I guess there can be quite a number of pains associated with stroke itself
not least the ones that are associated...
... with changes in brain functioning following stroke, the so-called central stroke pain
thalamic pains but also some of the pains associated with the secondary effects of having a stroke...
the musculoskeletal problems associated with... hemiparesis for instance
and also neuropathic pain associated with
with the stroke as well... on one side or the other of the body
Most patients will tend to describe their pain in a multitude of ways
some patients may describe their pain as variously burning, aching, internal...
various specific descriptors like that, other patients would describe their pain really
... how it relates to them emotionally and so many patients will tend to describe their
pain as intolerable, as insufferable, using language like that which we can vase
... the sense not just of the nature, the physical nature of the pain but the impact
it's having upon them emotionally as well.
There's a great wish and a very understandable
wish for health professionals to... to try something and do something that will have an immediate...
or a quick impact upon the pain
my view would be that actually... the things that we do sometimes that we don't see
as direct interventions can have a huge impact and
I'm thinking more in terms of the sorts of... interventions such as simply listening and validating
patients experience.
One of the problems with... chronic pain for a great number of patients is that they
... are concerned and that they won't be understood, their pain won't be understood
or indeed that they won't be believed, so I think a hugely
therapeutic first step for many health professionals working with...
...stroke patients can be in simply taking the time to listen, understand
and spend a bit of time validating what the stroke
patient is actually saying to them about their pain
and the sort of phrase that we tend to use in the pain clinics is
"whatever the patient's says their pain is, that's what their pain is"
its as simple as that
so I think those things that perhaps or seem to be a little ...
... touchy-feely are actually incredibly important
... for all health professionals to be doing before we rush in with specific interventions.
I think that we're seeing quite a number of primary care developments...
in a range of different sort of areas here for paying patients to access
... and you know the third sector, particularly taking quite
an initiative now in terms of helping patients
... access pain management in one form or another
outwith the pain clinic and certainly outwith psychology.
I think we always need to insure though
that the types of interventions that patients are given outwith pain clinic,
match that particular patients need
and where there are more complex issues, even in terms of...
biological presentations but also psycho-social presentations
that the pain clinic is always considered... in those sorts of cases.
The types of patients that... are probably most suitable for psychology are those ones who
tend to be displaying high levels of distress,
high levels of frustration, confusion about the nature of their ongoing pain,
or where other factors such as
fear of movement or fear of pain are becoming as much of a disabling
factor as the pain itself
beyond that I think
also being aware of a patients willingness to engage with psychology
can be an important factor to think about before assessment as well
sometimes psychology can be seen... in particular ways by particular patients,
and it's not unreasonable for some patients to be a little bit concerned
about the role of psychology and
perhaps are a little bit fearful that psychology
is suggesting that their pain is in their mind in...some ways
so I think spending a bit of time
addressing these sorts of issues with patients before making referrals
can be incredibly important as well as giving patients a real good
sense beforehand of what to expect from a psychology referral
those are the sorts of factors
... that I think are important when considering such a referral.
I think it's important for potential referrers to think a little bit
or be aware certainly that there can be a number of psychologically
based interventions available within the pain clinic
... that do not require the intervention of psychology
and therefore those long waiting lists, so there can be quite a number of
interventions such as patient education classes
... that post stroke pain patients can access much quicker