations. You may also wish to read our Understanding and Managing Pain: information for patients booklet.

You can also find further information about pain and some common causes of pain on the NHS Choices website:


11. Can I talk to someone who has experienced severe, long-term pain themselves and understands what I am going through?
Yes, some helplines are manned by people with long-term pain and some charities run self-help groups where you meet other people with long-term pain. Pain Concern, Action on Pain, Arthritis Care and BackCare all have telephone helplines; see our useful addresses section for contact details.

12. What is the Expert Patients' Programme? How can I find out if there is one running in my area?
The Expert Patients Programme (EPP) is a NHS-based, lay-led training programme that provides opportunities to people who live with long-term chronic conditions (such as arthritis) to develop new skills to manage their condition better on a day-to-day basis. For further details, including how to find your nearest programme, you can visit their website www.expertpatients.nhs.uk.

13. Why have I been prescribed anti-depressants for my pain?
It has been known for some years, that some antidepressants may help pain, particularly neuropathic pain. These older antidepressants are called the Tricyclics and examples are amitriptyline , imipramine nortriptyline. They act through complex mechanisms, which may include inhibition of the two nerve transmitters, noradrenaline and 5-HT.

There is some evidence that the newer antidepressants, e.g.duloxetine may also be helpful in some painful conditions.

You can also find out more about antidepressant drugs on the NHS Choices website.

14. Should I have an X-ray or MRI scan?
This is difficult to answer for an individual. In general, X-rays take a picture of the bones. They are used for diagnosing cancer, tumours, rheumatoid arthritis and osteoporotic collapse.

An MRI scan also take a picture of the body. MRI scans of the spine are done to identify cancer or tumours and slipped discs. They are indicated to identify the level of the lesion. MRI scan do not show why someone has pain. Unfortunately, although they are one of the most detailed investigations that we have today, they cannot tell a patient exactly what is causing their pain.

15. Where can I find help with depression?
Depression is a very common feeling amongst people suffering pain for a long time. In the first instance you should contact your GP for advice on local services. You can talk to other people in pain by telephoning a helpline (see question 11 above).

You can also find out more about depression, or take a simple test to see if you may be depressed, on the NHS Choices website.

16. What is musculoskeletal pain?
A pulled hamstring or a broken bone are examples of musculoskeletal pain. It is pain that is felt in the muscles or bones of the body.

17. What is nociceptive pain?
A bruise or a swollen foot are examples of nociceptive pain. It is the pain that happens because of tissue damage or inflammation.

18. What is neuropathic pain?
Sciatica, or the damage done by shingles are examples of neuropathic pain. It is pain to do with the nervous system. Pain that people with diabetics or multiple sclerosis get can also be neuropathic.

19. What is referred pain?
There are times when people may get pain in one part of their body, but the actual reason is based with a problem in another part of their body. Strange but true! An example is the pain in the left arm caused by a heart attack. This is called Referred Pain.

20. What is an epidural steroid injection?
Epidural steriod injections are one of a number of procedures or injections that may be offered for some types of back pain. The doctor offering you the injection should give you verbal and written information about it before the procedure is done.

21. What is spinal cord stimulation?
The British Pain Society has published a booklet entitled 'Spinal cord stimulation for pain: information for patients'. You can download a copy free of charge from the BPS patient publications section; hard copies are available on request from the Secretariat at a cost of £2.40/copy.

22. How do I find out about funding that may be available to help me?

Benefits are complex and subject to changes, so we can't offer detailed advice. There are a number of places that may be able to help you. Your local Citizens Advice Bureau can give up to date advice on benefits and may be able to help on completing forms.Some Local Authority advice centres offer a similar service. Job Centres can give advice on the Access to Work Initiative. This website gives information on the scheme. The Disabled Living Foundation at www.dlf.org.uk has factsheets on sources of funding and links to other useful sites. Their website, www.livingmadeeasy.org.uk also gives information on equipment provision and direct payments through local authorities. For other possible sources of funding, there is a search database called Funderfinder, at www.funderfinder.org.uk which matches potential sources of funding, charitable trusts, benevolent funds etc. against an applicant's particular needs. There is also a charity called Turn2Us at www.turn2us.org.uk which offers a similar service.

 

 

 
 

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