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Chronic Pain

Medical treatments and pain clinics for chronic pain

Several of the people that we talked to had attended hospital appointments for medical treatments to relieve their pain or for prescription of specific pain relieving medication. Medical interventions are not intended to cure pain but may give relief when pain is particularly bad and help people get more mobile.

Often people attended a specialist pain clinic. Pain clinics vary in the treatments offered and not all hospitals have a specific pain clinic. Some are run by a Consultant with a special interest in pain, others also have a physiotherapist, a nurse or a psychologist. Some had attended a pain clinic that was run by a specialist pain nurse.

Most people found the pain clinic staff helpful and some commented that it was good to be referred somewhere with a real interest in pain. A man who was very sceptical at first said that the nurse who put him on an exclusion diet and then gave him gabapentin and morphine, had been more help than his four consultants put together.

Another man said he was even happy when they told him that they couldn't cure him, although he was a little disappointed that the waiting lists for treatments were so long.

Some were critical of aspects of the pain clinic. A woman who found the pain clinic helpful felt it would be better if she could always see the same doctor, especially if it could be one of the 'good ones'.

 

Finds the pain clinic very helpful with her medication but would prefer to see the same doctor...

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Age at interview: 30
Sex: Female
Age at diagnosis: 26
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Okay, when I go to the pain clinic, now since I was, since I've given up on the idea of the whole training thing, they're very nice in there. The only disadvantage I would say is that you don't see the same doctor every time you go. You just put your name in and they call you as the doctors become free, they take the top file no matter who that is and who they last saw.  

So I literally haven't seen the same doctor twice. Most of the time they'll want to examine me, but I'm not quite sure why that's necessary because you can't see anything from the outside apart from the scar. And then they'll talk about my pain, whether it's improved. They'll check that the medication that I'm on is what they have on record, so what they last gave me, kind of thing, or whether it's been upped or changed by my doctor. 

They'll ask if there's been any change in the actual pain itself and any improvements, anything worse. And sometimes, when you get a good one, they'll ask about anything else that I want to know. The last doctor I saw at the pain clinic was fantastic and we talked about everything from what drugs I'd need to change if I wanted to become pregnant to seeing a genetics consultant if I wanted to try pregnancy to more general things about my condition as well.  

He talked about absolutely everything with me. I suppose some of them you just feel more comfortable with than others, which I suppose could be an advantage of swapping round all the time. But, you can be in there, they usually up my drugs in one way or another, change them or up them. So I'm on quite a cocktail now. But it's just, you know, I can be in there for anything from ten minutes to forty minutes depending on the doctor that I see. It's mostly talking and then go and get your prescription.  

A man found it frustrating that the pain clinic seemed to follow an inflexible protocol and didn't seem to listen to him. Others were not interested in the treatments offered, either because they were concerned about the side effects of steroid injections or because other patients told them that they had found treatments were painful or ineffective.

 
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Was frustrated that the pain clinic seemed to follow a protocol for backs and didn't listen to him.

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Age at interview: 43
Sex: Male
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They had a Pain Management Clinic at the local hospital but those were the ones that gave me the injections in the back which didn't help, they didn't seem to, well they did for a few days but that was it, they didn't seem to do anything. And they didn't seem to listen to what I was saying and that got frustrating.  

There seemed to be a protocol for back pain and we'll do this, this and this in this order and if it doesn't work we'll try something else but they never actually listened to what I was saying about the pain that I was having or the treatments they were giving. And so in the end I just stopped going because they weren't doing any good and it was more of an inconvenience in the end of having to go up there. 

What would you have liked them to have done?

I suppose if they had listened to me a bit more about what I was saying and the fact that I, you know, I've had these sort of TENS machines, tried before, I didn't get on with them. And some of the tablets they wanted to put me on I said I didn't want to take because they just made me so sleepy. 'Oh well try them anyway'. And they gave them to me but I didn't bother taking them because I knew what they were like. But it was what they had to try on their list of, you know, their list of orders for treatment of back pain.  

And so that's why I got upset and cross because they wouldn't listen, you know, you'd said you'd tried something before and it, and it didn't help 'Well try it again.'  'Well the tablets make me really sleepy', 'Well try them again'. And you know that they do, so I just gave up going in the end and sort of just sorted things out between myself and my GP now. And she looks up the information and she gives me information that comes through so we tend to do it that way now.

Sometimes people have their medications changed after assessment at the Pain Clinic. Often this was morphine based medication or medications prescribed specifically for nerve type pain (e.g. gabapentin and amitriptyline) (see also 'Medication: strong opioids'; Medication: antidepressants and antiepileptics').

