What is the role of a specialist pain nurse?

These are nurses who have special training in working with patients with chronic pain and their families. Specialist pain nurses often work with pain specialist doctors in hospitals, as well as with other members of specialist pain teams. These nurses can help you:

•   Learn how to use pain-relief drugs more effectively, enabling you to manage your pain levels better. For example, if the pain specialist has given you drugs to try, the nurse may teach you how best to use them in your situation.

•   Learn more about different ways of managing pain, especially during setbacks.

•   Use other pain-reducing methods, such as TENS machines.

•   Gain access to other specialist treatments for persistent pain, such as acupuncture.

What is the role of a pain specialist?

A pain specialist is normally a doctor who has trained as an anaesthetist and has developed additional skills in pain relief. Pain specialists usually work in a pain clinic and can offer different pain-reducing treatments. These treatments can include a range of drugs – in different forms, such as tablets, suppositories or skin patches.

Sometimes the pain specialist may suggest injections of pain-reducing drugs close to the nerves near the pain site. These treatments may help to relieve chronic pain for certain periods of time – perhaps weeks or months.

The pain specialist will sometimes carry out investigations to see if there are any specific causes for chronic pain. This may reveal the main factors contributing to the pain, and make it easier to plan different ways to reduce the pain levels. A pain specialist is more likely to carry out tests or investigations if you have additional symptoms, such as numbness, loss of feeling in the arms or legs, loss of bladder or bowel control, or great difficulty in walking.

If you see a pain specialist, you might want to ask what tests or investigations would be helpful.

What is the role of a psychologist?

Psychologists use a range of different talking therapies to gain an understanding of the way the mind and the body work together. These techniques enable them to help people who have chronic pain to understand how and why the pain affects their moods, thoughts and behavior (see the Person-Centred Model in Chapter 1, p. 26).

Psychologists can help people to:

•   Understand their own reactions to upsetting or traumatic experiences in their lives, such as illness or family problems.

•   Manage or cope with distressing mental health symptoms, which are relatively common. (As many as 1 in 4 people experience mental health problems at some point in their lives.)

•   Cope better with emotional distress or mood problems, such as depression, anxiety, panic attacks, anger, eating disorders, post traumatic stress disorder, phobias and other mental health problems.

•   Cope with the emotional upset and distress of having a physical illness, such as asthma, diabetes or heart failure.

Psychologists are not medically trained and do not prescribe drug treatments, such as tranquillizers or anti-depressants. They work with other healthcare professionals, such as hospital pain specialists or psychiatrists.

They use talking therapies and work with individual patients. They work with patients who have common problems, such as anxiety, worry or pain. They can also work with patients with chronic pain in a group.

HOW DO PSYCHOLOGISTS WORK?

Firstly, psychologists make an individual assessment and listen to your experiences. They are skilled in asking questions to help you understand:

•   Your difficulties with pain now.

•   How much the pain affects your thinking, your moods, and things you do or don’t do.

•   How much the pain has changed you as a person.

•   How you cope and struggle with the pain.

Secondly, they help you understand that chronic pain can sometimes overwhelm your ability to cope. If this happens, you may become depressed or have other mood changes.

Thirdly, they help you realize that there are many strategies you can use to gain more confidence in managing and living with your pain. These may include:

•   Ways of managing your own fear, frustration, anger, guilt and other moods or unhelpful thoughts linked to the pain.

•   Relaxation skills, or problem-solving or other techniques.

•   Ways to cope with other people’s reactions to your pain and to be more assertive.

•   Ways to cope with the losses in your life because of your pain.

Your GP or hospital specialist may refer you to a psychologist because some of your symptoms are affecting your daily life. For example, you might be worrying a lot, having difficulty sleeping, getting very irritated and angry, bursting into tears a lot more than usual, and perhaps avoiding going out and meeting people.

They will first refer you for an assessment, because time is needed to talk and listen, to make sense of difficulties and find helpful ways of coping. Your GP or hospital specialist may feel that it would be helpful to focus on what can be changed, because of the effect of the pain on you as a person.

If you are referred to a psychologist, it does not mean that the pain is ‘all in the mind’.

It does mean that your pain is real and its effect on your life can sometimes be very hurtful, distressing and limiting. Any continual or repeated health problem (such as kidney failure, severe angina, colitis or epilepsy) will affect a person every day and will therefore affect their moods, their thinking and what they do.

Hospital specialists are not trained in psychology or psychiatry. They only have specialist experience in one area of the physical body. They will refer you to another healthcare practitioner, such as a psychologist, for an assessment of the pain and its effect on you as a person.