My previous post explaining chronic pain (and my post about how to manage it) were quite popular, so this week I'm bringing you more of my reflections on working with people who are struggling with chronic pain.
As you know from my previous posts, chronic pain is pain that goes on longer than six months. Some people can struggle with chronic pain for decades, and it can affect much more than just your physical ability. I've been working with people with chronic pain for quite a long time, and these are some of the things I've learned along the way:
Nobody wants to take medication
I've never met a single person who says, "I quite like taking Tramadol, thanks!" Pain medication, like other medication, has a whole host of side-effects ranging from mild nausea to difficulties with memory and concentration. For most people struggling with chronic pain, medication only helps 30-50%, and it's always a balancing act between pain relief and side-effects. Whilst part of my job is helping people to reduce their pain medication if they want to, nobody with chronic pain takes it because they want to.
People in pain are vulnerable to being scammed
It's a natural, normal human drive to relieve pain. When faced with pain that won't go away, some people struggle to accept that there isn't a readily available cure. I've had people accuse me of withholding treatment because the NHS can't afford it, and people who refuse to believe that I can't take their pain away. But the people I really feel for are the ones who spend thousands of pounds on remedies or cures that do nothing of the sort. People often prey on vulnerable people who are desperate for relief, and it can be costly and disappointing for a lot of the people I've worked with.
People are so resilient
I've worked with people who are under incredible amounts of stress. Life doesn't stop just because you have chronic pain, and all the life stresses and strains that we all go through are still there for people with any chronic health condition. In spite of this, so many of the people I work with are incredibly resilient. I'm always amazed and humbled by how people face adversity and come out bruised but mostly in tact, due in part to the close and supportive relationships they have with friends, family and loved ones.
People want to work
In spite of what the media will tell you about benefits claimants, the vast majority of people I've met who don't work are devastated about it. Chronic pain can make you feel unreliable as your pain levels fluctuate, so the things you did on Monday might not be possible on Wednesday. Employers don't always understand that, and the benefits system isn't really set up to support people to get back to work gradually. Because of that, it can be really hard for some people with chronic pain to stay in work, and I have so many conversations about how horrible and frustrating the whole system is. Again, part of my job is to help people to try to get back into work if they want to, and overwhelmingly most people tell me that they do.
Society isn't set up for chronic pain
This one might seem obvious, but it becomes more apparent the longer you think about it. Look around your house right now - what would you struggle to do if you had low back pain, for example? Those items in your kitchen in the lower cabinets, that you have to bend for - you can no longer get to them on bad days. Have to get up two flights of stairs to your bathroom? Forget it. How far is it to walk to the local shop - double how long it will take you sometimes. How long can you comfortably drive for? Halve it. Add to that the fact that so many people seem to see the mind and body as an either/or deal, and don't understand that just because they can't see pain does not mean that it's "in your head," and you've got the perfect set-up for becoming increasingly inactive, isolated and depressed. When I'm talking about anxiety with my patients, the example I usually use is going to the Trafford Centre on a Saturday afternoon - it always evokes a response, because it's loud and crowded and often difficult to find a seat. There are so many things we could do to be better at making community spaces more accessible (that doesn't just mean wheelchair access, although that is also lacking in a lot of areas), but a little understanding and a willingness to help people - yes, even strangers, especially strangers - is a good start.
These are just a few of the things I've learned working in chronic pain - I'm sure I'll think of more at some point in the future. If you've got anything you want to share, let me know either in the comments, or on Twitter.
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Dr Sarah Blackshaw: Clinical Psychologist, blogger, tea drinker, interested in dinosaurs and shiny objects