It's a pain but it can be controlled

ALAN Flintham is used to pain. It has become a constant companion over the past 13 years ever since the day the watch company area manager stooped to lift a briefcase out of his car.

He had a sudden, blinding flash of pain and felt his legs going numb. When he got over the initial shock, the customer he was visiting in Newcastle helped prop him up on cushions in the car and he somehow managed to drive home, double-declutching because he couldn't move his legs properly.

It was a slipped disc, complicated by years of driving 1,000 miles a week which had, he says, put a huge strain on his back.

Over the next few years, Alan struggled on. He read books about back pain which suggested various exercises, and switched to an automatic car which was easier to drive.

But the pain persisted. In 1998, he was referred to the pain clinic at York hospital. They arranged various types of treatment - anti-inflammatory steroid injections into the joints of his back, electrical stimulation, epidurals - but nothing worked.

Now, with the clinic's help, Alan has come to accept that pain is with him for good - and he has learned to manage it.

It's an attitude of mind as much as anything, he says. At 67, he insists he's still 'only young', and he is not going to let it dominate his life.

He remains an active sportsman - trapeze, wind-surfing and cycling - and every morning does 200 stretch exercises. "It's boring, but it works," he says. "If you don't use it, you lose it."

Maintaining that kind of positive attitude in the face of constant pain is not easy. Chronic, or long-term, pain can have a devastating impact on your life, says pain management nurse Linda Grewer.

"It can affect every aspect of your life - employment, relationships, your ability to socialise, your ability to sleep. It can be so intrusive that people become socially isolated because they don't want to take part in life any more."

Nevertheless, Alan's approach to life is the right one, says Linda. Because the cruel truth is that for many of the 1,000-or-so patients referred to the pain clinic every year - many of them suffering from chronic back pain - there is no magic cure.

Doping patients up to the eyeballs with painkillers for the rest of their lives is no answer. Taken over long periods of time - and may people have to live with chronic pain for years or even decades - even simple painkillers such as aspirin can have unpleasant side effects, including stomach and bowel problems. More powerful drugs, such as morphine, can over time affect the immune system and even cause problems with blood pressure.

Often, anyway, painkilling drugs simply aren't very effective for people suffering from chronic pain, consultant anaesthetist Dr Peter Hall says (see panel).

If they are ever to lead full lives again, therefore, patients such as Alan have to come to terms with their pain. What the pain clinic aims to do, Linda Grewer says, is help "put them in control of the pain, rather than the pain being in control of them".

To help patients do this, the pain management team at York hospital includes three consultant pain specialists, two clinical psychologists, two senior nurses, two physiotherapists and two occupational therapists.

Between them, they can offer patients a range of strategies for coping with pain, and minimising its effect on their lives.

These include:

Stretching exercises and other physiotherapy to minimise pain

Relaxation and other pain management techniques, such as learning to 'background' your pain by shifting your focus elsewhere

Strategies for coping with daily activities and chores

Help in coping with depression and mood swings caused by your pain.

Psychological techniques can be a big help in dealing with chronic pain, Dr Hall says: not because the pain that sufferers experience isn't real but because the brain can be trained to find ways of back-grounding it.

"Are you aware of the watch strap on your wrist?" he asks. I glance down involuntarily, suddenly made aware by his words of the feel of it around my wrist.

The point is, Dr Hall says, that even when I was not consciously aware of my watch, my nerves were sending signals to my brain telling me it was there, and that it was wrapped around my wrist. My brain just chose not to be conscious of them. Similar techniques can be used to deal with pain, he says.

Exercise, and leading as active a life as possible, is also vital for those suffering chronic pain.

The days when doctors prescribed bed rest for a bad back are long gone.

The reason is simple. "When you move, you oil the joints," says Dr Hall. "If you stop oiling the joints, you are more likely to seize up."

"So no longer do we advise people with back pain to get bed rest," adds Linda Grewer. "We tell you to exercise!"

Understandably, people suffering from back pain can sometimes find that difficult to accept. It is easy to imagine that movement will only make whatever is causing the back pain worse.

