Why going to a Pain Clinic can be a really good step to recovery

When the physiotherapist mentioned going to a Pain Clinic, everything about it that I could find suggested to me that this was a last resort – a place that you go once you have lost every last vestige of hope that you can get better and just want to manage the pain to try to find a way to get through the minutes and hours of an agonized existence. And talking with a number of other people in pain, this perception is very common, and none of the things that I could find online change that view.

However, the reality was so very different, and this is why I wanted to write this to help others to get the help that they need faster.

They never dismiss your pain

I can imagine that one of the challenges for Health Care Professionals is when they have to admit that something is complex and they don’t really know the answer. The downside of this is that thousands of people every year are dismissed by comments and inferences that imply that the pain is ‘all in their head’. You only need to take to Twitter or patient forums to hear the things that people have been told (or at least how they have interpreted comments from Doctors and Physiotherapists).

At the pain clinic, dealing with serious pain is their ‘thing’ and they are overflowing with compassion, knowledge, support and genuine interest in your pain. This alone is a huge relief, when you have been spending months battling to get people to listen the symptoms and take them seriously. It feels like getting into a comforting, warm bath! Plus they have models and simple explanations that help you to make sense of how your life is unravelling and what you can do about it.

One model that was enlightening for me was the ‘pain triangle’ that they said was universal in serious pain – where the relentlessness and intensity of it makes you feel helpless and hopeless, and your incapacity and reliance on others then drives feeling worthless. Then each point of this ‘helpless, hopeless, worthless’ triangle reinforces the other points, dragging you lower and lower until you can find something to break out of the vicious cycle.

They really want to get to the root cause

The next bit of brilliant news at the pain clinic is that they profoundly believe that your pain has a cause and that with work, they can find it. I felt that there was almost a detective vibe – where they are searching for the cause with different clues, hypotheses and points of evidence. They listen intently to every clue that you can give them, weighing it and thinking about what it could mean in a medical sense.

The pain clinic felt different. How? Well, I sometimes joke that when you see a consultant, they only have the 3 N’s (kNife, Needle or Nothing) and physiotherapists only have the 3 P’s (Poke, Push or Pray). This is of course brutally unfair and negates all of the knowledge and complexity of what they do, but as a patient it can reflect the outcomes and the lack of transparency in the process where they have the knowledge and you are just left with the problems. But, in the pain clinic, it felt like there was a logic in the way that they assessed the total body and looked at the interactions of different body parts. This is especially important when there are different body parts involved or overlapping conditions that come under two different surgical specialties because it leads to a lack of clarity about where the leadership and ownership sits between the different specialties once you are an out-patient. Whereas in the pain clinic it is all assessed together and at the same time (almost like you are one person with all of the parts of your body connected!)  

They take a multifunctional approach

The other brilliant bit is that all of the different disciplines work together and talk to each other in the pain clinic. This is so different from life as an out-patient and even as an in-patient, when even when you try to get the physiotherapy and surgical side to align behind one treatment plan and talk with each other, one party always resists it (even if you promise to sign GDPR releases, volunteer to manage the phone call within your appointment and volunteer to step outside if there is something that they want to discuss without you present).

At the pain clinic they have a common goal to reduce and eliminate your pain, and they each bring their own specialist skills to this team goal. It feels like a sports team, with everyone rooting for each other and working hard to get a result. As a patient, you feel in good hands.

This team support is important. If there was one tip that I would give to Physiotherapists in the out-patient context it would be ‘don’t comment at all on any previous physio that the patient has had’. I have seen nine different physio’s through the path of my pain and universally in the first stage (when they ask you lots of questions about what has happened and what you have done before), every single physio has critiqued what the previous physio has done with very negative tones and criticism. This really does not help! We cannot turn time back and I have already decided to change physio to see you, so there is no need to justify why you will be better. It makes me (as the patient) feel vulnerable and scared, because it makes me wonder if I allowed the ‘wrong’ treatment to be given to me (even though there was no way that I could have had the knowledge to make this judgement). And when you have seen as many as me, you start to build a picture that there is no common view of best practice and that there may be a lot of snake-oil sales people in the physiotherapy profession who maybe have not kept up-to-date with best practice. I hope that this is not true, but is a clear impression that the criticism of others can generate.

So my advice for patients is to seek out a group who work together across functional boundaries with your wellbeing as a patient as their over-arching goal.

