Positive Health Online

I woke up one morning after a long day’s work the previous day, to find that I could not walk properly or, even go to the toilet. Panic set in; I had not experienced such severe pain before.

I saw my GP and he prescribed more painkillers and anti-inflammatories.

When they were shown not to work, he sent me for an X-ray, which didn’t reveal any major pathology. In the meantime, I also saw various Osteopaths/Physiotherapists. In that first year I spent £8,000 seeking a cure from these therapists. All I was doing was what is what I now call ‘Therapy Shopping’. Just as you take your car to the garage to get the exhaust replaced, I was looking for someone to ‘sort out’ my back problem.

I saw a couple of Orthopaedic Consultants who told me my back problem was not serious enough to merit an operation – not that I wanted one anyway.

The last consultant told me to learn to live with the pain. To be told that at 39/40 I’d have to learn ‘to live with it’ came as a bit of a shock, especially when I still had sciatic pain going up and down my leg at the time, and I walked with a limp.

Soon after I found out that this Consultant was an arm specialist! My faith in the NHS was rapidly disappearing. I just knew there had to be another way of dealing with this, but I didn’t know where to find it.

One day I was thumbing through a telephone directory (having run out of books to read) when I came across the NBPA. Quite by chance, I had bumped into the National Back Pain Association, which is still the only charity in the UK, and world-wide to help those with back problems. I rang to find out if they could help me, and that same day I joined up.

There wasn’t a support group in the East London & Essex area. I had been involved with other self-help groups over the past few years so, bearing in mind the old adage: ‘If you want to learn something, teach it’ , I asked the NBPA if I could start a support group here in Essex. “No problem” they said. Chris Cotterell their branch organiser came to see me and gave me a few guidelines. Someone showed me how to write a press release and in May 1994 we held our first meeting. On the night, it seemed as if the entire cast of Ben Hur had turned up, all of them with similar problems, and seeking answers just as I was. Since then I have run the NBPA Havering Branch

My true turning point

At the September meeting ‘94 Amanda Williams came to see us from the INPUT Pain Management Programme (PMP), St. Thomas’s Hospital, London. She talked to the group about learning multi-disciplinary skills to manage chronic pain. That was just what I wanted to hear. This was the other way I was looking for.

In July ‘96 I attended a two week course at INPUT. The PMP was designed to help EVERYONE who has experienced chronic pain. This was the turning point in my recovery. The course organisers said that they could not make my pain go away completely, but they could help me to learn to manage it in a more effective way. Previously, I had subscribed to the old fashioned theory that pain management meant doing nothing and exercise would aggravate problems. How wrong can you be? The course convinced me that if I followed the simple pain management programme things would become much easier. They did.

Pain Management Programmes

The aim of Pain Management Programmes is to use a number of practical techniques and psychological strategies to enable a person with on-going pain to maintain physical performance, optimise day to day function and reduce distress and suffering.

The components usually include:
•    Physiotherapy: Where a programme of stretch and exercise helps the patient regain fitness and flexibility. The patients are helped to identify their baseline activities and learn how to build on these so that they, not the pain, control their level of activity, which is conducive to improvements in their physical state. Individual exercise plans can be implemented where patients have particular problems.
•    Occupational Therapy: Helping patients identify the activities, duties and hobbies that they want to resume and teaching them how to achieve these tasks in a measured and controlled way without overdoing or straining.
•    Psychology: Many patients feel frustrated, angry and disempowered because they cannot achieve the tasks they have set themselves as they would wish; or they may feel anxious or panicky at times of increased pain. These thoughts and feelings can lead to feelings of depression. Sessions with the psychologist help them to recognise these thoughts and feelings and introduce practical techniques to help their thoughts work for them rather than against them.
•    Nursing: Looks at the medication being taken by chronic pain sufferers. Research shows that many drugs are unhelpful in chronic pain and often produce side effects such as drowsiness, dry mouth, constipation and lack of concentration. The advantages and disadvantages of medication are discussed and guidance given on gradual reduction, where possible. Sleep difficulties are identified and discussed, with strategies to improve habits being taught. Relaxation skills are also taught to help patients cope better with pain and pain-related problems. These start with simple techniques that focus on breathing and overall reduction in muscle tension. Other techniques are introduced to extend the patient’s range of skills and their application.
•    Education/Information: Sessions are aimed at providing patients with a greater understanding of the underlying causes of pain (such as injuries which have usually healed) and the effects of pain upon them and treatments available. This ensures that they are better informed for the future. All members of the team, including the Doctors, participate in these sessions.

