Managing Long Term Pain

‘Sorrow that finds no vent in tears may make other organs weep’

Sir Henry Maudsley, 1835 – 1918

 According to the British Pain Society, almost 10 million Britons suffer pain almost daily resulting in a major impact on their quality of life and more days off work at a cost estimated at around £5billion per annum, with around 20% of all new consultations involving pain. Long term pain is both disabling and distressing. The story of Gill Pharoah, a former palliative care nurse who passed away at the age of 75 at an assisted dying clinic in Switzerland in 2015 with chronic back pain raises important questions about euthanasia and the traumas that can come with old age not just in the context of terminal illness, but also for conditions which can ruin people’s quality of life. It also raises important questions about ageism and how society values elderly people.

For clinicians working in both primary and secondary care, persistent pain is common whilst for policy makers it is expensive. Furthermore it is neglected in medical training. Chronic pain is both disabling and distressing for the person and stressful for doctors and other clinicians. Whilst patients are often over-investigated, there are few care pathways or services, with effective treatments not usually available.

Dr Simon Heyland and Dr Julian Stern are both Consultant Psychiatrists specialising in Medical Psychotherapy. Their innovative work in medically unexplained symptoms in Birmingham and in City and Hackney in London highlighted how GP’s and other clinicians typically devalue their psychological skills in working with MUS (medically unexplained symptoms) including chronic pain and GPs frequently suggest physical interventions even when patients are not demanding them whilst consultation skills are not taught to acute care specialists at any stage of medical education.

But the good news is that effective evidence-based treatment strategies exist based upon a biopsychosocial model of illness. Collaboration between mental health and physical health specialists can improve both physical and psychological symptoms, improve quality of life, well-being and functioning, and reduce attendances.

What should we be doing?

We need to improve clinicians’ and healthcare commissioners’ awareness of the treatability of long term pain. By making physical and mental health services less separate and by joining-up care, we can create collaborative professional relationships which also enable patients to gain positive experiences of care, reducing symptom severity and improve well-being. Pathways which are more patient focussed are also popular with GP’s who are eager to develop their skills in managing complex conditions. In short we need community based medical symptom management clinics with experienced clinicians across specialisms and sills which include psychological. We are currently developing a pilot for such an initiative with a group of GP practices in central Birmingham. Watch this space!

Dr Adam Cleary is a Consultant Clinical Psychologist with Birmingham Community Healthcare NHS Foundation Trust Pain Service

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