This edition of Airing Pain is on the topic of early childhood experiences.  

(Content warning: includes abuse, neglect, and household dysfunction) 

The World Health Organisation states that ‘adverse childhood experiences (ACE) can have lifelong consequences on a person’s health, and well-being, and can lead to a person developing persistent pain in later life’. A lot of this research is conducted in adults, and of course with changes in attitudes and beliefs surrounding raising children over the years, would they consider events in their childhood to be adverse? 

Listen to learn more about this complex discussion. Find out how this kind of trauma in formative years impacts neurobiologically on the stress response, and causes changes on a structural and functional level in the brain that can predispose young people not only to pain but depression, cardiovascular disease, behaviours with increased health risks, and can have impact on mortality.  

Contributors: 

Dr Katie Birnie, Clinical Psychologist at the University of Calgary, on the importance of validating pain in young people.   

Professor Lesley Colvin, Project Lead at Consortium Against Pain InEquality (CAPE) and Professor of Pain Medicine at the University of Dundee, and consultant in pain services. 

Jen Ford, DRAP Pain Physio & Therapy Lead at Bath Centre for Pain Services & Bristol Paediatric Pain  

Professor Lesley Colvin, Project Lead at Consortium Against Pain InEquality (CAPE) 

Professor Tim Hales, Project Lead at CAPE and a non-clinical Professor of anaethesia at the University of Dundee. 

Dr Lauren Heathcote, Senior Lecturer in health psychology at Kings College London 

2:06 Prof Tim Hales discusses the impact on ACE on chronic pain and how people respond to treatment. 

7:02 Prof Lesley Colvin Professor on how ACE causes persistent pain. 

16:05 Dr Lauren Heathcote discusses the psychology of pain and symptom perception in young people. 

23:26 Jen Ford on the different approach required when working with children. 

26:05 Dr. Katie Bernie explore the importance of children and family partnerships. 

Related links 

CAPE Consortium Against Pain InEquality 

Health Scotland – Adverse Childhood Experiences

 

TED talk: Carol Dwerk – The Power of Believing you can improve 

Bath Centre for Pain Services 

Airing Pain survey

Pain Concern Children and Families resources 

This edition of Airing Pain was recorded at the Living Well with Persistent Pain in Wales conference during Pain Awareness Month in September 2023. The topic of the conference was the launch of the revised Persistent Pain guidance first published in 2019. 

The COVID-19 pandemic has changed how we live and access services. How are healthcare professionals who treat patients with persistent pain capitalising on this improved digital literacy by using a digital-first approach to improve the patient experience at their clinics? With the aim of this year's conference being to see the person and not the symptoms, how can the patient's voice be heard and kept central to ensure this is done? And finally, how can the Third Sector and the NHS work more cohesively to work towards this goal? Listen or read the transcript to find out more. 

Contributors 

Bethany Davies Health care support worker, Aneurin Bevan University Health Board

Gethin Harries, Physiotherapist, Powys Health Board (Powys Living Well Service). 

Eluned Morgan MS, Health Minister 

Owen Hughes National Clinical Lead for Persistent Pain in Wales 

Stephen Allan, Regional Director New Citizen’s Voice Body for Wales 

Dr Sue Jeffs, National Clinical Lead for Persistent Pain Patient organisation representatives 

Mary Cowern Head of Nation for Cymru Versus Arthritis 

Heather Wallace, Pain Concern 

Representatives of other organisations present at the event, including Health Education for Improvement Wales, Real City Strategy North Wales, Cardiff and Vales University Health Board and Case UK Ltd.

Read Transcript  Feedback survey

Timestamps 

0:35 Eluned Morgan MS welcomes delegates to the launch of the revised Living With Persistent Pain in Wales guidelines. 

3:04 Owen Hughes explains the updates to the guidelines.

6:04 Eluned Morgan MS on the feedback received regarding the guidence and how it can continue to evolve. 

6:35 Representatives from Real City Strategy North Wales and Powys Living Well Service discuss how those living with pain can be supported.

12:48 Eluned Morgan MS and a representative from Cardiff and Vales University Health Board talk about self-management and peer support groups. 

