Dr. Helena Miranda has hadchias in her right hip and leg for the past ten years; she is a lifelong migraine patient, has arthritis in her left knee and neuropathy (nerve damage) on both feet.
51 years old, and a single mother of two teenage boys, Dr. Miranda has also been working in pain research since 1999, but she says a Damascene moment came during a therapy session six years ago when she realized that she too was suffering from chronic pain.
"I had had hip pain for years, but I worked like crazy so I ignored it," she says. She took daily doses of ibuprofen, paracetamol and sometimes codeine, with little effect.
And like Dr. Miranda, between the third and half of the British live with daily pain – it's the most common reason why people see their doctors – but it's frustratingly hard to treat.
Dr. Helena Miranda, 51, has had sciatica in her right hip and leg for the past ten years. She has been working in pain research since 1999
British doctors have indeed started using opioids such as morphine and codeine – highly addictive painkillers that are useful in acute pain but have little effect on chronic pain (defined as longer than three months).
A review published in the British Medical Journal in 2013 revealed that opioids are ineffective in 90 percent of the most common types of chronic pain, but UK prescriptions have risen by 80 percent in the decade to 2017 to 23.8 million per year. concerns about over-medication with drugs that are not only addictive, but can also cause paralyzing withdrawal symptoms and side effects.
After years of struggling with chronic pain, Dr. Miranda vividly recalls a light bulb moment in 2007 when she encountered a brain imaging study that showed volunteers who had received exactly the same pain stimulation for the same part of the body, a very different response in the brain, and reported an enormous response variation in the intensity of pain, because the brains of each person interpreted the signals differently.
And, she says, she now manages her pain well thanks to a series of analgesic techniques that she has learned through her research. These techniques are set out in her new book, Living Well Despite Pain, which will be serialized in the Daily Mail next week as part of our monthly Good Health For Life series.
The strategies offer hope for those struggling with chronic pain who have not relieved medication: although there is no & # 39; panacea & # 39; exists, Dr. Miranda tips that, in combination, can significantly reduce these.
There are 18 of these strategies – which they have all tested personally – that form what they call a varied toolkit for good pain management.
British doctors have become opioids such as morphine and codeine – highly addictive painkillers that are useful in acute pain but have little effect on chronic pain
Her message is one of empowerment. "You were born with a built-in ability to feel better," she says. & # 39; It is important to remember that you have not lost this ability despite prolonged pain. & # 39;
Central to her approach is the concept that all pain is real – even if doctors cannot find an obvious physical cause, but wherever it is felt, it is really experienced in the brain. Mood, quality of sleep and stress levels, as well as long-term pain itself, all have an effect on our nervous system and on our perception of pain – just like our childhood experiences.
Her "aids" (including pet therapy) help by stimulating the body's own analgesic systems. If there is anyone who understands the mechanism of pain and its mysteries, it is Dr. Miranda.
As a doctor and pain researcher at the Finnish Institute for Health at Work in Helsinki, she has spent the last 20 years trawling every last piece of research on this subject, while she herself was in almost constant pain.
In the book she collects information from more than 400 research reports for the first time and tells about strategies that have helped her. But she struggled a long time before she decided to share her own story.
"Doctors do not normally reveal their personal lives to patients," she tells me in her hometown of Helsinki, Finland, where she has her own GP practice.
"I was worried that it would diminish my credibility as a pain professional. But actually I want to show people that this process takes time.
"You will go through the same emotions as me: from denial to sadness and anger and ultimately acceptance. For me, this meant that I had to get to know the competent, courageous person in me again before the pain started to win. & # 39;
Thanks to her practical strategies, such as walking in the countryside, swimming, bathing and saunas, as well as reducing her enormous workload, she says she now enjoys longer periods in which pain does not interfere with her life.
In addition to the significant improvements in her own life, she has & # 39; enormously promising & # 39; seen changes in her patients who used her strategies. "After a few months, they become less frustrated, defensive and scared," she says. "They become calmer, braver, more active, more efficient and take more control of their own lives."
She is clear that medication will always have a place in chronic pain management alongside her strategies. & # 39; I could not survive without a migraine, & # 39; she says.
"Tricyclic antidepressants (a form of antidepressants that is also used to treat chronic pain) raise the pain threshold and help patients sleep better. I sometimes use one myself. & # 39;
But she believes that a pain revolution that will bring "understanding, comfort, hope and courage to people living with pain" has begun.
The core of this revolution is the twin notion that all pain is experienced in the brain and that chronic pain changes the structures of the brain.
"Doctors are beginning to understand that pain is not the same as tissue damage and that chronic pain is not necessarily a result of nerve damage," she says.
