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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. Why is co-proxamol being withdrawn and
can I still get it to treat my pain?
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.
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.
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).
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. Why is
co-proxamol being withdrawn and can I still get it to treat
my pain?
Some people have found that their GP
or GP practice may be reluctant to continue prescribing co-proxamol
after December 2007 as the licensing authorities have withdrawn
its license and the prescribing responsibility now rests with
the doctor, leading to an additional liability burden.
Within each Primary Care Trust is a Medicines
Management Team or Practice Prescribing Adviser who may be
able to offer advice to a GP or practice.
At least one pharmaceutical company, Meda
Pharmaceuticals Ltd., have announced that they will be continuing
to manufacture a branded version of co-proxamol, Distalgesic
[TM].
The reason for these changes is that a risk-benefit
review was undertaken by the Medicine and Healthcare products
Regulatory Agency (MHRA) in April 2004. The review concluded
that co-proxamol should be withdrawn on the grounds that the
risks outweighed the benefits. It estimated that there were
300-400 fatalities each year, following deliberate or accidental
drug overdose involving co-proxamol in England and Wales alone.
Approximately one-fifth of these deaths were considered to
be accidental. Many deaths involved people taking co-proxamol
that had not been prescribed for them. UK research showed
that co-proxamol alone was implicated in almost one fifth
of drug related suicides, second only to tricyclic anti-depressants.
It was decided to withdraw co-proxamol over a period of 36
months, in order to allow long-term users an opportunity to
move to suitable alternatives.
It was recognised that there was a small
group of patients who are likely to find it very difficult
to change, or who may have an identified clinical need: when
alternatives appear not to be effective or suitable. For these
patients, continued provision of co-proxamol through normal
prescribing was allowed to continue until the cancellation
of the licences at the end of 2007. After this time a provision
will remain for the supply of unlicensed co-proxamol, on the
responsibility of the prescriber
The British Pain Society (BPS) shares the
view of the British Society of Rheumatologists and Arthritis
Care that there are a small number of patients with chronic
pain who benefit from co-proxamol and who find that alternatives
do not give the same level of pain relief without unacceptable
side effects. . Co-proxamol is reported to cause less constipation
and drowsiness than other opioid analgesics, but unfortunately
it has not been studied in persistent pain over a long period
of time and there is no proof that this is so.
Other alternatives to co-proxamol in clinical use in the
UK are tramadol, codeine, and dihydrocodeine. Tramadol has
many limiting side effects when the dose is increased, and
also interacts adversely with some of the newer forms of anti-depressants
- which can be significant for people with chronic pain. Codeine
may be ineffective in 10% of people, particularly white races,
because they do not have the enzyme needed to metabolise codeine
to morphine.
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