Whatever the nature of the injured person’s condition, early treatment from the best providers is imperative. We know and work with the leading treatment providers nationally and our immediate focus is helping clients to identify and undergo treatment that may have so far proved elusive. That is what we mean by our treatment-focused approach. We have enjoyed phenomenal success in putting funding for treatment in place.
There is a wide spectrum of treatment available for chronic pain, ranging from the totally non-invasive to the highly invasive.
Depending upon the condition, chronic pain treatment will often begin with medication and/or physical therapy such as physiotherapy.
Medication is effective in less than two thirds of sufferers.
Achieving the right balance of medication can often prove difficult. Very broadly speaking, the stronger the analgesic (painkilling) effect of the medication, the greater effect it will have cognitively upon the individual and therefore the more difficult it will become to function on a daily basis. The pain may be less, but tiredness, lack of concentration, poor memory and reaction time, may be the price to pay.
Doctors will often prescribe drugs such as Tramadol, which is an opioid. A client recently told us that she does not feel safe to drive for several hours after taking Tramadol. She has managed to continue working, but has to commute by car. She therefore avoids taking Tramadol until she arrives at work, whereupon she takes a low dose “to take the edge off”. By the afternoon, the effect of the Tramadol is wearing off, but she cannot take another until she arrives back home.
Drugs may be prescribed in groups so as to maximise the painkilling effect. Tramadol is often prescribed in conjunction with Amitriptyline (or Nortriptyline), which is an anti-depressant often prescribed to chronic pain sufferers as it has been found to be helpful for nerve pain. One side effect, or as some clients have described it “a side benefit”, is that it also aids sleep.
The next ‘step up’ are anticonvulsant drugs such as Pregabalin and Gabapentin. Whilst these drugs are used to treat epilepsy, they are also prescribed for serious neuropathic pain. However, clients often report to us major cognitive side effects. One described feeling “like a zombie. I was no use to anyone.”
Some chronic pain sufferers are prescribed Buprenorphine (which is similar to Morphine) as skin patches, or even Morphine itself, usually as Oramorph solution.
Injections and Denervation
More invasive treatments often start with injections of local anaesthetic and steroid, sometimes under x-ray guidance. This is not curative, but if it does ‘work’, can offer a few weeks of reduced levels of pain, during which time sufferers may derive further benefit through forms of manipulative therapy such as physiotherapy, which were previously impossible because of the level of pain. Once the effect of the local anaesthetic and steroid has worn off, it is hoped that the level of pain will be less than before.
Denervation, which takes place under x-ray guidance, damages specific nerves so as to interrupt their ability to send pain signals to the brain. This can be used as a diagnostic tool (ie to establish which nerves are responsible for the pain), but is not curative as the nerves will eventually repair themselves. However, if denervation ‘works’, it can provide several months of pain relief which, for some people, can help to break the long term cycle of pain.
Pain Management Programmes
Most hospitals run pain management programmes. Whilst a programme will usually be coordinated by a consultant in pain medicine, the treatment is multi-disciplinary and as such, the sufferer may also receive input from physiotherapists, occupational therapists and psychologists.
Unfortunately, pain management programmes are not curative, but can help to improve function and mood and therefore quality of life.
There are a few residential programmes, available both privately and within the NHS. The intensity of the therapy on these residential programmes often significantly improves the prospects of a positive outcome. We have been hugely successful in arranging funding for clients to attend these residential programmes.
Spinal Cord Stimulation
For some chronic pain conditions, the implantation of a spinal cord stimulator can help to provide long term pain relief.
The procedure is invasive, as it involves the insertion of electrodes into the epidural space in the spine. These are connected to a battery powered device which is implanted under the skin and controlled externally by remote control. The device delivers electronic signals which, it is hoped, will interrupt the pain signals to the brain.
A number of our clients have undergone the procedure. Whilst all have reported a reduction in levels of pain, the degree of pain relief experienced has varied considerably.
Some sufferers find alternative therapies effective for short term relief of their symptoms, particularly therapies aimed at relaxation. Yoga, meditation, acupuncture and gentle, low-impact exercise are particular popular.
The large number of people suffering chronic pain means that there is a lot of ongoing research into new forms of treatment. A good example is the LIPS trial of immunoglobulin therapy for people suffering therapy resistant CRPS / RSD.
Whilst medical trials are outside of the scope of their claims, several of our clients have been selected to take part in medical trials, sometimes with encouraging results.