I have developed a similar 7 week programme here in Essex called Fighting Back. Fighting Back is based on the PMP but it is not intended to supersede a PMP. I envisage it simply as a tool to help people get into recovery – a fast track. Those attending are required to pay an attendance fee of £45.00 for the 7 one and half-hour sessions with professionals in various fields.

The components of Fighting Back include:
•    Physiotherapy: A programme of stretch and exercise to regain fitness and flexibility Identification of baseline activities, control and progressive increase of their level of activity. Appropriate, sustainable levels of activity lead to improvements in their physical state.
•    Alexander Technique: For many, the unconscious, harmful way they have used their bodies in activity over the years could be a major cause of their chronic pain and present difficulties. Alexander looks at the causes of pain and how to limit further physical damage or discomfort, rather than treating the symptom.
•    Self Care and Incentive Strategies: Helping people to pace themselves so that they can resume key activities, duties and hobbies in a controlled way, without subjecting themselves to the setbacks provoked by undue strain or overexertion.
•    Dealing with emotional issues: Addressing the anger, frustration and disempowerment caused by failure to achieve tasks or goals, and the panic or anxiety occasioned by increased pain, which, if not dealt with, can result in feelings of depression.
•    Identification and discussion of sleep difficulties: together with the teaching of strategies to improve habits, starting from simple techniques that focus on breathing and overall reduction in muscle tension. Relaxation skills are also taught which encourage people to cope better with pain and pain-related problems. Further techniques are introduced to extend the patient’s range of skills and their application.
•    Education/Information: Sessions aim to provide people with a greater understanding and information as regards the causes and effects of pain, as well as treatments available. This is coupled with discussion of their general life style.

The 7-week Fighting Back Pain Management Programme

Week 1    Coping Skills: Pacing and Goal Setting.
Week 2    (a)    Education: Providing a sound basic knowledge of the causes of pain, exploring the over-activity/under-activity cycle.
    (b)    Introducing carefully paced Stretching/Exercise.
Week 3    More detailed Stretching/Exercise Session and discussion of overall life style:
Week 4    Alexander Technique: an empowering approach to the common problems of chronic pain; discomfort, limitation of movement and the effort of keeping the body erect. Imparting fundamentals that can reduce levels of pain in activity.
Week 5    Relaxation Techniques/Stress Management for home and work: Teaching practical relaxation
techniques, combating sleep difficulties, improving stress management.
Week 6    Stretching/exercise follow up: To reinforce the importance of pacing, and not over-doing.

4 Week break to enable people to put the Fighting Back skills into action.

Week 7    Follow up session: People are asked to return in order to reinforce their skills in Stretching, Pacing etc. and discuss any difficulties they may be experiencing. This is a trouble shooting session. Where to go from here? Follow up advanced sessions.

Other therapies that have helped me.

Another therapy that was to help me was the Alexander Technique. When I took my first lessons I expected dramatic results – I didn’t get them. It seems I now had to learn patience. I stuck at it and over the years I can say the Technique has really helped me by showing me how not to wear my body out and how to use it in the most effective way. It is for this reason that I have included the Alexander Technique in the Fighting Back programme.

How I cope today.

Yes, I still get problems and flare ups even today, but this is mainly due to me forgetting and not following the INPUT programme. Either, I have not paced myself sufficiently, or I have failed to set goals and not paced myself at all. The good thing is that these days I do have a first aid plan to fall back on if I run into problems. This is the plan that was shown to me at INPUT. In the old days if I had a flare up I would take to the floor, in a panic. These days I use ice… and just keep going.

Further Information

National Back Pain Association, 16 Elmtree Road, Teddington, Middlesex TW11 8ST. Tel.0181-977 5474. Fax. 0181-943 5318. Web: http://www.backpain.org  101540.1065@compuserve.com
National Back Pain Association – Havering Branch, 53 Wolseley Road, Rush Green, Romford, Essex RM7 0BS. Tel 01708 741080. E-mail: backtalk@nildram.co.uk  http://www.backtalk.nildram.co.uk
INPUT Pain Management Programme write or call: – Input Pain Management Unit St. Thomas’ Hospital, Lambeth Palace Road, London SE1 7EH UK Tel. 0181-922 8107
Alexander Technique. Society of Teachers of the Alexander Technique (STAT), 20 London House 266 Fulham Road London SW10 9EL. Web: http://www.stat.org.uk