Module 3: Chronic Pain – SURG0133

Chronic pain is defined by IASP as pain that persists or recurs for longer than 3 months. It is a frequently encountered condition, as approximately 20% of the population worldwide suffers from it. It presents a challenge to treat, as chronic pain is multifactorial. Chronic pain comprises biological, psychological and social factors, which together contribute to the patient's symptoms and degree of suffering.
Fortunately, there are many forms of therapy available to help sufferers, but all have their limitations depending on the individual to whom they are being applied. Also, the bio-psycho-social factors, co-morbidities, age, resilience etc. can also limit the effect of any therapy being tried.

I was looking forward to this module with some personal interest, as I am a chronic pain sufferer, due to having multi-joint pain as a ‘bonus symptom’ of Crohn’s Disease, along with the usual gastro-intestinal symptoms, fatigue etc. Lucky me! So I was hoping that perhaps I’d come across a new, previously unknown approach that just might help me as I worked my way through the module. Of course, I didn’t, because the perfect management system doesn’t exist yet, but it's good to read that no one has given up on finding it yet!  

I work in private practice as an osteopath in the UK, and pain, whether it's acute or chronic, is something I encounter as a clinician on a daily basis. I have a broad demographic of patients, the most common age group is from 55 – 75. Some conditions talked about in this module were very familiar to me in that I help people manage their arthritis symptoms, and treat their back pain, neck pain, help with fibromyalgia, visceral pain and some neuropathic pain, amongst others. The ‘how to examine your patient’ section within the module was good revision, as were the tips on taking a good pain case history.

I increasingly get patients asking me about how to use marijuana or psilocybin to treat their pain – I enjoyed that part of the learning within this module, as beforehand, I hadn’t got a clue! At the very least now, I can have a discussion with the patient, highlighting the pros and cons, explaining how it likely works, and above all, hopefully keep them from doing themselves harm. Frustratingly, the medical use of marijuana is well-known to the public, but there are so few doctors who are willing to actually prescribe it. I feel this needs to be re-examined – like most pain medicines, it will help some people, but not all, and it’s illogical to leave it out of the list of ‘things to try’.

I found the Acceptance Commitment Therapy (ACT) section very interesting, as I had vaguely heard of the concept before, but not seen it described in as much detail. I’ve used similar mindfulness techniques myself e.g. I cannot change my situation/pain, but I can change how I feel about it. This has prompted me to use these techniques with my chronic pain patients. Some patients really like this, while others won't engage at all. There is much more to learn here on my part I think! 

Osteopathy, since it began 150 or so years ago, has always taken the bio-psycho-social factors of the patient into consideration – we treat the patient, the whole person, not their symptoms. We were/are the original holistic therapists.
Upon reflection however, I don’t feel that I have really been doing this the justice it deserves, not because I consider myself a bad practitioner or anything like that, but because my patient list is only a tiny sliver of the population. There is so much in the world of chronic pain I have simply never encountered before – as the saying goes, you don’t know what you don’t know! I think in the future, I’d really like to spend some time in a chronic pain facility to observe and expand my knowledge. This module has been great, but words on a page can’t beat a bit of real-life experience.