23:59 Mary Cowern, Neil Fowler and Bethany Davies on how the guidelines will impact their organisations. 

37:39 Eluned Morgan MS on the need to reduce ineffective treatments. 

38:35 Information on upskilling for healthcare professionals from Catrin from Health Education and Improvement Wales. 

40:38 The Patient Voice – Stephen Allan, Eluned Morgan MS and Dr Sue Jeffs on the importance of patients informing on the services available. 

48:11 Heather Wallace reflects on the event and a final request about person-centred care from Eluned Morgan MS. 

Additional Resources 

Living with Persistent Pain in Wale Guidance 

eppcymru.org 

All Wales Analgesic Stewardship Guidance  

Airing Pain 109 Fibromyalgia  

Airing Pain 121: Living with Persistent Pain in Wales 

Well-being of Future Generations (Wales) Act 2015 

This edition of Airing Pain was made possible by the invaluable contributions of our participating artists who showcased their works at the Edinburgh Fringe Festival, and those in the academic field. We learn the motives behind using dance as a way of supporting those in pain, but also expressing and communicating pain to audiences.

Dr Sarah Hopfinger, Artist and Researcher (Edinburgh Fringe: “Pain and I”)

Victoria Abbott-Fleming MBE, Founder of the Burning Nights CRPS

Dr Emma Meehan, Associate Professor, Centre for Dance Research, Coventry University

Tali Foxworthy Bowers, Choreographer and Movement Director (Edinburgh Fringe: “Monoslogue”)

Jenna Gillett, PhD Student, Department of Psychology University of Warwick

The music used at the beginning of this edition was an original composition for Pain & I by Alicia Jane Turner.

Images provided by Sarah Hopfinger.

Read transcript

1:35 – Miriam Introduces Sarah Hopfinger’s “Pain and I” performance during Edinburgh’s Festival Fringe, and asks what techniques from the world of dance offer those living with pain?

3:41 – Pacing as a technique. Also see 13:25 for Sarah Hopfinger on pacing.

6:34 – Emma Meehan, at the British Pain Society, on how dancers living with pain approach pain.

8:34 – Introducing Tali Foxworthy-Bowers

15:54 – A huge thank you, and invitation, for filling in our survey

16:20 – Emma Meehan and research into what somatic practices in movement can offer those living with pain.

18:20 – The importance of sharing and telling stories about pain experiences as an act of self-compassion for performers, and mutual connection. See also 25:53 for a continuation of this sentiment from Tali Foxworthy Bowers.

21:25 – Pain catastrophising, how we frame pain, and techniques for being kinder to ourselves with self-love and compassion.

27:54 – Suggestions of how to support those close to you who are living with pain.

31:34 – Emma Meehan discussing agency with pain, as showcased at the British Pain Society ASM 2023.

35:10 – The role of charities in patient support, and what else can charities be doing?

37:27 – Chronic pain is chronic strength: acceptance of pain as part of the bodies we love and care for.

Burning nights 

NHS Resources

Somatic Practice

Dr Meehan's Book: Performing Process

This edition of Airing Pain was prompted by the 2022 NICE Guidelines which followed a Public Health England report (2019) looking at medicines associated with dependence and withdrawal.

Read transcript

This new legislation follows increased concerns in high levels of prescribing.

This edition discusses the challenges and opportunities of de-prescribing; and poses a shift in focus towards supported self-management and de-medicalising the management of pain for some patients. By this we mean the exploration of alternative therapies and supported self-care customised to individual needs, which come hand-in-hand with any de-prescribing of medicines.

We discuss the incredibly important role of the advanced pharmacist practitioner in adjusting the prescriptions of medicine, and the long-term regular use of pharmacists for these purposes.

Dr Emma Davies, Advanced Pharmacist Practitioner specialising in Pain Management

Dr Keith Mitchell, Consultant in Pain Medicine at the Royal Cornwall Hospital

Dr Jim Huddy, GP and Clinical Lead for Chronic Pain

This edition of Airing Pain was possible thanks to support from the British Pain Society.

