Reframing Chronic Pain with Skills Not Pills

September is World Pain Awareness Month - a global initiative to highlight the challenges faced by those living with chronic pain and the importance of better support and management.

This year, the British Pain Society is focusing on a unified approach across the UK to a Four Nation Strategy to improve pain management, raise awareness, and empower those affected.

Chronic pain (also termed long-term or persistent pain) is pain that lasts for more than 3?months and is the biggest pandemic in healthcare. It has been called an invisible or ‘iceberg’ condition – devastatingly felt but unseen.

“Pain is a universal experience. Yet it’s hard to comprehend what being ruled by fear and wracked by a continually sounding alarm can do to a person — even for those of us who have, at some point, experienced a long stretch of severe pain.”

Lucy Odling-Smee

Nature | Vol 615 | 30 March 2023

Chronic pain: an unacceptable human cost

• There can be no denying the impact of living with long-term pain
• Severe and persistent physical discomfort
• Poor sleep
• Reduced capacity to complete daily activities
• Social isolation
• Poor to severe mental health

Data from the UK National Pain Survey 2023 showed that many respondents expressed dissatisfaction with the recognition and treatment of chronic pain in the healthcare system.?

Nearly 48% of respondents reported having thoughts of taking their own life and some 29% experienced thoughts of self-harm – highlighting the severe mental health challenges faced by those in chronic pain.

Amongst male respondents, over half reported suicidal thoughts, while women reported impacts and stigma affect them more often than men.

Adams & Salomons, in the Canadian Journal of Pain (2021) reported that employees’ attendance of work with chronic pain was associated with higher levels of psychosocial stress, lower vocational fulfilment and feelings of being ostracised in the workplace – findings that suggest that “the presence of pain in the workplace goes well beyond lost productivity due to absenteeism”.

• 64% were less likely to view their job as rewarding
• 47% were more likely to be subjected to threats/abuse in the workplace
• 30% were more likely to report poor supervisor support
• 28% were more likely to perceive discrimination in the workplace
• People with pain missed approximately nine more days of work per year than respondents without pain

?

Chronic pain: an escalating economic cost

?

Arthritis and back pain account for a third of all claims for disability benefits in the UK. If long-term pain has been prevalent for a year or more or likely to continue for at least a year, (or for the remainder of life), and it significantly impacts daily activities, potentially, it could be considered a disability.?

The estimated productivity costs of back pain are ￡5 – 10 billion.

?

Re-framing chronic pain

?

In his book ‘The Pain Free Mindset 2023’, leading pain consultant Dr Deepak Ravindran says:

?“The present model of thinking about pain is wrong. It is also responsible for some of the worst and unnecessary healthcare spending that we have seen in the last three decades.”

While pain medications such as paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen, opioids like codeine and morphine and medications like gabapentin and pregabalin all offer various degrees of relief for acute pain, their efficacy and long-term usage for chronic pain conditions is problematic and comes with significant side-effects.

In ‘Chronic Pain in England – Unseen, Unequal, Unfair’ Versus Arthritis has called for “A fundamental re-think in how we support people with chronic pain through far-reaching solutions. The approach must be holistic, comprehensive and integrated across our health and care systems and public health, at a national - and fundamentally - at a local level.”

In this context, how can we re-frame chronic pain? After spending a few years educating GPs about the dangers of high dose opioid prescribing a ground-breaking ‘Chronic Pain in Cornwall’ team are working to raise awareness and availability of non-medical strategies for people with pain.

Cornwall’s Pain Cafes

Working with world leading expert Dr Frances Cole, Chronic Pain in Cornwall is creating a network of Pain Cafés across Cornwall to support people in their journey to a better quality of life. The team comprises an expert patient with lived experience Sean Jennings , a GP Dr Jim Huddy, Debbie O’Nyons lead for personalised care in Cornwall, @Nikki Kelly and Kevin Feaviour directors of ImagineIF community connect and Dr Keith Mitchell pain consultant at Royal Cornwall Hospital.?

Deborah O'Nyons , Clinical Lead for Personalised Care and Health Coaching NHS Cornwall and Isles of Scilly and explains their approach to health:

“We take a 'socialpsychobio'?approach to health focused on ‘skills not pills’ with the aim of reducing levels of medication, visits to GPs, health services and emergency admissions to hospital.

A café style atmosphere provides an informal, accessible, safe psychological space where, supported by their peers, people can develop confidence to talk openly about their health develop techniques to better manage their pain and well-being.

It’s about self and social development to help people to feel more empowered to manage their own pain, experience improved wellbeing and greater social engagement and reduce isolation and?psychological distress."

The Cafés offer a de-medicalised environment, with links to services through social prescribers and GPs, within a non-judgemental and confidential framework where people’s experiences are heard and validated. Focused peer support cultivates a sense of belonging and skills development, knowledge, motivation and self-efficacy are supported by trained facilitators to manage sessions around mindfulness, Tai Chi, yoga and sleep.

The Cafés are attended by an age group of between 18 – 84 years, most participants are aged between 55 and 74 and most people are referred by GP surgeries or other health professionals with, for some cafes around 50% are self-referrals. 75% of participants are women. The progress Café participants make is really encouraging with 100% feeling more able to manage pain; 92% learning new tools and techniques to manage pain; 83% feeling more in control of their lives. Half reported seeing their GP less, and 64% were able to decrease medication. Overall, participants experienced increased confidence in managing pain, improved sleep, fewer incidents of pain-related catastrophising, improved sense of purpose and well-being.

?

Self to social management

?

The Café’s underpinning philosophy is the concept of ‘self to social management’. This recognises our basic human need for belonging and connection, valuing and using shared experience and community as a major place of natural support.”?

Fellow team member and ‘expert patient’ Sean Jennings shares his experience:

“I’m 62 years old from Cornwall, and a former mechanical engineer. When I was 32 I had what I thought was a routine hernia operation. Unfortunately, from that day I have suffered chronic pain and prescribed ever Increasing opioids, gabapentin and antidepressants, for the next 25 years. I am now 5 years medication free thanks to distraction and mindfulness techniques along with exercise/movement to manage my pain. I have used the last 5years to tell my story to clinicians and patients advocating SKILLS NOT PILLS.”

There are now 13 pain cafés in Cornwall, with this number expected to grow significantly over the 15 originally planned; the concept is spreading across the country and the team is also working with the national charity?Help for Heroes.

References:

?

Lucy Oldling-Smee: Chronic pain: the long road to discovery:

https://media.nature.com/original/magazine-assets/d41586-023-00869-6/d41586-023-00869-6.pdf

Dr Deepak Ravindran: The Pain Free Mindset – 7 Steps to taking control and overcoming chronic pain

https://www.amazon.co.uk/Pain-Free-Mindset-Control-Overcoming-Chronic/dp/1785043390/

Narinder Sheema: From Pain to Power

https://www.amazon.co.uk/Pain-Power-Chronic-Roadmap-Healing/dp/

Sean Jennings: Sean’s Story – There is another way (NHS England and NHS Improvement South West)

https://youtu.be/l17SjDth4pU?feature=shared?

Support the British Pain Society:

Support our mission to improve pain management and patient care by making a donation to the British Pain Society?here

?Explore More:

BPS Patient Publications

Useful organisations

Live well with Pain?

Pain Concern

Pain Association

Versus Arthritis

Flippin’ Pain

?

?

?