Date: 22.07.20

Duration: 1 hour

Online via Microsoft Teams

Reflective Summary:

I missed Nic’s session on Chronic Pain via teams because I had other commitments on that day.  Because I did not attend the session, I was unable to access the recording on Microsoft Teams.  Nic very kindly sent me a copy by email and I went through the presentation in my own time.

I had already gained some understanding of pain and pain management in the year 2 module on injury treatment modalities.  I also began a placement during March 2020, with the Pain Management Clinic organised by the NHS.  I enjoyed working with Peter Storrey (the lead physio) and his team.  I was enjoying the placement but unfortunately the placement was suspended due to the UK national lockdown during the COVID-19 Pandemic.  I had only attended three sessions of the placement.

The presentation slides helped to reintroduce me to the definition of pain, the different terms and the concepts of pain.

Pain is a subjective experience and a protective mechanism to prevent movement of an injured body part.

Chronic pain is persistent, long-term pain that has gone on for over 3 months e.g. Complex regional pain syndrome (CRPS), phantom limb syndrome, arthritis and chronic low back pain (CLBP). There are changes in psychology, environment and behaviour.  Chronic pain sufferers may believe that there is still underlying tissue damage causing their pain, long after the tissue has healed. Environmental factors such as family influences, culture/ethinicity, secondary gain, socio-economic factors, physical factors and work factors can have an impact upon a person’s pain experience.

There are three pain mechanisms:

Nociceptive pain, peripheral neurogenic pain and central sensitization.

In a sensitized nervous system fatigue, anxiety, low mood and other negative associated feelings turn up the volume switches that make it easier to trigger pain.  Stress increases cortisol levels which result in poor memory, poor tissue healing and poor sleep.  These factors make it harder for individuals to cope with pain.  Their pain experience can be improved by doing things that make us feel calmer and happier, turning down the volume switches.

Chronic pain has an impact upon quality of life as patients learn how to cope.  Patients with chronic pain change how they perform simple activities, because they require more attention and take longer to do.  It may be difficult for them to return to their role at work and they may have to change the daily routine to include more rest periods.

Pain can be managed with a positive attitude, encouraging the patient to engage in exercise e.g. Tai Chi, pacing ADLs, pain education, talking therapies – cognitive behavioural therapy (CBT), manual therapy – mobilisations and soft tissue massage, low level laser therapy, ultrasound, TENS, Taping and strapping, stretching, mindfulness activities such as meditation, talking and listening.  Medication is not recommended because it has been shown not to be the answer to managing chronic pain.

I would like to pursue Chronic Pain further in the future by possibly reengaging with the NHS Pain Management placement when Peter Storrey and his team can run it again, COVID safe.  I believe it will give me a better understanding of patient’s pain whether they are being treated for a sports injury or for a medical condition.

Areas for further improvement plus action plan:

 

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