That is why part of what the pain clinic does is to help patients understand their pain - so that they know that by appropriate exercise, far from making things worse, they will make things better.

It's a philosophy Alan Flintham has embraced with a vengeance.

Now, thanks to his active lifestyle, he only experiences real pain for a few days once every couple of months or so. It's pretty bad - but even then he doesn't reach for the tablets. "I exercise my way out of it," he says. "I'm not a lover of tablets."

Patients must be referred to the pain clinic by their GP. Clinics are held twice a week in the pain management clinic itself, and also in pain clinics held in the hospital's outpatient department.

Some patients are also offered places on the York Pain Management Programme - a year-long course consisting of 12 group sessions in which patients are taught a range of pain management techniques.

What is chronic pain?

DRUGS can play a part in helping to manage chronic pain, but usually they are not in themselves the answer, Dr Hall says.

The key to understanding why lies in understanding what chronic pain is.

There are two broad categories of pain. Acute pain is caused directly by a physical injury such as a broken leg. It tends to be comparatively short-lived, and drugs for pain relief may help.

Chronic pain, however, is different. It is not just pain that goes on for a long time, Dr Hall says - it is different in nature from acute pain.

There may well have been a physical injury that initially triggered chronic pain - but what then happens, Dr Hall says, is that your nerves undergo a change and become 'sensitised.' Because of this, long after the injury that originally caused the pain has gone, the nerves themselves continue to generate pain.

It's a bit like if you hit your fingers with a hammer. The initial blow is hard, so it is unsurprising that it hurts. Afterwards, however, your fingers become very sensitive - so if you press them even very gently, in a way that would not normally hurt at all, it still hurts a lot.

Because with chronic pain it is your nerves themselves that are often producing the pain, Dr Hall says, traditional drugs which target pain caused by an injury to your body tissue have limited effect.

New painkilling drugs are being developed which target the nerves themselves - but the problem is that they target all the nerves in the body, rather than simply those causing pain. Because of this they tend to leave patients feeling drowsy and dizzy.

Hence the emphasis, for those coping with long-term pain, on pain management rather than medication.

It hurts so much Jeanette is on 16 painkillers a day... and she still has to wait 17 weeks

About 1,000 people every year are referred to York pain clinic.

That sounds like a lot - but in a way is only the tip of the iceberg, says consultant anaesthetist Dr Peter Hall.

As many as one in five people could suffer from some form of chronic pain, he says - which means, in the area served by York hospital, up to 66,500 people.

Those who are get referred to the pain clinic, therefore, are simply those most in need - with GPs acting as the 'gatekeepers'.

Even once you do get referred, because staff at the clinic are so stretched, you could face quite a wait for an appointment - as Jeanette Johnson found out.

Mrs Johnson, left, of Middleton Road, Acomb, said she "burst into tears" when she was told she would have to wait 17 weeks, despite the referral from her GP.

The 54-year-old says she has been in pain and unable to work ever since suffering a stress injury to her neck 15 years ago. She gets sharp pains down her right hand side, and suffers tingling in her arm and leg.

A few months ago, the pain became worse leaving her on 16 painkillers a day to cope. She can only sleep by sitting upright in bed supported by two pillows and with a third wrapped around her neck.

She couldn't believe it when she was told how long she would have to wait, she says. "I just burst into tears, I was so upset."

After her GP called the clinic again, her appointment has now been brought forward to next month - but that will still amount to a wait of 14 weeks before her appointment, she says.

Seventeen weeks, however, is par for the course for 'non-urgent' referrals - which includes most people suffering from back pain - and within Government targets.

The hospital, however, hopes to reduce that to 13 weeks by the end of the year. Five years ago, pateints had to wait 52 weeks for an appointment.

Michael Harvey, the administrator in charge of the hospital's pain services, said he "completely sympathised" with Mrs Johnson. "We would like to reassure her and other patients that, although we are meeting national waiting time targets, we are working hard to bring the times down for non-urgent referrals from 17 weeks to 13 weeks," he said.

Updated: 09:32 Thursday, October 27, 2005