0:49 – Paul introducing the topic NICE Guidelines 2022, following from a Public Health England report 2019 looking at medicines associated with dependence and withdrawal.

1:38 – Introducing Dr Emma Davies; advanced pharmacist practitioner in pain management, Co-Founder to Living Well With Pain, prescribing for chronic pain, and involved in setting NICE guidelines.

6:23 – The problem: knowing the medicines may be harmful but a lack of correct support in place for other ways of living with pain. Reducing this type of medicine must come hand-in-hand with proper support to living well with pain.

7:24 – What does support look like? Alternative therapies and support based on their personalised circumstances.

9:15 – Talk from the Patient Group at the British Pain Society on intersectional problems and barriers to accessing care particularly for socially minoritized individuals and groups.

13:28 – Introducing the educational resources Pain Consultants Dr Keith Mitchell and Dr Jim Huddy, at Royal Cornwall Hospital, have put together for prescribers.

14:12 – Introducing Dr Frances Cole’s 10 footstep model to pain management as another possible alternative to prescribing.

16:26 – Social prescribers and upskilling non-clinicians to provide support.

17:27 – Discussion on how to pose non-medical supported self-management to patients, in place of medicalised support. 

17:49 – Explaining the Pain Café in Cornwall

20:00 – Invitation to fill in our survey

20:45 – Advanced pharmacist practitioner, Dr Emma Davis, on the diverse and essential roles pharmacists play in pain management.

21:40 – Introducing the ‘medication review’.

28:48 – The ‘healing power of a good book’: escapism techniques.

Referenced Edition 123: Dr Jim Huddy Royal Cornwall Hospital, in ‘Opioids and Chronic Pain’

The Pain Café in Cornwall

Imagine If – Social Prescribing Team

NICE Guidelines (2022) ‘Medicines associated with dependence or withdrawal symptoms’

Living Well with Pain – Ten Footsteps Programme

  

Recently healthcare technology and innovation has seen a rapid acceleration, particularly following disruption caused by the Covid 19 pandemic. In this edition we look around the corner and examine the most current technological advances for pain therapy, especially those that can be used with or even in replacement of conventional medical treatments. 

The Airing Pain team attended the British Pain Society ASM in 2022, to listen and interview top thought-leaders on pain technology advancements and the projects they are working on. Hear them introduce their specialist areas of: new scientific evidence for fibromyalgia; neuropathic pain in the form of phantom limb and post-surgery back pain; and cutting-edge developments in neuromodulation techniques, specifically non-invasive Virtual Reality and Gaming for treating neurological distortions.  

Contributors: 

Time Stamps: 

0:20 – Introductory quotes of internationally recognised Clinicians from the British Pain Society Annual Scientific Meeting (ASM). 

1:24 - Introduction by Paul Evans to British Pain Society ASM attendance. 

1:58 - Dr Stephen Ward, Chair of Scientific Committee, St Thomas Hospital London, on emerging scientific evidence for the study of Fibromyalgia. 

5:16 - Dr Simon Thomson, Consultant, Pain Medicine and Neuromodulation, Mid and South Essex University Hospitals NHS Trust introducing the basics of neuromodulation and neuropathic pain, using secondary back pain as an example. 

11:10 – Dr Simon Thomson on the process of Spinal Cord stimulation and equipment. 

18:33 - Dr Owen Williamson, Pain Medicine Specialist, School of Interactive Arts and Technology at Simon Fraser University Vancouver British Columbia, on virtual reality (VR) for chronic pain treatment, particularly the uses of VR for painful distortions. 

25:05 – Dr Owen Williamson on his talk titled ‘Modifying the Matrix: Virtual Reality’ at the British Pain Society ASM. 

30:22 – Dr Owen Williamson on potential drawbacks to using VR Therapy. Followed by a discussion of mitigation techniques; artificial intelligence and body sensors for patient-monitoring in virtual environments.

32:56 - Invitation to fill out our Online Survey 

32:42 – Introducing Dr Timothy Deer, Interventional Pain Doctor West Virginia and President of The Spine and Nerve Centers of the Virginias on the future of personalised management and remote home programming to benefit those living with chronic pain. 

