Many people with persisting and chronic pain elect to have an intervention for pain relief. This can include steroid injections, facet joint injections, nerve root blocks, epidurals, denervations and sympathetic blocks to name but a few. These procedures are usually administered by a pain consultant (a doctor who specialises in pain management), an orthopaedic surgeon, a radiologist or a rheumatologist.
Undoubtedly, the interventions can afford pain relief but of course the results do tend to vary from person to person. Ideally, the procedure forms part of a multidimensional treatment programme that aims to reduce symptoms, increase activity levels and improve quality of life in the patient’s eyes.
So, what happens next?
In some cases nothing and in others patients are advised to reactivate with the help of a physiotherapist. In the former scenario, the expectation is that the procedure will solve the problem, the pain will ease and life returns to normal. Unfortunately there is an error with this thinking as in the vast majority of cases this leaves the patient with a host of unanswered questions: how much should I do? Can I do this or that? Is it safe? etc etc. If the pain persists in any shape or form, this increases the threat value of these questions. They must be answered with practical solutions.
Undoubtedly to follow a comprehensive programme that addresses the physical and cognitive dimensions of pain is desirable. The intensity and length of a programme will vary from person to person, but as a minimum, the patient should know what they can do and how they can do it as a way of moving forward.
Within the programme there are fundamental issues that must be tackled. For example, in many cases of persisting pain, the way in which movement is controlled has changed as has body perception. This has to be retrained and there are specific ways of achieving this goal. We know that these mechanisms play a role in sensitivity and hence need to be targeted.
Concurrent with physical training is the absolute need to create the right mindset and deal with any associated fears of movement. This may include working upon resilience, motivation and coping so that the training outcomes are optimised.
In summary, the understandable use of pain interventions should be part of a multidimensional treatment and training programme that tackles the physical, cognitive and emotional aspects of the pain problem.