DR MAX PEMBERTON: Pills aren’t always the answer to chronic pain …talking can help too
- People with chronic pain often rely on strong painkillers to get through the day
- However, Dr Max Pemberton reveals that the side effects can be debilitating
- READ MORE: Dr Max Pemberton: I saved a life on a night out …and you can too!
Of all the medical problems my patients have, chronic pain has to be one of the worst. People are often referred to me with this condition due to the crushingly low mood their pain causes and it’s heartbreaking to watch them in agony, unable to sleep and never getting any proper rest.
They often rely on strong painkillers just to get through the day. The pills, of course, can have equally debilitating side-effects and frequently don’t really work.
The person can’t fully engage with life as the pain is always front and centre, getting in the way. In fact, it can be so debilitating and isolating that it is considered to be an important risk factor for suicide.
One lady in her 70s I saw recently had degeneration in her spine that meant she could never get comfortable. She spent all night sitting in a chair in pain, alone and staring at the walls.
Someone who suffers with chronic pain may find it difficult to get through the day and could find themselves with crushingly low moods
She would get up and try to walk about, but was so unsteady on her feet she’d suffered several falls. It was a living hell for her — was it any wonder she felt miserable and wondered what the point of going on was?
The causes of chronic pain are complex and we are still trying to fully understand how — and why — it manifests itself.
To complicate matters, there’s sometimes considerable variation in the pain experienced by different people with a comparable underlying cause, such as a slipped disc. It’s not clear why some people experience pain so differently to others.
What’s more, sometimes no underlying cause can be found at all. And yet the person is severely disabled by it.
Dr Max Pemberton (pictured) details how psychological steps to manage this pain could be taken and how they would work including going through five steps of addressing the problem
People with chronic pain are often surprised to find they are being offered psychotherapy, rather than simply more and more painkillers.
In fact, research last week from the Stress Illness Recovery Practitioner’s Association showed that many chronic pain conditions can be triggered or exacerbated by emotion.
Conditions such as sciatica and fibromyalgia can be the result of a complex interaction between physical and mental states.
Researchers argued that emotional and physical problems are processed in the same part of the brain, and that it’s likely chronic pain is actually a ‘mindbody’ condition, with emotions playing an important part in triggering or exacerbating it.
One of the pioneers in this area, clinician and researcher Dr Howard Schubiner, has explored how pain can be made worse by the ‘Five Fs’ — fear, focusing on the pain, attempting to fix it, frustration and fighting it.
Psychological steps to managing chronic pain often involve exploring and addressing each of these in turn. This chimes with what many clinicians know to be true — that how we feel mentally can have a big impact on how we experience pain.
We have actually known about this for many years, as it was first appreciated by the anaesthetist Henry K. Beecher during World War II, who observed that soldiers sent home to their families often didn’t need painkillers, even if they had suffered amputations or horrific injuries. This puzzled Beecher, until he realised that — unlike the civilians he was used to treating — for the soldiers, a severe injury was actually a good thing: it meant they would be discharged from the Army and could return home.
Beecher’s breakthrough was that it is not necessarily the magnitude of the injury that’s important for how a person experiences pain, but the circumstance in which it occurs. It was one of the first studies that clearly documented the power the mind has over the body.
However, I only know this story because an old, wily anaesthetist told me when I was at medical school — lamenting how, because of advances in pharmaceuticals, this aspect of pain management had been largely forgotten (except as a historical footnote in textbooks) in favour of exciting new pills and potions.
So I’m delighted to see new studies shining light back on this complex and fascinating topic — we should not underestimate the power of the mind.
Sadly, it is true that it’s far easier to prescribe painkillers and allow the patient to toddle off out of the surgery clutching a prescription in their hand than to explore what might be happening socially and emotionally in their life that will be affecting their experience of pain.
I often think this is why complementary medicine — such as homeopathy, naturopathy, and types of healing like Reiki — is so popular with patients with these conditions, especially those for whom conventional medicine hasn’t worked.
It’s not just that people believe it’s going to work and, therefore, it does — the placebo effect — that’s relevant, but the fact that the practitioner will sit down for a considerable length of time beforehand, talking to the patient in depth about their life. It’s this interaction, I am convinced, that helps as much as anything else.
The real shame is that more psychological support isn’t readily available for those with chronic pain. Too many are dismissed with yet more pills.
The problem with painkillers is that they are not always that effective in long-term use and have a multitude of side-effects, especially in higher doses.
Science is starting to show, though, that by providing sufferers with emotional support, their lives may be hugely improved.
Today’s medics would do well to follow in Dr Beecher’s footsteps and remember that what’s going on around the patient is as important as what’s going on inside them.
Too many people are being sent to A&E because the computer algorithm NHS 111 uses is ‘too risk averse’, Dr Adrian Boyle, president of the Royal College of Emergency Medicine, told MPs. I agree. So much of medicine is a judgment call based on experience and gut feeling. You can’t put that into a tick box.
We’re not all as lucky as Paris
Dr Max Pemberton says that although Paris Hilton (pictured) went public with the birth of her baby via a surrogate, we need to remember that this isn’t possible for everyone
Paris Hilton has welcomed a baby boy conceived via a surrogate. The 41-year-old has made headlines around the world with the news. Of course, she paid for this herself and, usually, I don’t think people’s reproductive choices are anyone else’s business. But she is just one of a growing number of women in the public eye who have resorted to using a surrogate, and I wonder about the false expectations this sets up in young women’s minds about when to start a family. Using a surrogate is a very expensive and complex way to conceive. No one likes to talk about the limitations of things such as IVF because there are many couples desperate to start a family and fertility treatment is their only chance. But, equally, we need to make young women aware that while their favourite celebrity might seem to be able to delay motherhood until their 40s or older, for most this is a pipedream.
Dr Max prescribes…
Dr Max Pemberton argues that orientation is good for the memory and could off-put cognitive decline
This used to be all the rage but seems to have fallen out of fashion in recent years. Yet new research shows that orienteering could help stave off dementia. The researchers argued that in the age of GPS, critical areas of the brain responsible for navigation and memory are not being used and this can speed up cognitive decline. So get out your maps and compasses and have a wander!
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