39:08 - Dr Owen Williamson discussing the optimistic yet cautionary future of virtual reality and wider emerging technologies for pain therapy; the importance of preserving empathy as typically found in the doctor-patient relationship. 

This edition of Airing Pain was possible thanks to support from the British Pain Society.

Airing Pain 61: Deciding Together

Pain Matters 73: Neuropathic Pain Issue

Manage Your Pain leaflet

Chronic Pain and Health Inequalities

In the two or so years of living with Covid-19, the face-to-face relationship between doctors and patients was one of the first casualties. With restrictions relaxed, have we returned to the status quo, or has what was developed at breakneck speed led to new working practices? 

In 2019, just months before Covid-19 became part of our lives, a workshop, ‘Experts by Experience – Working Together in Pain Management Programmes’ explored an innovative approach to pain management in which patients became integral members within the clinical pain team. Has this relationship survived social isolation and lockdowns? 

Contributors include Consultant in Pain Medicine with the University Hospital Southampton NHS Foundation Trust, Dr Cathy Price and Consultant Clinical Psychologist Dr Nick Ambler of the North Bristol NHS Trust, and people living with chronic pain.

Read transcript

Issues covered in this programme include: 

COVID, self-management of long-term conditions, peer support, communicating pain, community healthcare, patient volunteer, support group, training course, volunteering and workshops. 

Time Stamps: 

 

1:15 – Dr Cathy Price on delivery rapidly changing from face-to-face to online, having to prioritise vital healthcare, and what didn’t work remotely.

6:00 – Dr Cathy Price on the barriers the technology can create.

7:05 – Paul Evans recaps Airing Pain 119 Experts By Experience: Working Together In Pain Management Programmes

10:10 – Dr Nick Ambler talks on the Experts by Experience: Working Together In Pain Management Programmes Workshop.

14:12 – Nick on the service user involvement in delivering Pain Management Programmes and what it means for health professionals.

17:00 – Paul ask Nick how a GP could approach a repeat consultation about pain to create a productive outcome.

19:55 – How the Covid pandemic impacted the work of pain clinics.

22:25 – Paul questions whether post-pandemic approaches to healthcare will revert.

27:00 – Cathy Price on the positive outcomes of working during a pandemic.

28:00 – Nick Ambler on the impact of patients being part of the team.

30:00 – Primrose Granville on her pain management programme experience.

 

Contributors: 

Special Thanks: 

This edition of Airing Pain was supported by the British Pain Society and funded by grants from the James Weir Foundation, the Hospital Saturday Fund and the Erskine Cunningham Hill Trust.  

More Information: 

Pain Matters 78: managing pain during the coronavirus pandemic 

Airing Pain #119 Experts by experience Working Together In Pain Management Programmes 

Airing Pain 133: How Group Consultations Can Help Long COVID And Other Conditions 

What is mental defeat and does it have an impact on the experiences of those living with pain?  

 

In this edition of Airing Pain, Paul Evans interviews the team at the Warwick Study of Mental Defeat in Chronic Pain (WITHIN Project) and research participants, as well as taking part in the study as a participant himself. 

The study, which runs until May 2023, is investigating how mental defeat can influence pain sensation, sleep patterns, social activity, physical activity and the general health of individuals who have chronic pain.

Mental defeat is defined as the perceived loss of autonomy in the face of uncontrollable, traumatic events. In the context of chronic pain this can be explained as a loss of identity and self in relation to repeated episodes of pain.

Paul talks to the team about their experimental, lab-based study and the sleep-tracking survey, then undergoes the lab experiment himself. He discusses how he found it, the possible outcomes of the research and also interviews other participants.

The WITHIN Project will generate information to help further understand the influence that mental defeat has on distress and disability in chronic pain patients. This is essential listening for anyone wanting to know more about the research process, or wanting to participate.

Issues covered in this programme include: Mental defeat, pain research, insomnia, psychological effects of pain, chronic pain, patient perspective, acceptance and commitment therapy, research participation, pain thresholds.

