In setting up such a clinic, the specialists had become convinced from experience that an in-patient facility was important in the assessment and management of chronic pain patients. They also believed that such a unit would operate best on a ‘behaviourial model’ based on principles of behaviour modification as set out by Dr W. Fordyce of Seattle.

This involves changing the behaviour of chronic pain patients and encouraging them to return to normal behaviour. In other words, patients must start managing or coping with their pain, and not allowing it to completely control their lives.

The programme’s aim is to improve the quality of life of patients with chronic pain. Accordingly, a programme of pain management was organised to minimise the length of stay in hospital.

The unit is staffed by:

• A clinical director who is a consultant psychiatrist, with experience in managing chronic pain patients.

• A full-time charge nurse and two other nurses.

• A clinical psychologist who acts as programme director.

• A part-time occupational therapist.

• A part-time physiotherapist.

• A part-time dietician.

• A unit physician.

• A social worker.

The programme usually runs for about four weeks. Under most circumstances, patients are initially admitted for a five-day assessment period which runs from Monday to Friday.

At the end of this time, the patient’s major areas of difficulty, both physical and psychological, are discussed and a contractual period of admission is agreed upon, with the specific aims being clearly defined.

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When all else fails, pain management calls for the specialised skills of the neurosurgeon . Surgical procedures interrupt the pain pathways by making incisions into various levels of the nervous system. Thus, cordotomy (in which the pain pathways in the spinal cord are interrupted), removal or destruction of the pituitary gland and the destruction of various collections of nerves known as ganglia may be carried out.

All or any of these treatments may be used in the one person at the same or different stages of the disease.

Physical treatments of cancer pain

The physical methods of treatment as discussed in other chapters of this book are also helpful for the pain caused by the cancer itself and also that caused by non-cancerous conditions which may add to the sufffering. Treatments include acupuncture, TENS and conservative physiotherapy methods.

Psychological management

In some cases, psychological methods using imagery, relaxation and hypnosis can give cancer sufferers relief, as can physical therapy and measures such as sympathetic understanding of their thoughts about pain and its effects on them. This can dramatically help put the pain into perspective.

Carl and Stephanie Simonton describe these techniques in their books ‘Getting Well Again’ and ‘The Healing Family’.

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TENS is a method of encouraging your body to produce its own pain killers — the endorphins and enkephalins. Thus it is far preferable to take yourself off strong pain killers which may be putting your liver and kidneys at risk, as well as exposing yourself to the risk of drug addiction.

The benefits of TENS may well be enhanced by the use of an antidepressant at the same time. The use of TENS before going to bed may reduce the need for sleeping tablets. 8. Is treatment with TENS painful?

During TENS treatment you will experience a tingling or pulsing sensation under the electrodes or spreading away from the electrode site. TENS should never be painful as such pain would open the ‘pain gate’. The whole idea of TENS is help the body to close the gate.

In some types of treatment muscular contractions may be produced. These aid the breakdown of painful muscle spasms and increase the amount of blood flowing through the area. The strength of the muscle contractions should always be within your ability to cope without undue discomfort.

You should be able to wear a TENS unit for up to several hours without discomfort. If you experience pain during treatment you should speak to your doctor or therapist.

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