Pain Management Program


Some physical health conditions can be managed but not cured. Some unfortunately have no diagnosis. Many result in what is called 'chronic (or long term) pain'. These problems vary in complexity, severity, predictability and the extent to which medical intervention alone can restore normality.

For any one of us, the persistence of pain for a long term will have consequences for our general life. It can affect our work situation, social life, sport, financial independence, eating and drinking patterns and wellbeing in general. This, broader effect, will magnify and maintain pain. It makes it more difficult for us to break out of what has become a cycle.

Research has shown that Cognitive Behavioral Therapy (CBT) can help in these situations and especially in the management of chronic pain. The National Institute of Clinical Excellence recommends its use. 8-12 weekly sessions of CBT are recommended. 

What does a pain management program consist of ?

1- A medical assessment by Dr Harley who is a musculoskeletal physician. This is to review your diagnosis, the investigations and treatment you may have had and also to ensure that you have the most appropriate medication for your condition. 

2- Assessment by Mrs Julie Colthorpe, a psychotherapist and experienced CBT therapist. She will explain the program to you and ascertain your suitability for it. It is also an opportunity for you to decide whether the program is for you. 

3- If you decide to proceed then you will have an assessment of the mechanics of your problem by osteopaths Andrew Gilmour or Felix Cory-Wright and physiotherapist Mark Endacott determine whether osteopathy or physiotherapy could be helpful alongside CBT. 

4- Once your condition has been reviewed, the team of clinicians will determine any additional physical treatment or injection therapy needed, in addition to the 12 CBT sessions, which are at the core of the program. You will receive written feedback at this stage. 

5 - When the program is completed, your progress will be reviewed and you will again receive a written report with any further recommendations. 

6 - We recommend follow-up reviews at three and six months to ensure your progress is maintained and to reduce the possibility of relapse. 

How much does a Pain Management Program cost?

The core of the program is 13 x 1 hour CBT sessions at a cost of £70 each
Initial medical assessment - Dr Simon Harley - £70
Initial osteopathic assessment - Andrew Gilmour or Felix Cory-Wright £50
Initial physiotherapy assessment - Mark Endacott £44
Review meeting and report cost £200
NB Many insurers will fund pain management programs

The total cost is approximately £1300 but this will vary according to how the program is tailored to individual problems

Evidence
The evidence for this approach can be reviewed at - http://global.oup.com/us/companion.websites/umbrella/treatments/evidence/

Background information for patients

The way in which we experience pain is very complex. All sorts of factors influence our experience, including our thoughts and feelings. Pain may cause us to have low mood, feelings of anxiety or disturbed sleep.

CBT has been found to be effective in helping people reduce symptoms of anxiety and depression and also to help manage pain better. When this approach is combined with physical treatment such as osteopathy, physiotherapy as well as medical review and therapy, if necessary, it becomes a very powerful tool.


What is Cognitive Behavioral Therapy (CBT)?

Cognitive Behavioral Therapy (CBT) is a talking therapy. It can help people who are experiencing a wide range of mental health difficulties. What people think can affect how they feel and how they behave. This is the basis of CBT.

History of pain

Descartes suggested that pain was a linear process. That there is a causal link between the amount of damage to the body and the amount of pain, more damage would mean more pain. In reality this is not the case. Some patients have remarkable problems 

 
Gate control theory of pain (Melzack and Wall, 1965)

The theory suggests that there is a gate mechanism in the spinal cord, which can be widened or narrowed to different degrees. When you are injured a signal travels from the site of injury through nerve fibres to the spinal cord, and then up to the brain. The brain interprets the signal and you perceive pain.
The gate control theory suggests that there is a type of 'gate' in the spinal cord that can open and close based on input from the brain and body.
Changing the gate allows, relatively, more or less pain signals to be sent to the brain - affecting the level of pain an individual experiences.

CBT can help you to learn ways to manage your pain better.
We can help you to learn ways to take control of your pain by learning techniques to help you open and close the gate.

Things that Open the Gate

Physical - Degenerative changes, muscle tension, drug abuse
Cognitive - Attention to pain, thoughts about uncontrollability of pain, beliefs about pain as a mysterious, terrible thing.
Emotions - Depression, fear/anxiety, anger.
Activity - Too much or too little activity, poor diet and other health behaviors, balance between work, social, and recreational activity.
Social - Little support from family and friends, others focusing on your pain, others trying to protect you too much

Things that Close the Gate

Physical - Drugs, surgery, reduced muscular tension
Cognitive - Distractions or external focus of attention, thoughts of control over pain, belies about pain and predictable and manageable
Emotions - Emotional stability, relaxation and calm, positive mood
Activity - Appropriate pacing of activity, work life balance, recreation, rest, and social activity
Social - support from others, reasonable involvement from family and friends, encouragement

Who should attend a Pain Management Program?

If your pain has persisted for more than 6 months in spite of multiple investigations and treatments by a number of clinicians.
If your work, social, sport, financial independence is affected
If you find yourself becoming ground down by the pain, and are feeling low.
If you are becoming irritated by the clinicians who are trying to help you and their inability to find the answer to the problem.

Where is the Program run?

The program is run from Andrew Gilmour and Associates, Tollgate Cottage, Yarmouth Road, Melton Woodbridge, Suffolk IP12 1QF.
www.gilmourosteo.co.uk. 01394 387818

Our premises are custom built for our multidisciplinary physical medicine practice.

Overall

Whilst recognized as a powerful approach, it is time consuming and requires dedication on the part of patients. It is not a 'quick fix'. The program is also costly in practitioner time; this is out of necessity in such a course of treatment.

If you would like to find out more please contact:-

Andrew Gilmour  01394 387818 and ask for a call back to discuss The Pain Management Program
Or e:mail andrew@gilmourosteo.co.uk

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