Frequently Asked Questions

Contents

  1. What is pain?
  2. In what way can the British Pain Society help patients?
  3. Which is the most effective painkiller for my pain?
  4. Is there any medication that may help my condition?
  5. What things besides medical treatment 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?

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 toothache 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 helpful.

By contrast chronic pain often serves no useful purpose. Medical assessment and diagnosis does not usually lead to the pain going away and over time it may affect what we can including ability to work and sleep patterns may be interrupted. It can affect mood and relationships with our family and friends too.

Pain signals from injury normally travel to the brain via specialised nerve fibres and the spinal cord.. These nerves also 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. Thia is one reason for chronic pain, which can be very difficult to treat because we cannot just re-boot the system.

Pain usually causes strong emotions and these can interact with our other feelings. If we are angry, depressed or anxious, our pain may be worse.Alternatively if we are feeling positive and happy, our pain may be less and we are able to cope better. This shows that pain is never "all in the mind" or “purely in the body” - it is a complex mix depending on many factors.

A slight pain can become amplified.rather like in a football crowd: one person starts a chant or a song and very quickly the whole stand has joined in. When this happens with pain, doctors call it central sensitisation and is one of the reasons why the severity of pain experience may have little relationship to the size of the cause of pain.. The ‘chant’ can last for hours, days or even years.

One of the ways in which pain signals are regulated within the nervous system is by the release of tiny quantitiies of neurotransmitter chemicals -, over one hundred types have been discovered.

The balance of neurotransmitters in the nerves can affect the amount of pain that is experienced. By doing something that we enjoy like having a good laugh or exercising, we can strengthen our ‘good’ neurotransmitters and so limit pain. However, if we are depressed or moody, lack motivation and are not active the bad neurotransmitters take over and our pain can get worse. Pain killers are sometimes used to 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.

Pain doctors understand that pain is a very personal experience with only the person in pain being able to say how much pain they are in..

Assessment of a patient’s pain by healthcare professionals needs to be thorough and include many aspects health, emotions and functioning in life.

 

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In what way can the British Pain Society help patients?

The British Pain Society (BPS) is the UK chapter of the International Association for the Study of Pain (IASP) supporting medical professionals working together to provide better understanding and treatment of all forms of pain.

The BPS organises regular eductional events about pain for medical professionals and patients. It manages scientific conferences and training events. Together with other organisations it lobbies for better healthcare resources for pain and is a member of the Chronic Pain Policy Consortium.

The BPS provides general information about pain. This includes

  • details of pain clinics
  • a list of self-help groups
  • a suggested reading list
  • a number of publications designed for patients about the management of pain HERE 
  • Patients and their families and friends can help to support this important work by making a regular donation.

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Which is the most effective painkiller for my pain?

The type of painkiller required will depend on the cause of the pain. The best way to find the most effective painkiller for you and your pain is to talk to your doctor, pain nurse or pharmacist. They can give you individual and detailed advice.

You can veiw our guide to over-the-counter painkillers  HERE.

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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.

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What things besides medical treatment 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
  • mindfulness techniques

The British Pain Society cannot recommend any specific products.

There is more information in the Society's Understanding and Managing Pain: Information for patients  HERE. Further information can also be found on our website under suggested reading.

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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.

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Are Pain Clinics NHS or private?

Pain services should be accessible through the NHS via your GP. Some services for NHS patients are now run by private companies acting on behalf of the NHS.

You may opt to see a pain doctor privately; this can also be arranged through your GP

 

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What is the best pain clinic to attend?

The Society does not give ratings for individual pain clinics. 

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

Generally 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.

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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: HERE

  • Living with pain
  • Joint pain
  • Back pain
  • Shoulder pain
  • Arthritis
  • Complex regional pain syndrome
  • Fibromyalgia

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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. HERE

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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.

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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 evidence that some of 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.

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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 is also a picture of the body and is more useful for examining the soft tissues such as muscles and nerves.

However scans and x-rays often do not show the cause of a pain and they may identify changes that are of no relevance so they must be selected, interpreted and explained to patients carefully.

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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.

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What is musculoskeletal pain?

A pulled hamstring, a broken bone or an arthritic joint are examples of musculoskeletal pain. It is pain that is felt in the muscles or bones (skeleton) of the body.

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What is nociceptive pain?

This is pain that results from actual injury and damage to tissues including inflammation.  The pulled hamstring, broken bone and arthritic joint are all damaging (noxious) situationsn.

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What is neuropathic pain?

This is pain that results from damage to the nerves – muscles and bones may not be directly affected.

For example:

Sciatica where a nerve is irritated or compressed in the bottom of the back giving pain down the leg,

Shingles where virus damage to a nerve causes extremely painful sensitivity of the area of skin supplied by that nerve.

Diabetes and Multiple Sclerosis can damage the nerves at multiple points resulting in more widespread pains.

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What is referred pain?

A pain is referred when somebody gets a pain in one part of their body, but the cause is in another part of their body. Strange but true!

Pain in the left arm caused by a heart attack, and sciatica are both examples of referred pains.

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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 nerve pain originating in the spine. The doctor offering you the injection should give you detailed information about it if this treatment is being considered.

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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. HERE

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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 Initiatives.

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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