"The central nervous system's own pain relief system releases analgesic chemicals that block pain signals before they reach the brain. It is this system that has been damaged in some people. They feel pain, but it does not come from damaged tissue; it happens because the natural braking system of the body does not work. & # 39;
After her light bulb moment in 2007, Dr. Miranda spent four years learning everything she could about how the brain interprets pain and what we can do to influence it. Then she was desperate to start treating patients again.
"I naively assumed that this knowledge had spread to clinical practice," she says.
But when she started working as a doctor at a large bank, she was shocked to discover that nothing had changed except that opioids were prescribed even more than before.
"That was the time when developing practical pain management and educating patients and professionals about pain became my mission," she says. Her "tools" want to use the body's own pain relief system.
This is a care package approach – each step in itself will only bring about a small change, but combined the impact can be significant. "I'm not saying that if you do yoga, you will see 70% less pain, but maybe you will get 5%," she says.
"If you play your favorite music, you might get 5 percent. But by combining the methods that work for you, you reduce your pain to a level where you can enjoy your life again.
"It is likely that the pain will still be present in a certain form, but the less you strive to be completely pain-free, the better you will manage your pain. It's about making peace with the pain and rebuilding your life. We can do that by teaching the brain to feel safe instead of being alert. & # 39;
As part of her approach, she asks patients about their experiences as children. Was their childhood happy? Did they have headaches or growing pains? Did their parents have pain?
"We must recognize that these events have an effect on how the nervous system develops and processes pain," she says.
"For many people this is a relief. They have doctor after doctor unable to find a reason for their symptoms and they start to wonder if they are going crazy.
"We know from long-term studies that neglect and abuse affect the way a child's nervous system develops and these children often develop chronic pain complaints as adults.
"But there may be other triggers: a serious car accident, a traumatic divorce, the breakup of a relationship, all of which can help make the nervous system more sensitive."
Dr. Miranda & # 39; s own childhood was difficult: "My mother was very demanding and my father was an alcoholic – we were fed and dressed, but I never felt loved or heard," she says.
"Doctors are beginning to understand that pain is not the same as tissue damage and that chronic pain is not necessarily a result of nerve damage," says Miranda (file)
She pushed herself hard at the medical school, partly to gain acceptance from her mother, who she thought remained indifferent to her daughter's success.
"I have recognition, acceptance and reward for my work and I have worked hard to get it," she says.
It also helps her patients lead a better life due to her patience and empathy. But she didn't find it so easy to embrace her own message.
"It's still a struggle," she admits. "It is a lifelong challenge for me to talk nicely to myself and to respect myself – not for my achievements, but for who I am. Many pain patients take care of everyone except themselves. & # 39;
Dr. Miranda said she took daily doses of ibuprofen, acetaminophen and sometimes codeine, with little effect
Does she think she would have been a good pain doctor if she hadn't been in pain herself? & # 39; I think you can be a good gynecologist if you are a man. Or a great pediatrician if you have no children. So of course you can be a good pain doctor if you don't have chronic pain, but for me it's a bonus because I can go into the head of a patient.
"I know what it feels like when you are in pain and a doctor simply tells you to lose 30 kg."
She has personal regrets. She wished she had treated patients in a more friendly and holistic way. "I told a nurse with a huge swollen knee that she could no longer kneel. That kind of negativity is harmful. & # 39;
It may even be tiring for Dr. Miranda to conduct a long interview. "After that I get a headache," she says. "But getting enough sleep, avoiding alcohol and taking nutritional supplements – coenzyme Q10, vitamin C and magnesium – means that they happen much less frequently." A long time ago she abandoned the idea that she could experience a pain-free day herself.
She describes a jar in her head filled with pain, frustration, fatigue and fear, an image that resonates with other pain patients: "Sometimes you have to add one more thing and the jar overflows. But acupuncture, a bath and a sauna, walking my dog, being held by another person, all make the pot bigger. & # 39;
I ask her what pain patients can do to help themselves.
"I'm going to sound traditional," she says. "But it is moving. Move your body without fear and especially with pleasure.
"Do things you love. If you hate swimming, don't do it! Close the curtains, put on your favorite music and dance. The most important thing is to prioritize things that you love, because if you suffer from chronic pain, you lose the ability to feel joy. & # 39;
Take the pain quiz
Everyone's perception of pain is different, but when you get a grip on pain, it can be useful to be clear and consistent in your judgment about what & # 39; ow & # 39; really mean to you.
For example, when a doctor asks you to describe your pain on a scale of 1 to 10 (the standard way to assess pain levels), your answer will inevitably be very personal – the '3' of a person can easily be the '8' belong to another person.
