Information of managing pain - includes men this time!

[Alaine1]

Hello Everyone

As promised I have returned armed with more information on pain. At a parliamentary event I attended last year on pain I was fortunate enough to meet Pete Moore who was part of a panel including a specialist GP and pharmacist. The meeting had a variety of people in the audience from charities, BMA and doctors/medical professionals

Two of the take away messages was that GPs should be working with their patients to help manage their pain instead of telling them to wait for their next specialist or pain management appointment. This can include increasing or changing medications.

An under used resource is the community pharmacist who are not just a wealth of information for how to manage a cold but how to take medications such as for pain. Often medications aren't taken correctly due to the hospital pharmacist or specialist not explaining how to take them or the patient becomes freaked out at the potential side effects so doesn't take them. I take a number of medications which have awful side effects but have yet to experience a single one, but other medications not so lucky. Again the pharmacist can explain more about side effects, how to treat, etc. It helps to try and use the same pharmacy for regular medications to help build the relationship with the pharmacist and their team.

A point that the entire panel were in agreement with was that sometimes drugs and surgery isn't the answer to treat all pain. This again is dependent upon the medical condition- endometriosis will need to have surgery but often pain continues even when it has been fully excised. The same is true of other conditions. Sometimes the patient is left in pain and despite medical treatments being used nothing works. It is here that sometimes pain management not using medications is used but physiotherapy/physical therapy, psychologists who help patients to manage pain using various techniques. The availability of these may depend on which part of the UK/local NHS resources and country you live in. Some of these are given in pain management clinics but others might have to go to their GP for referrals.

Pete Moore himself is an author who has suffered with pain himself. He gives talks on the subject to a variety of audiences and developed the paintoolkit website which is a wealth of information. The link to the site is posted below:

paintoolkit.org/tools

I might start a thread on here where myself and other admins will post information on pain from other sites. If anyone has any suggestions for sites they'd like to see added please let us know

[chillijava]

i think a lot of the time in my experience, gps and even other types of doctors do not have enough experience of pain medications and their side effects, i was lucky in my area of nottingham that we have a very good pain clinic with knowledgeable consultants, but even here we are now going to have problems as due to costs the pain clinic is closing and the care is then going to go into the community to be administered, to such as gp surgery's and local health centres and even in patient's homes, really not sure how these are going to work and i am quite fearful of the service that is going to be offered.

pain treatment really needs to be given by consultants and experts such as specialist staff, as some of the side effects are very hard to handle and encouragement is needed in some cases to continue with drugs that might eventually help

andrea

[Alaine1 Administrator in reply to chillijava]

I think it can be the case with gps not having the experience but with my surgery I've been told consistently it's not their job. The GP at the parliamentary event Dr Martin Johnson GP & RCGP Clinical Champion for Pain Management actually said GPs are very well equipped on how to manage pain as they are used to managing long term conditions in the community. It was suggested that it was more of an 'attitude' rather than lack of ability. It was only recently when I had mentioned I had attended this event to my GP and name dropped Dr Johnson I received a very different outcome - they altered the dose of one of my pain medications. Many people will never gain access or be considered to meet criteria for referral to a pain specialist so they will need to have the GPs manage it in the community. The pharmacist is actually better placed to advise on side effects and encourage patients as they are expert in medicines. Specialists are specialists in the diagnosis and management of conditions- many doctors have very little knowledge of the pharmacology of drugs They have very little pharmacology training as both undergraduate and during specialist training. They simply know which drugs treat conditions. The same way that I wouldn't discuss a surgical procedure with a pharmacist as they'd not have a full understanding of the condition. This was something I learnt first hand as an undergraduate- a prof who I was doing a ward round with the pharmacist, doctors and myself an undergraduate pharmacology student admitted that doctors have very little knowledge of pharmacology unless they become a clinical pharmacologist. But they are very able at managing conditions.

I'm very fortunate in London with the pain clinic I'm under, the pain management specialist I see is the clinical lead for pain for the BSGE endometriosis centre. She manages all 3 of my pelvic pain conditions along with the specialists treating me. Nothing is ever perfect though as the NHS simply doesn't have the funding but there is now being placed a greater emphasis on patients self managing where possible and working as part of a team alongside their specialists. I think and this was discussed at the Long term Conditions conference I attended last month that there will be a greater emphasis on shared care, patients self managing and becoming their own expert in their conditions. It's a sad truth but the way the NHS works is changing- in some ways for the best and in others for the worst

[chillijava in reply to Alaine1]

i do have multiple pain conditions, as do a lot of people, it seems one triggers the other, in my case, and you are very lucky, as i said i to have a lovely consultant at my local pain clinic and i will be loathe to loose him as he has a great empathy for his patients,where as my gp is little more than useless and he is the 2nd gp i have changed to and many times has told me he cannot prescribe multiple pain meds at the same time where the pain clinic does. i do agree about self managing some conditions, but isnt that what most people do with pelvic pain, i certainly know that i know more about my condition than do most doctors, and also about treatments

[Alaine1 Administrator in reply to Alaine1]

* The long term conditions conference wasn't focusing just on pelvic pain conditions but included diabetes, epilepsy

* I've spoken to patients in the endometriosis clinic I attend and told them some of the things I do to help myself only to have them reply that it's not their job to get better it's the doctors job.

* Please remember that many patients with pelvic pain conditions such as endometriosis, adenomyosis, IBS eventually go on to have successful treatments, surgeries and don't suffer from long term pain memory which is a recognised problem so won't come onto this and other charity sites. Patients are then often given a skewed picture that there is no chance of success. Some patients won't have success unfortunately

[pillidge1 in reply to chillijava]

I was in contact today with my gp about some pain meds I've been on for 12 days and I started having side affect. My gp said these side affect i was having wasn't with these tablets. I pointed out to her I had read the information leaflet and it mentioned these side affects. The gp was gobsmacked that she didn't know about it. I believe in working with my gp and pharmacy im very lucky I can talk straight to my gp they are only human after all

[Alaine1 Administrator]

Definitely Pillidge1 I think sometimes we do forget that they are only human and they often set themselves up to fail by pretending they know everything. Some of them could definitely help themselves by becoming more human. I'm 'happy' to acknowledge they the GPs can't be expected to know all medical conditions, and side effects from treatments. I also think that there needs to be a more focused campaign on getting people to use their pharmacist more - I think many people underestimate just how much of an expert they really are and might be pleasantly surprised. I've been luckily that growing up I had a great GP who would work with me even at a very young age. I unfortunately don't have a very good gp surgery and changed to my current one after a similar experience with the one before. It does leave you feeling more than a little deflated but there has been a glimmer of hope recently with one GP so will work on that 😊 Luckily I've got great specialists with one being absolutely amazing!

[chillijava]

i agree about pharmacists, the one i use is very knowledgeable about side effects and i go to her if i need advice about these, as my gp will normally say that he has never of heard of some side effects. my pain dr too is also very good with things like side effects, which i fully expect him to know