0:25 Dr Nicole Tang, the Principal Investigator, discusses the definition of mental defeat.

1:22 Explanation of the WITHIN Study of Mental Defeat in Chronic Pain.

5:55 Jenna Gillett, PHD student and study researcher, on the relationship between pain and mental defeat.

7:17 Jenna Gillett and Dr Nicole Tang explain the sleep tracker study.   

12:19 The impact of the COVID pandemic on the study – adaptations and the unexpected outcomes.

14:00 Participant Lauren Pulsford describes her experience of taking part in the study.

16:00 Producer Paul Evans meets Research Fellow Kristy Themelis to participate in the lab-based experiment.

20:00 Dr Nicole Tang on the association between chronic pain and Post Traumatic Stress Disorder.

21:00 Exploring what happens to those with chronic pain have a strong sense of mental defeat.

22:00 Explanation of the longitudinal study – looking at sense of defeat, pain and activity over time.

23:00 Jenna Gillett talks about Acceptance and Commitment Therapy and its possible links with mental defeat.

24:00 Back in the lab with Paul Evans and Kristy Themelis, measuring his pain pressure threshold.

27:00 Paige Karadag, research assistant, explains the challenges of recruiting research participants online.

31:30 Paul Evans and Kristy Themelis discuss the experiments that he participated in and how he found it.

35:30 Paige Karadag and Jenna Gillett outline the criteria for research participants for the study, which will be running until May 2023.

39:00 Participant Caroline Perry offers her take on why people should take part. 

 

Contributors: 

Special Thanks to the WITHIN team at University of Warwick

This edition of Airing Pain has been funded by grants from the Medical Research Council. 

 

More Information: 

Warwick Study of Mental Defeat in Chronic Pain 

Pain Concern Getting a good night’s sleep leaflet 

Pain Matters Magazine  

Now that COVID has become a part of our day-to-day lives, so too has long COVID. So, with so much money now being directed towards researching treatments for long COVID, how might this impact the way we treat all manner of chronic conditions?

In this episode of Airing Pain, Paul Evans interviews the team at the Berkshire Pain Clinic, who run a specific long COVID service, on treating people with the condition. Notably, there are many similarities between the symptoms of long COVID and the symptoms of other long-term conditions, such as fibromyalgia or chronic fatigue syndrome. Issues like managing pain, fatigue, sleep and pacing are not only common in those with long COVID, but those with chronic illness in general. This raises the possibility that the money being spent now on long COVID may have a far wider reaching benefit in the long term.

The team at the Berkshire Pain Clinic have already found success in using group consultations to manage long COVID. Listen, or read the transcript, to find out how these consultations are run and why they are proving so beneficial.

group consultations, long COVID, self-management of long-term conditions, fibromyalgia, fatigue, brain fog, shortness of breath, pacing, sleep problems, building support networks, managing mood problems and goal setting.

02:02 – Dr Deepak Ravindran explains how existing knowledge can help us to manage long COVID.

08:22 – Dr Rupa Joshi explains how group consultations can provide support to those with long-term conditions.

11:09 – how did group consultations start at the Berkshire Pain Clinic?

13:50 – Dr Rupa Joshi discusses how both patients and healthcare professionals can learn from group consultations.

14:17 – how do group consultations for long COVID differ from those for other health conditions?

15:33 – Dr Deepak Ravindran on how our understanding of COVID and long COVID have changed.

18:52 – Caroline Mole shares her experience of long COVID, pain and fatigue and how it has impacted her life.

20:25 – Dr Deepak Ravindran shares how his experience of COVID gave him perspective on the experiences of his chronic pain patients.

21:54 – how funding for long COVID can help those living with other long-term conditions.

24:25 – Airing Pain producer Paul Evans shares his experience of fibromyalgia and how it has a lot in common with long COVID.

26:04 – could the treatments we discover for long COVID be used for people with other conditions?

27:13 – Caroline Mole explains what it was like to have a long COVID flare up and her struggles with fatigue.

29:08 – Greg Scott on talking therapies and managing the mental health aspects of long COVID and other conditions.

