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Harvard Health Publishing wrote that “ Chronic pain is an enigma for both pain doctors and their patients: difficult to understand (as everyone’s pain is different), challenging to treat effectively, and frustrating to live with. Desperate patients sometimes turn to drastic and irreversible surgical procedures, like amputating nerves to relieve pain, and unfortunately even those procedures may fail to provide the hoped-for results.”
Fortunately there have been great strides in research related to pain perception and our nervous system’s reaction to various pain treatments, and we’ve been able to develop novel devices that provide many people with much-needed relief and improve their quality of life.
Neuromodulation is “the alteration of nerve activity through targeted delivery of a stimulus, such as electrical stimulation or chemical agents, to specific neurological sites in the body.” Dr. Norman Shealy, a neurosurgeon, implanted the first device for the relief of intractable pain in 1967, and his work ushered in a new era for chronic pain management.
One of the most common examples of neuromodulation is the use of spinal cord stimulation (SCS) for chronic pain management. SCS consists of a very thin lead (or wire) that is placed in the space just outside the spinal cord (known as the epidural space). The lead is attached to a small generator device that is implanted under the skin and subcutaneous layer in the back or buttock. The devices will deliver frequent, low-voltage electrical impulses to the spine, with subsequent modulation of the pain signals in transit to the brain. Those impulses often feel like a gentle tingling or buzzing (which is called paresthesia) on the body.
Harvard explain that another form of neuromodulation is the intrathecal pump, which is a device designed to deliver a desired medication directly into the spinal fluid surrounding the spinal cord.
Neuromodulation treatments have typically been offered to patients only after they have tried conventional treatment options such as medications, physical and occupational therapy, or surgery. Although the treatment is not without risks it is a cost affective option for managing chronic pain, in particular after failed surgery,
Guy’s & St. Thomas’ NHS Hospital in London have a Chronic Pain Management & Neuromodulation Centre. It is internationally recognised as a centre of clinical and academic excellence in the management of chronic pain.
They have a long history of providing traditional chronic pain management treatments such as day case procedures and outpatient treatments.
They have also established world prominence in the fields of spinal cord stimulation and other neuromodulation techniques, as well as in addressing the psychological, physical and social impacts of chronic pain with our pain management programmes. This is delivered through the INPUT pain management department.
The centre collaborates closely with spinal surgeons in the assessment and treatment of spinal pains, and similarly provides highly specialised, multidisciplinary assessments for conditions including chronic headache, facial pain and pelvic pain.
After meeting my new Pain Team last week I was sent for a blood test to check my Vitamin D levels.
Symptoms of Vitamin D Deficiency include –
Getting sick and infected often
Fatigue and Tiredness
Bone and Back Pain
Impaired Wound Healing
Any Fibromyalgia or Back Pain sufferer will pick up on some of these symptoms and I know people say you should never read into these things but if you have the symptoms you can’t help but look into it.
Today I received a call from my GP to say I am Vitamin D deficient and I have been put on a strong course of Vitamin D only available from your GP for one month.
According to Biomed Central “Vitamin D is a pleiotropic hormone with a critical role in modulating several inflammatory and pain pathways in addition to calcium homeostasis. Observational studies suggest an association between vitamin D deficiency and chronic pain, most promisingly in fibromyalgia “.
On one NHS website they explain why Vitamin D is vital for health?
Vitamin D is needed by the body for both physical and mental health, but is best known for making sure bones are strong and grow properly. Vitamin D is needed all through life and even before birth. Pregnant and breastfeeding women need to have enough vitamin D so that developing and growing babies form healthy bones. Vitamin D is also essential for calcium to enter the body and strengthen bones.
Recently, it has been found that not having enough vitamin D is also related to other physical conditions such as diabetes mellitus, heart disease and certain cancers. The development or worsening of mental health conditions, such as depression, low mood and schizophrenia, may also be related to inadequate levels of vitamin D.
Where is vitamin D found?
Vitamin D is made in the skin by the action of sunlight. This is the best natural source of vitamin D. In northern countries, such as the UK, sunlight is only bright enough to make useful amounts of vitamin D from April to October and between 11am to 3pm. Sunscreen and clothing blocks out sunlight, so vitamin D cannot be made in the skin. Being out in the sun without sunscreen is associated with skin cancer, however sunbathing for about 10-15 minutes without sunscreen is considered safe for most adults. You should aim to get out of doors everyday. Sun beds and tanning salons are not recommended.
Some medication used in mental health can make your skin more sensitive to sunlight, therefore discuss safe sunbathing with your doctor or pharmacist.
Vitamin D can be found in some foods, but is usually only present in small amounts, so dietary sources are unlikely to provide enough.
Some vitamin D can be found in oily fish (such as kippers, sardines, mackerel, trout and salmon), meat and eggs. A few foods have vitamin D added to them, such as some margarine and low fat spreads, some breakfast cereals, powdered milks, dairy and soya products.