When should you go to a Pain Clinic?

There is not really a clear view on when to go to a pain clinic, and again you can get a lot of contradictory advice. The textbooks says that pain is considered to no longer be ‘acute’ and to have become ‘chronic’ after 3 months, although many GPs seem to operate on 6 months.

I also think that there is a lot of pressure on the resources of the pain clinic (and there is a really long waiting list for it – over 9 months in our area). My hunch is that this leads to a tendency to hold off from a referral to the pain clinic until it has been a very long and serious issue. If you have health insurance, there are also private pain clinics, although you will need to have a look at the terms of your policy to see whether this is covered and what the referral process is.

I would suggest that for the reasons above a pain clinic may be especially helpful if:

  • You have overlapping conditions that make you feel that you are falling through the gaps
  • You are not making any progress and need a different approach
  • You are reaching a point of despair

I wish you the very best of luck – you are not alone, and there is a brilliant team somewhere who can help you! Stay strong in order to find them and start to move forward.


The UK’s Mental Health Awareness Week 2019 started today.

At 11am almost all UK radio stations joined together to broadcast a minute of focus on mental health, with Stephen Fry and Prince William taking the microphone to ask “Are you listening? Are you really listening?”

Statistics from MIND show that 1 in 4 of all UK adults will be affected by a mental health challenge in any given year. And of course the battle when you are injured and in pain is more dramatic.

But it can be so difficult to talk about. Hence the importance of working out ways to talk about it and raising the thought in all of our minds with awareness weeks like this. Just being there and listening is really, really powerful and supportive. Overcoming our shame and embarrassment to have meaningful conversations really matters. And we do not have to have any answers or solutions – just listening really helps, plus there are a number of great charities to support any of us when we are in a difficult place.

The twitter feed is full of good advice from these brilliant charities and also experts in this area, and I have tried to retweet as many as possible (see the @AthleteInjured feed). I hope that you find support, kindness and love within them.

I have just tried to pick out some themes from my own experience of living with injury and pain, in case they are helpful:

  1. There are moments when you feel so alone, and possibly rebuffed by people who you hoped so much would help, but there is always someone or some people who will support you. Keep looking!
  2. There can be times in your treatment that make you feel ashamed or humiliated. Work actively on putting them out of your mind and focusing on something more positive.
  3. Even the most left-brained and analytical people in the medical profession are starting to talk about the BioPsychoSocial model –so what and how you think are a big part of your progress and recovery from any injury. Keep searching out and holding on to reasons to believe that you can recover.
  4. We are all conditioned to want to hear the simple redemption/resolution story with the linear beginning-middle-end narrative of (i) something happened, (ii) it was tough but I got treated and (iii) now I am stronger and wiser than ever before. Even people who write this story in their autobiographies are usually honest enough to admit that this not how it happened and that recovery was a messy path of a step forward and many back, having to knock on lots of doors and keep holding on to hope.
  5. Worrying is really toxic. Whenever you can, remove yourself from the source of worry and replace it with things, thoughts and places that make you feel good. And even when it takes a superhuman effort to do them, make yourself do one each day.
  6. Find the moments to cherish. Even in a terrible day, there is something that is worth cherishing, Write it down in a diary or a gratitude box and relive it when you feel low.
  7. Lots of people will ask you how you are (and actually when you are injured I found that many stop asking!) Find those who genuinely want to listen, and for the rest develop an honest one-sentence answer that lets them move onto the conversation that they want to have, without discomfort for either of you.
  8. Be kind to yourself. Pushing your body and mind beyond what it can do generally leads to a really unhealthy ‘boom and bust’ cycle that is physically and mentally damaging. Find things that are within your limits and spend time on them.
  9. Ask for help on the things that have to get done, but are currently beyond you. It is really hard for friends to be mind-readers, so ask for the help that you need. And if you cannot quite work out what the problem is, write it down on a piece of paper until you get to the bit that really has to be solved and then write down every possible solution that you can think of – even brainstorm it with a friend, and choose the best approaches.
  10. Loneliness is a real problem. Even if you can no longer keep up with your friends because they are all so into their sports, set yourself a goal of getting together for a nice chat with a friend at least once per week.

Good luck

#YouAreNotAlone #ItsOkNotToBeOk and #NothingIsForever