Others had received pain relieving injections. The type of injection depended on the origin of the pain. The drugs that are injected are also dependent on the condition but include steroids to reduce inflammation and anaesthetics. Steroids are known to cause bone disintegration if they are used long term.

Some people do not have sufficiently strong bones to have injections and others do not want to risk the side effects. People didn't always remember being told all about the possible side effects before treatment.

The two most common procedures talked about involved injections into the spine for back and lower limb pain. These were often day case procedures, however people were normally recommended to arrange for somebody else to take them home.

A man who had actually gone against this advice explained that one risk of injections into the spine was a sudden drop in blood pressure. Spinal injections were normally carried out in a special treatment room or operating theatre and sometimes it was necessary to use a type of x-ray to guide the procedure. People were awake during the procedures although some opted to take a sedative and others were offered a local anaesthetic.

 

Explains that epidurals can cause a sudden drop in blood pressure. He found the relief minimal...

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Age at interview: 53
Sex: Male
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It is' very easy. I suppose it's similar to the epidural that a woman gets when she has a baby, if she wants. It is just a rather large needle stuck in the spine. It's a production line thing. There is a lot of us lined up in the morning... you've got a choice of a sedative, which I declined because you can get out of hospital quicker if you don't. And you are basically laid face down on the operation table there's a local anaesthetic, then the epidural goes in which, its uncomfortable but that's all. It's not out and out painful. 

You've got a needle in your arm because sometimes it causes a very rapid loss of blood pressure, I don't have side effects from many things. You lay in recovery for 30 minutes and then you can go home. But they are happy if you got someone who can pick you up and drive you. So I told them I had but I didn't really, had two of those and I wouldn't bother with it again because the improvement is minimal and you slip back anyway so' I get on far better with the way I take the drugs and the way I manage what I do. That's the best way to do it.

People whose pain originated from damage to the joints in the spine were sometimes given 'facet joint injections'. Some experienced pain relief which they said allowed them to become more active. However, others found the procedure painful and felt that the pain relief was not worth it. A few people were concerned because they had been told that injecting steroid into the spine could cause further degeneration of the bones.

 

Had facet joint injections but found them very painful and did not get any relief from them.

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Age at interview: 64
Sex: Male
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Carried on under them for quite a while and they set up a new clinic and I went in to have some injections in my back. They're supposed to, what they try to do is inject fluid between all your joints to sort of open them. I'm afraid that didn't work.  

I didn't get off this settee for three days afterwards and the injections, I had 36 needle holes in me. And they did ask me if I wanted to go back and have it done again, there was no way I would have that done again and I wouldn't advise anyone to go with that. That is absolute diabolical.  

I mean they said I would be awake all the way through it and after about a couple of minutes they put me out. I was in so much pain with it. But as I say, it didn't work and that was when they referred me or meant to say that was when it must have been six months to nine months after they referred me to the pain clinic (Pain Management Programme).

 
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Had some steroid injections into his spine but knew they weren't a long-term solution because...

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Age at interview: 43
Sex: Male
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I had some injections in some of the muscles to try and relieve the muscle spasm that I get there and I actually have some steroids injected into the spine and they worked for a period of time but there's only so much they can give you because the steroids, again, with all their side effects in the long term, which has caused more problems than you have originally.  

Causing the bones to start crumbling because of all the steroids you've had. So again they're only a short term treatment, they're not a long-term cure really.  

A woman who had taken many years to decide to have these injections found them painful but not as bad as expected and was pleased with the pain relief. She and others were encouraged to return to normal activity and exercise a few days after the procedure. However, several stressed that it was important to stay within their limitations and not over do things.

 

Eventually had facet joint injections and found that they relieved her pain for two weeks and she...

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Age at interview: 52
Sex: Female
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Oh right. Yeah, I was, I went to the pain clinic and I was referred to have inter-facet joint injections and, you know, and I didn't, that didn't really impress me as far as having a needle in my spine, and I'd heard bad things about the facet joint injections.  

I'd heard that you, the onset of pain after, you know, you just get it overnight, so the level of pain that I'm used to, it's like turning up the volume from zero to ten and overnight. So that frightened me and I'd heard some other things about the, some other unwanted side-effects. So I left that.  

I decided that isn't the road I wanted to go on and I continued with medical treatment from the doctor and I continued with the exercises which I've since been neglecting and, you know, I went along my way of, you know my own way, stubborn kind of way. But, recently, I've decided to take up the inter-facet joint injections and, but that, like I said I waited ten years to make that decision and I had these, I had the inj', the injections in, I think it was in May and they were painful, extremely painful.  

I was offered a pre-injection, you know, to relax me, but I didn't want to, I didn't want to have that. So I just had the injections as they were. And they were great. I mean I felt like I'd been hit by a horse, or kicked by a horse in the back, after I'd had the injections, I mean apart from during. 

