London Pain Service
The London Pain Service was established to provide a multi-disciplinary approach to treating pain-related conditions. Naturally there are many causes of pain, depending on which body system is injured or simply not working properly. Due to the potentially large number of clinicians and practitioners that may be involved in a single patient’s care, it is impossible to house everybody in the same facility. Nicola and Sean have an extensive network of colleagues covering all areas of medicine, who all work in the vicinity to the London Pain Service.
Musculoskeletal pain from the spine or joints is a very common problem. Often simple problems such as low back ache will settle with rest, a hot bath and perhaps some simple over-the-counter anti-inflammatory tablets. However, if the problem is not just muscle soreness from overdoing things, then the pain may persist. Attending with an osteopath or physiotherapist can often solve the problem in the majority of cases. If not, then this is the time to have a medical assessment and investigations. In this situation the ladder of options to control the pain is a follows:
- Anti-inflammatory medications and muscle relaxants
- Stronger / more complex pain-killers
- Targeted steroid injections
Clearly, it is desirable to stop at the earliest possible options and avoid surgery. However, if investigations reveal a specific unstable structural problem, then surgery may be the immediate way forward.
If pain is generated by a completely different body system such as the gut, then the initial management and pathway may be somewhat different but the principles remain the same.
Pain often causes secondary problems. If pain persists for many months then it is often the case that a degree of incapacity develops. People vary in their priorities for what is basic for a happy existence, but most of us need the following:
- To be able to sleep
- To perform basic day-to-day activities such as washing and dressing
- To be able to venture from home and return safely without difficulty
- To be able to work or look after the family
- To have some semblance of a social life
If this basic list is not possible, then it is frequent and understandable that our mood and spirits drop. Anger, frustration, depression, inability to cope and even a sense of hopelessness can result. In such circumstances, dealing with the physical elements of the pain becomes impossible. At this time it is appropriate to consider the need for psychological support. To achieve motivation and a stable mood ‘platform’ is critical to being able to move forward once more and solve the problem and so we involve pain psychologists and doctors to address this component of the problem.
Clearly, each individual has an individual problem. The emphasis of treatment and the correct order of treatment is what Nicola and I set out to achieve. We do this by delivering an honest initial appraisal of the situation and aim to deliver a timely, supportive and sensible solution. If the treatment programme should break down at any stage, for any reason, we work hard to get back on track as soon as possible.
- Identify the cause of the pain
- Remove any contributory factor that promotes the pain
- Learn to do things in a better way e.g. paying attention to ergonomics
- Control the pain
- Restore sleep and dietary patterns
- Enable restorative exercise to regain function and strength
- Set realistic goals for what is achievable in the long term
- Encourage maintenance of good health practice to prevent recurrence of the problem