So Vitamin D is really important to our health and well being and I just have to wonder that had I not moved to a new GP and Pain Clinic who are looking at my chronic pain in a completely different light if it would ever have been spotted that I am deficient in it. Have you had your vitamin D levels checked?
I am also now waiting for an appointment for a bone density cytometry appointment. Not sure what that is as again I’ve never had one done before, have you?
As most of my readers will know I moved from the Midlands last July to the South. For the past 20 years, I had a great Pain Team looking after me in the Midlands and registered with a new Doctor the minute we arrived in Sussex so I could get the ball rolling to sort me out with a Pain Management Team here.
Just before I left the Midlands my Pain Consultant had referred me to a new PICS service which had just been set up near me. “PICS does not treat pain, they treat the patient which means using more holistic methods. Chronic pain can often lead to low mood, depression and anxiety because of being in pain all the time, so they work to try and get people back to what they enjoy and give them some quality of life. They have wellbeing practitioners who focus on support and activities. Hobbies and distractions are very important. Working through the pathway is proven to be successful with reduced GP visits and people returning to meaningful function – they start to do more in their daily lives.”
Unfortunately, with the move to Sussex I was unable to take advantage of this new facility for treating chronic pain, but a similar method is run here in Sussex, and yesterday I had my first meeting with my pain team which consisted of a Pain Consultant, a Clinical Nurse Specialist and a Clinical Specialist Physiotherapist.
Before the meeting, I had been given a number of Q & A’s to fill in all about my pain and how I dealt with it and I have to admit I was hoping that they would simply slot me in for some more injections and just discuss my medication.
We probably chatted for a good hour where they explained their program similar to PICS. The main points they felt about me was that I was not dealing with my pain well at all. They basically said that if the pain medications we’re working then I would not be asking for an injection and so they clearly were not working for me. They said I need to come off all my medication some of which I’ve been on for over 20 years. They made it clear that I will never have any more spinal surgery as the last two have left my spine in such a mess. “Your pain is never going to go away”, they said, “In fact it will probably get worse, so the only option is to show you how to cope and manage it”.
The sort of surgeries I had in the past is just not done anymore as they can now see how it affects the rest of your spine. ”Morphine”, was also given year’s ago they said but they now realise it’s the last drug they would ever give. With time everything changes and so I am about to embark on a journey I have never been on before.
All three of the team felt I was not pacing myself properly which is something they can teach me. I thought I was in control as long as I had my afternoon rest but they felt I was permanently pushing myself too hard.
Some of what they said did truly take me by surprise as deep down I thought I was doing ok and felt slightly intimidated by their opinion that I am actually not dealing with it well at all.
When I told my daughter she actually asked how I felt when they said “you obviously do too much”, ( as my family constantly tell me this ) and I said I guess it had to come from someone in the medical world for me to realise that maybe I am “sometimes” pushing myself too hard.
I was then sent for a blood test and they are organising a bone density scan ( which I’ve never had before) and the Pain Consultant told me to go and buy some Turmeric tablets as they are brilliant for inflammation.
One thing they could not stress more is how they say “ I will feel” when I am eventually of all my meds ( except for Paracetamol) as I am dealing with so many side effects from all the different medications I take. I guess I am quite anxious about coming off my meds but I would love to feel normal again.
My next appointment won’t be until after the scan and blood tests results are back. I will then be slowly cutting my meds down while being introduced to other ways of coping with my pain. I think this is going to be a very interesting journey to write about on here.
On the NHS website their description of Occupational Therapy is ‘Occupational therapy aims to improve your ability to do everyday tasks if you’re having difficulties‘
Occupational therapy is given to you by a therapist who is someone who can check your posture at work and at home, they can check your work-related positions and posture and suggest ways to help alleviate your pain at work or your work at home. They can also provide advice, look at ways an everyday task can be done differently; recommend alterations or changes at home; refer you to other services to help you and help you address work-related issues.
Occupational therapists can help you with practical tasks if you:
- are physically disabled
- are recovering from an illness or operation
- have learning disabilities
- have mental health problems
- are getting older
Occupational therapists have specialist knowledge and can advise you on disability equipment, housing adaptations and adaptations to the workplace. They are available through the NHS and your GP can put you in contact with your nearest therapist.
Within the context of chronic pain, occupational therapists evaluate the pain’s impact on your activities and quality of life, and equip you with the skills and strategies to manage the pain.
Occupational therapists can help you to carry out activities despite experiencing pain suggesting techniques to help you to conserve energy, and provide advice on caring for your muscles.
I have to admit I have not seen an occupational therapist and until I started reading into their services I was of the opinion they were mainly for the severely disabled and elderly.
I have always said to my children that ‘if you don’t ask you won’t get’ and ‘ if you don’t try you will never know’. So, I guess I should have asked as you just might get one pointer that could help you in one way or another.