But, for a few minutes after the injections I was completely pain free and it was amazing, it was absolutely just stunning and it was a high, it wasn't like you know having, you know, it was a drug but it wasn't like, it didn't have a euphoric effect, in that respect, didn't make me dizzy and loopy and weird it, it just felt great.  

And then, of course, because it was so invasive, it took about two weeks to get over it, the actual invasion but then I had, I was able to exercise more and to live without pain medication. And I had a break and it was really, I think I'm going to stick with the, the pain, with the inter-facet joint injections. 

However, due to lack of medical staff I have to wait a year for my next injection. So, in the meantime, at least I know that I can, you know, continue with exercising and, you know, try to do as best I can. 

How long did the pain stay away for after the injection?

The pain, after I had the injections, the pain stayed away for about, it's hard to say, I do remember two weeks, about two weeks without pain and except I would overdo it, I'd be, I was so excited about not having pain, that I would, you know, do things that, you know, clean the flat or walk the dog, you know, a little bit further than I should have and then of course the pain would come creeping back.  

So, I had to readjust my lifestyle, you know, after the injection and it was interesting, you know, just testing myself about how far I could go. But for two weeks, I would say, I was pain free... relatively pain free, for me pain free, you know. But the pain has come back but I'm kind of, now I'm just kind of confused as to how far I can push myself or not.  

But I spoke to a woman, a nurse at the pain clinic and she said that I was on the right track. Some people, unfortunately, don't exercise, don't watch their diet and expect the injections to do everything for them without, without you know adding to it, you know being their own doctor as it were and that's unfortunate.  

But she said I w

Epidural injections were given when the pain was believed to originate from the nerves of the spinal cord. After the initial couple of days recovery from the procedure most experienced some pain relief. However the relief was only temporary and some felt that if they were done repeatedly they became less effective, which put them off having any more.

 

Explains that epidurals can cause a sudden drop in blood pressure. He found the relief minimal...

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Age at interview: 53
Sex: Male
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It is' very easy. I suppose it's similar to the epidural that a woman gets when she has a baby, if she wants. It is just a rather large needle stuck in the spine. It's a production line thing. There is a lot of us lined up in the morning... you've got a choice of a sedative, which I declined because you can get out of hospital quicker if you don't. And you are basically laid face down on the operation table there's a local anaesthetic, then the epidural goes in which, its uncomfortable but that's all. It's not out and out painful. 

You've got a needle in your arm because sometimes it causes a very rapid loss of blood pressure, I don't have side effects from many things. You lay in recovery for 30 minutes and then you can go home. But they are happy if you got someone who can pick you up and drive you. So I told them I had but I didn't really, had two of those and I wouldn't bother with it again because the improvement is minimal and you slip back anyway so' I get on far better with the way I take the drugs and the way I manage what I do. That's the best way to do it.

 

Said that epidural steroid injections became less effective.

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Age at interview: 63
Sex: Male
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Can you tell me a bit about what it is like to have an injection done?

Depends how the anaesthetist feels at the time. The first occasion I had some local anaesthetic before the injections, the second time I think the anaesthetist was feeling a bit vicious and said 'You don't need any local anaesthetic you'll just have them'. They are very, very painful for a short period of time. They helped probably for about six months the first time.  

The second time only for about two months and they loose their effectiveness as time goes by. It was the same when the anaesthetist who gave me the last series of injections recommended that I went to the Chronic Pain Management Course.

A woman who'd had a number of lumbar epidurals pointed out that they only helped relieve the nerve pain in her leg not her low back pain but she still felt that they were worth having.

 

Found that epidural steroid injections only helped her leg pain and not her back pain but she...

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Age at interview: 32
Sex: Female
Age at diagnosis: 26
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Yeah, I know that, certainly for the lumbar epidurals that I have, it is a steroid, a long acting steroid they inject in. I'm, I know they do joint injections which I don't know what they do for that, I know friends who've had them. It's, the hospital, who look after my care and my pain management, I mean, the one great thing about the epidurals is you're in and out literally.  

The last time I was there I was probably in for three hours and then I was home again. Because it's all done as a day case and because it's not a theatre, it's not an operation, you can eat and drink, so you don't have to starve yourself in the morning, you know you can take your normal medication and everything as well. 

So you go in, you're admitted and the consultant obviously will come and do the consent form as you have to for these things, and basically they wheel you round to the treatment room and inject the steroid in and that's it done. 

I know that the first time I had it I was actually surprised at how much it hurt and it really does hurt, but they, they're injecting fluid into your epidural space and it's a fair bit of fluid they're actually injecting in and, although I knew it was going to hurt, I wasn't quite prepared for it. I think the thing is, I've had, what, five epidurals now, so I'm so used to it that I don't really think very much of it now when I go in. 