Your answer may vary from day to day. It is therefore useful to understand your current pain levels and your own personal pain threshold, so that you can be consistent with your perception of pain that you experience, so that your 1-to-10 scale always stays the same.
To help you do this, you take this quiz, devised in collaboration with psychologist Dr. Meg Arroll, a specialist in how we perceive symptoms and author of a book about pain in long-term circumstances.
The quiz helps you gain a better understanding of your personal pain perception and the many factors that may contribute. For example, it may help to reveal a high pain threshold that makes you reluctant to seek essential support.
Once you have determined whether you usually answer a, b, c or d to the questions, you will find specific advice for your type of pain.
& # 39; Pain can often seem to be directly related to the severity of an illness, injury or condition, but pain perception is an individual process that is guided by life experience, beliefs, social norms and physiological factors such as fatigue, stress response and hormones & # 39 ;, says Dr. Arroll.
"The good news is that this means that even if we are unable to address the underlying condition that causes the pain, we can change our perception to reduce the severity of the pain.
"By understanding your pain personality, you can take active steps to improve your quality of life."
1. How old are you?
a) Less than 20
b) More than 70
c) More than 50
2. How often do you experience pain?
b) On and off
c) Light but persistent
d) It is an ongoing problem
3. How often do you unconsciously scan your body for pain or problems?
b) Occasionally, if I'm not feeling well
c) Every few days
d) Many times a day
4. Have your parents experienced a lot of pain?
a) Not more than normal
b) Yes, a parent
c) Yes, both parents
d) One or both parents experienced chronic pain
5. How much does stress affect your life?
a) Not at all
b) My stress levels increase occasionally
c) I find life pretty stressful
d) I feel overwhelmed by stress
6. When it comes to illness, how likely are you to dwell on the worst possible outcomes?
a) Not at all
b) I could briefly consider negative complications from a bad or persistent disease / condition
c) It is good to be prepared for worst-case scenarios
d) Very often – I am afraid of death and illness, and Dr. Google is my friend
7. If you have a cold, you are more likely to:
a) Just grin and tolerate
b) Take acetaminophen if you have a headache or sore throat
c) Take a range of cold and flu remedies
d) Go to bed for a few days
8. If you have a headache, do the following:
a) Ignore it
b) Take acetaminophen
c) Search for strong painkillers
d) Go to your bed until it is over
9. During the past six months, how many days have you been dragged into work to feel terribly ill while you may have had to stay in bed?
d) More than 5
10. How well do you sleep?
a) Like a baby
b) Usually good, but I have a strange night
c) It is intermittent and I do not always get the quality that I need
d) I sleep poorly
WHAT DO YOUR RESULTS MEAN?
If you answer …
Usually one: You are very lucky to be someone who rarely experiences pain. You may be quite proud if your pain threshold seems higher than that of others, but people in this category can endanger their health by skipping screenings and possibly missing or ignoring important signs and symptoms of illness and illness.
Usually b: You experience pain occasionally and you are happy to treat it accordingly – you find a good balance between a consciousness of pain and your ability to control it. People in this category are slightly more likely to be masculine, as studies show that women are more likely to be affected by common chronic pain conditions, including migraine and tension headache, low back pain, fibromyalgia, irritable bowel syndrome and osteoarthritis – and perception of living pain may increase affect pain. You can consider expanding your analgesic options with non-drug alternatives, such as body-mind exercises – including tai chi, relaxation, and breathing techniques – to address pain when it occurs.
Usually c: You probably live with some degree of pain and this may affect your experience and perception of pain (you may find it harder to deal with pain, or vice versa, to block it). Age can be a factor that contributes to your pain perception. Studies show that common joint and nerve-related pain problems (eg, back pain and headache) increase between the ages of 30 and 50 before falling away in old age. However, pain-related illnesses (diabetes, osteoarthritis, many cancers and neurological disorders) increase in frequency with age, contributing to pain in older adults. To help you deal with pain, it may be helpful to improve your sleep quality (go to bed earlier, ensure a restful sleeping environment). Try to keep your stress level under control and try to build a strong social support network, because positive social support can help.
Usually d: You probably experience pain more often than most, and processing it takes a larger part of your time and energy. This in turn can affect your pain tolerance, which can be linked to seeing your parents who are dealing with chronic pain. Stress can have a huge impact on pain perception, and many studies show that stress reduction techniques can be a useful additional element in your painful toolkit. Talk to your doctor about a referral to a specialized pain clinic where specialists can work with you to get your pain under control.
- Invisible disease: dealing with misunderstood circumstances by Dr. Meg Arroll (Sheldon Press) £ 8.99.
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