32:06 – Health and Wellbeing Coach Fatema Hafizji on empowering people with long-term conditions to achieve their goals.

35:54 – Personal Trainer Kerry Doe explains how she supports people to return to exercise following COVID.

40:38 – Saira Mirza on the role of the physiotherapist in managing long COVID and other conditions and the importance of breathing techniques.

This edition of Airing Pain has been funded by grants from the James Weir Foundation, the Hospital Saturday Fund and the Erskine Cunningham Hill Trust.

This Airing Pain was recorded at the Scottish Network for Arthritis in Children SNAC’s 2022 Family Weekend at Crieff Hydro, which brings together families recently affected by juvenile idiopathic arthritis and some of the country’s leading paediatric rheumatology experts. 

juvenile idiopathic arthritis, autoimmune disease, coping as a family, rheumatology, paediatrics, support networks, identifying illness in young children, movement and exercise

00:00 - introduction to SNAC's family weekend by Sharon Douglas

04:03 - introduction to juvenile idiopathic arthritis by Julie Duncan

07:13 - how does juvenile idiopathic arthritis present?

09:00 - what is SNAC and personal stories from a parent.

12:56 - parent of a child with juvenile idiopathic arthritis shares how they first spotted it.

14:42 - Vanessa Raimondo discusses medication options for juvenile idiopathic arthritis.

18:44 - parents & children share their stories.

21:33 - Vanessa Raimondo discusses medication side effects.

23:57 - Alison Ross discusses coping mechanisms for juvenile idiopathic arthritis & more on medications and treatments.

30:23 - parent of a child with juvenile idiopathic arthritis on her daughter's journey with JIA, medications and diagnosis.

31:15 - coping as a parent of a child with juvenile idiopathic arthritis.

31: 54 - coping with juvenile idiopathic arthritis as a family

34: 29 - parents of a child with juvenile idiopathic arthritis share their family's story.

39:10 - how does juvenile idiopathic arthritis make the children who suffer from it feel?

41: 18 - family from Shetland share their story of having a child with JIA in a remote area.

43:27 - Jo Walsh tells us about SPARN (Scottish Paediatric & Adolescent Rheumatology Network) and how they support families with JIA.

47:00 - how to handle the transition from children's health services to young adult services.

48:06 - Vanessa Raimondo tells us about what we can do (aside from medications) to manage JIA.

49:27 - young person shares their experience of juvenile idiopathic arthritis and still enjoying sports, exercise and success growing older with JIA.

54:20 - Sharon Douglas, chairperson and co-founder of SNAC, conclusion and raising awareness about JIA. 

This programme exists due to funding from Trefoil House Organisational Grants, the New Park Educational Trust and WCH Trust for Children.

In this episode of Airing Pain we cover facial pain in its many forms, what treatments are available and how to cope better with your pain.

Funded by The Hospital Saturday Fund.

In collaboration with UCLH Royal National ENT & Eastman Dental Hospitals.

The way our face feels and how we move it is a massive part of our identity. Feeling pain in the face, or not being able to use your face the way you want to, is not only a physical burden on the person suffering, but a heavy psychological load to cope with as well.

01: 54 - Trigeminal neuralgia (TN): what is it and what does it feel like? Dr Joanna Zakrzewska explains.

06:27 - Dr Zakrzewska discusses what treatments are available for TN, including carbamazepine.

10:37 - How can neurosurgery help treat TN?

18:11 - Psychology Pain Management Programmes (PMPs) for sufferers of TN.

19:11 - Susie Holder on the psychological impact of face pain.

21:36 - Dr Roddy McMillan discusses temporomandibular disorder (TMD) as a source of face pain.

22:29 - Burning mouth syndrome and other types of face pain.

25:50 - Treatments available for other types of face pain.

28:30 - TMD and how it is different from other types of face pain (usually neuropathic in origin).

30:00 - What is central sensitisation syndrome?

32:21 - Pain management for chronic pain sufferers.

36:05 - Susie Holder explains what acceptance and commitment therapy (ACT) is.

44:07 - Obstacles to living well with pain, including the coronavirus pandemic.