And it's, I sit there and I remind myself that it's worth it if I get some relief out of it. The one I had earlier this year that only lasted for a month, I remember afterwards thinking 'do I really want to go through all that pain again if it's only going to last a month' but I did and it's lasted longer. And I mean when you have them, what they say, what they say to you is it tends to work better on your leg pain than on your back pain. 

It often doesn't work for your back pain at all and in fact for the first time ever, when I last had it done, I ended up with a really, really bad back. And my back pain was unmanageable for a couple of weeks, then it settled down again, but my legs have been much better since.

A man who had an epidural, which had helped him get back on his feet, was put off having any more because of the potential side effects, including the risk of injecting into the wrong part of the spine. An older woman had been told that she wasn't suitable for a second epidural but wondered whether this was more to do with her age.

 
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Had an epidural, which helped him get back on his feet, but was put off having more when he asked...

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Age at interview: 54
Sex: Male
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Yeah, I was desperate to relieve myself of the pain, the pain and the only thing that could be offered to me for that, because even, I don't know how many Morphine injections I had, it wasn't a lot, but they didn't last very long. 

It would last for a few, a maximum of about four or five hours and then it would come back again and they said to me if I had this epidural it should last, give me a bit of a respite from the problem and so I said 'Yes I'll have this epidural', and they said 'Well, we'll give you the epidural and we'll also pump in some steroids' and something else which I can't remember, an antibiotic I think. 

To 1) try and relieve the inflammation and 2) as I say give me a respite from the pain so I went into the hospital for the day to have that and I had it and yes that did work, but only unfortunately for about a week and a bit, and then it seemed to creep its way through but then, and I then found that it did enable me though to take a bit more notice of what the physio was trying to make me do and get on with that. 

I was able to do a little bit more and get myself slightly more fit, even though it was only a week or two, and that little jump forward gave me enough to start getting the muscles in my legs and my stomach and my back to a level where there was some stability in the bottom of my back, because the major problem that I was having was because I'd been laying around for so long and lost a lot of muscle strength, I'd had no stability so any slight movement would trigger off major spasms and major pain and my muscles would then contract with everything probably really misaligned and the problem would get worse. 

I kept on with my normal orally taken drugs and resting and physio and the next time I came round to thinking about it was in a different hospital and I felt uneasy about it, for some reason, I don't really know why, I just felt that I'd had enough intrusion and enough drugs that I just didn't feel the benefits were great enough for me to warrant it. 

It may have been that I'd gone into accepting the pain a bit more and wasn't prepared to lose it, I'm not sure, so it sounds weird but something like that occurred and so this time I asked a few more questions and when I heard about all the possible side effects and all the possible damages that it could have done to me, I don't think I'd have an MR ' I don't think I'd have had an epidural in the first place if I'd have known about it.

What sort of side effects?

Well the fact that, you know, you were obviously introducing quite a long needle into a very small space and you might well push it into the wrong place, the fact that you might have a reaction against the chemicals that they're putting in there, you might well have another bacteria put into your spinal canal. Those were the major ones that I remember, but the chap spoke for at least 35 minutes telling me about it so there was probably a lot more that I don't even remember. 

Now one of the consequences, not of that in particular, but one the biggest, very difficult symptoms that I've got now that I can't get rid of is these incredible headaches. They're not, they're not like migraine, they are, they're like a typical Frankenstein type, somebody doing up the nuts and bolts on either side of your head, type headache and they go on for days and days. 

Now because one of the symptoms you can get from having an epidural is these headaches I often, I often wonder whether the two are linked, but they didn't come about immediately and so those are

A few people were offered cortisone injections for pain in the joints of their limbs. Many people were put off having them because they only provide short-term relief and that they could only have a limited number because of bone degeneration. A couple of people that we talked to had experienced some relief, but a woman said she found the procedure unpleasant and was not sure she would go down that route again.

A few people mentioned other treatments that are sometimes offered at a pain clinic specifically for nerve pain. These included ketamine or lignocaine infusion and sympathetic blocks for nerve pain due to a brachial plexus injury. A woman with MS had been referred to an anaesthetist who had given her hope that her pain might be helped by lignocaine patches.

Some had heard about procedures, which are not widely available in the UK including spinal stimulators and morphine pumps and wanted more information.

A few people had also received acupuncture through a pain clinic and others had been able to borrow a TENS machine (see also 'Complementary approaches' and 'Physical therapies').

In some areas there are plans to set up more pain management services in the community, no one we interviewed had used these services.

Last reviewed August 2018.

Last updated November 2012.

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