In whatever guise it appears; whichever label the medical profession places upon it, it is accepted that to treat chronic pain effectively, it is fundamental to address both its physical and psychological aspects in tandem.
Psychological therapy helps the sufferer to understand and manage the thoughts, emotions and behaviour that accompany their pain and in doing so, the intensity of their pain can be reduced and their ability to adapt to living with their pain can be improved. It has been demonstrated scientifically that psychological therapy can alter the way the brain processes pain sensations.
No two sufferers are the same and psychological treatment plans are necessarily subjective. Before they can formulate a treatment plan, the treating psychologist will therefore need to ‘get inside the head’ of the sufferer to better understand their pain, concerns, worries and other stress factors. This is achieved with tools such as a questionnaire prior to a lengthy discussion.
As a personal observation, in my experience men seem to find it more difficult to lower the drawbridge and allow the psychologist entry. If and when they do gain entry, the psychologist will often find considerable pent up emotions waiting to flood out. The same is true when it comes to treatment; many men, initially at least, find it difficult to embrace psychological therapy techniques.
An example was my client, Gareth; a very matter of fact, six foot five inch, former professional Rugby player, for whom I had been able to arrange funding to attend a four week, inpatient, multi-disciplinary rehabilitation programme at the Bath Centre for Pain Services (BCPS). As might be expected, this programme includes a significant psychological therapy component. During the morning break on the first day of the course, Gareth phoned me and, in none too polite terms, informed me that the course was going to be “a complete waste of time” as he was “surrounded by tree-huggers” who were “intent on breaking my mind”.
Fortunately, I was able to persuade Gareth to stay the course and, importantly, to at least try to embrace the treatment, whatever its nature. At the end of the programme he told me that he had found the first two weeks extremely difficult, but that things had then started to fall into place such that in the end he said he was “in a hugely better place”.
Treatment plans are aimed at attempting to change the sufferer’s way of thinking about their pain. Relaxation techniques are taught and new coping skills are developed, including lifestyle changes to enable the sufferer to continue participating in work, home and leisure activities. It is also extremely important to address any related anxiety or depression.
Some people will necessarily require more psychological therapy than others. However, it is important to remember that once the initial course of therapy has concluded, ongoing ‘top up’ sessions are essential as well as medication reviews with a psychiatrist. Remember that somebody treated for depression as a result of their pain has a statistically greater than 50% chance of their depression recurring in the future. That chance, together with the need for ongoing therapy, must be factored into any claim.
For those attending inpatient rehabilitation, the effect of leaving the rarefied environment of such a programme with its supportive staff on hand every day, can in itself have a very negative impact. To avoid the ‘crash and burn’ of going ‘cold turkey’, I always ensure that before a client commences inpatient rehabilitation, that they have been assessed by a treating psychologist close to home and that therapy sessions are pre-arranged to commence a day or two following their return home.
All sufferers of chronic pain react differently to psychological therapy and the long term benefits vary considerably from person to person. However, I cannot think of a single client who has reported not gaining any benefit at all. The reaction of most people is along the lines of “I’m still in pain, but I can now do more than I could before and do it for longer.” Occasionally though, the results can be stunning. In the case of one client, after not being able to work at all for two years, he was able to commence a phased return to work within a couple of weeks of the end of his treatment programme.
A solicitor specialising in chronic pain should be able to advise a client on the availability of appropriate treatment; physical, psychological and multi-disciplinary. This is important as a client will need to be assessed as to their suitability for treatment before the treatment provider can provide a costing; a necessary precursor to the solicitor arranging the necessary funding. With some inpatient rehabilitation programmes costing over £16,000, the solicitor will also need to be adept at persuasion as Defendant insurance companies can, initially at least, prove resistant to funding treatment.
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