S E6: Ep 6 – Why you need to know the difference between acute pain and chronic pain?

Welcome to the Pain Free Living Podcast.

My name's Bob Allen and my aim is to help you to live pain free.

Let's begin.

Hello and welcome to the Pain Free Living Podcast.

And Louise, I'm a change coach and consultant.

So I work with people and businesses to navigate change, but I like asking lots of questions, which is why I'm here.

Exactly that.

And today we're going to be talking about chronic pain.

And you mentioned chronic pain.

Bob, what's the definition of chronic pain?

Okay, so as far as the medical world is concerned, there is acute pain and there is chronic pain.

So acute pain is pain that has lasted for less than 12 weeks and chronic pain is anything that's lasted 12 weeks or more.

Okay.

So I guess, you know, a number of people listening to this may identify with they've probably got chronic pain somewhere, whether that's back, knee, shoulder, neck, wherever they're in chronic pain.

And they may have been sent for a scan by their gps.

They've been to the gp, been sent for a scan, and that scan has come back as clear.

It would be interesting to get your advice in terms of what people should be doing if they encounter this scenario.

So what would your advice be to somebody that is facing this?

They've got chronic pain, there's nothing showing up on their scan.

What should they do next?

Okay, so when you go to your gp, they kind of have to follow a standard process when you first go in.

Depending on the type of pain you have, then they generally recommend painkillers.

If that doesn't have an effect, then they will step up the painkiller strength.

So they may put you on something slightly stronger.

If that doesn't work, then generally speaking, there's kind of two ways they will go on it.

They will either refer you to a pain clinic, although that can take a few weeks, refer you to a physio.

The last time I spoke to a physio, the waiting list In Northampton was 40 weeks.

Right.

Or they may send you for a scan, which is the scenario that we're talking about.

Now, the problem with a scan is it doesn't always show that there is a problem, as you've alluded to.

They've been for a scan and it's come back totally clear.

Now, the problem with scans is they aren't foolproof.

You can use a scan to confirm a diagnosis, but you can't use a scan to make a diagnosis.

And what I mean by that is, is that if you were to MRI scan 100 people, and of those hundred people, 20 of them, say, had back pain, you could scan them, look at the scans, and of those 20 people, you may find that 10 of them have absolutely nothing showing up on the MRI scan at all.

So their backs look absolutely perfect and clear, and.

And yet they're in excruciating pain.

So if somebody's got raging sciatic pain down the right leg, and you look at an MRI scan and it shows that they've got a disc bulge or there's obvious nerve irritation on the right side of the lumbar vertebrae, you can go, okay, that scan says that the pain is caused by this nerve compression.

But if you've got somebody who's come back with a clear X ray, clear X ray, or MRI scan, and there are no signs of any issues with the spine at all, then what do you do next?

What you should do is you then say, okay, I had a working diagnosis that this was a problem.

There are no signs that that's actually what's happening.

So therefore, we need to do some more investigation.

We need to have another look and a rethink about what's going on.

Now, what would happen if somebody had gone to the gp?

Typically, what should happen is they should have what we call a differential diagnosis.

So what you do is you have a list of four or five different potential causes of the problem, and then you work your way through that list from most likely to least likely.

If you're not noticing a change, you're not noticing a difference, then you then go to the next one on the list and you go, if it's not that, then it may be this.

So if you're treating back pain, for example, and the results are clear, then it's not necessarily a mechanical problem.

So therefore you go, it's not that.

So let's have another look and let's have a rethink and let's do something else now.

Because gps are rushed because they don't generally have a lot of time to do.

What they tend to do is they tend to escalate the pain management process with more drugs, and then they'll do the scam.

And then the good ones will then have a rethink and say, well, okay, what else could it be?

The ones who are rushed off their feet, borderline burnout, and don't have the time will potentially go, and I know People this has happened to keep taking the tablets.

They very rarely say, I don't really know what's going on.

So they'll carry on treating for kind of like general low back pain, but they won't really know why.

They just hope that it resolves over time.

And that's when people will generally go, okay, I'm not getting anywhere with this.

A lot will stay on whatever regime that they're on and some will go, okay, this isn't working, I'll go and find somebody else.

If you can't afford to go private and come and see someone like myself, what you need to do is you need to go back to your GP or consultant and say, right, okay, we've been doing this for a little while.

I don't seem to be making any progress.

The pain's the same or potentially getting worse.

What are we going to do next?

Now most people won't do that.

Like in the olden days where gps were put on a pedestal and they were not to be questioned.

And what they said, this is what your problem is, was not to be challenged.

People are much more likely to challenge now.

And I would always say to people that, yes, go back to your gp, tell them that this approach isn't working.

What else can they offer you and kind of take it from there.

It's a very long winded answer, isn't it?

I think you've covered a number of my questions there.

But in terms of just going back, then, if there's a scan result or an X ray that's coming back clear, but you're still in pain, keep going back to the doctor, you know that you're in pain, so keep going back and ask for clarity around the diagnosis and what the options are.

Yeah, absolutely.

You then mentioned around there may be a raise in pain medication level and I know you've mentioned this before previously, that you encounter or some of your clients do not want to take pain medication either, do they?

No, they don't.

But I always say take the pills.

If they work, if they can reduce the pain levels, then that means you can move more.

And as I always say, movement is medicine.

The more you can move, the better, because that always helps the healing process.

Moving within your pain limits.

Yeah, yeah, you know, so bit of discomfort.

Okay, carry on moving.

If it's painful or it makes the pain worse, then you're overdoing things a little bit.

But yeah, pain medication has its place, but it should only really be seen as a short term measure.

Now, there are occasions where, yes, you May be on tablets for a much longer period of time, but as long as that is part of the treatment process and it's explained to you why you're on that medication, what the process is, then.

Yeah, I would say taking the pain medication can be very effective, but it's not a long term solution.

Yeah, it's not going to the source of the issue.

No, you're treating the symptoms rather than identifying what's causing the problem in the first place.

And what about, obviously with any medication there's always side effects or what's your advice around that?

Particularly if people might already be on other medication and now they're getting some quite strong painkillers.

I mean, that's an interesting one.

And the term is polypharmacy.

What that basically means is you're on a load of different medications because what can happen, particularly with older adults, because one of the ways of the health service for its sins will try and deal with, with some long standing problems.

And I said particularly with older adults is they will give you medication to manage your pain.

And when you're on the medication to manage your pain, they will also give you something like what we call a proton pump inhibitor.

Because some of the medications like naproxen and ibuprofen can affect the stomach lining, they can give you medication to manage that irritation of the stomach lining.

And then because that medication sometimes has side effects, they will give you something to manage the side effects, the side effects of the product.

So by the end of it, you can be on seven or eight different medications.

And the problem with that is that some of those interactions can also cause a problem.

So giving more medication is not always the solution.

It's always much better to identify what the problem is and manage and treat that problem.

And if they are on a number of medications, what would your advice be to them?

Well, what should happen if you're on a list of medications is the GP should review that list at least every six months.

Typically it might be a year.

And I know that some surgeries are actually brought in a pharmacist to go through the pain medication with them.

My dad's 94 now.

I went with him to the last medication review and the guy was brilliant.

Gps, general practitioners, they are not necessarily experts in the interactions between all the different medications, whereas a pharmacist has spent, I think it's a five year degree course and that is all they do.

So they are very, very experienced in talking about medication interactions and giving advice on the best medications to take.

So I have often recommended clients that come to see me to go and talk to a pharmacist rather than trying to get an appointment with the gp, which can be very difficult.

Go and talk to your pharmacist, tell them what medications you're taking.

If you feel that some of the symptoms that you're getting may be related to the medication, talk to the pharmacist, because they can then, if they decide that, yeah, actually, you're right, they can then go back to your GP and make some recommendations for what they should do next.

So the pharmacists out there may get a little upset because I'm advising people to do that, but that would be my recommendation every time.

And in your capacity as an osteopathic, can you refer people for a specialist opinion?

Yeah, I mean, that's one of the joys of being an osteopathic.

If I think that something's been missed, or if I think that somebody needs a scan or they need an X ray, then I will write to the GP or I will write to the consultant and make that as a recommendation.

I have to be fairly careful with the words that I use, not make it look like I am frivolously sending somebody for an MRI scan, which I have sent people for MRI scans, but I do it fairly rarely.

If I feel that an additional examination or there's something that's been missed, I will write to a GP or a consultant and I will say, this is what I think is happening.

Are you happy to do some further investigation on it?

And 99 times out of 100, the GPL consultant is happy to do that because they know that they get 15, 20 minutes to spend with a patient, whereas I get 45 minutes to an hour.

So I can do a more thorough examination and investigation than they can in the small, short time they're allotted.

So, yes, you know, one of the.

Key takeaways from this one as well is not to be afraid to ask for a second opinion or maybe even a third.

Yeah.

I mean, if you've been going to see your GP or you've been going to see someone and you're not noticing an improvement or things seem to be getting worse, do not be afraid to ask more questions, do not be afraid to say that, okay, we've got to this stage and we don't seem to be getting anywhere, I'm going to go and get second opinion.

I want to go and see, to make sure that there's nothing else going on, because I know cases where people have been going to see somebody in the health service for a number of times.

They've had a battery of tests, nothing's been found, and yet they're still in pain.

So I also know people who have been effectively sidelined because they've said there's nothing else we can do.

We've done all the tests and we haven't found anything.

Whereas actually, you know, your own body, you know, if there's pain there, you know what it is and where it is.

And people should never be afraid to push for additional testing until they actually get an answer that they're happy with.

Right.

Okay, thanks.

Bob answered my questions.

Thank you for asking those questions, Louise.

That's one on chronic pain.

If you've been in pain for a while, not sure why or what's been going on, then do not be afraid to challenge your gp.

Feel free to ask a professional like myself.

I do free 15 minute assessments.

Most therapists will be happy to have a conversation with you just to help narrow down what may be going on.

It's chronic pain in a nutshell.

If you've got any questions, as always, you can message me on the socials and hope you got something out of this.

And please tell all your friends how useful and valuable this podcast was.