Questions arising after and during Pain management courses

Please do not mention specific dosages in this section.
Issues relating to pain management - from the latest drug therapies and combinations to pain clinics and cognitive behavioural therapies.

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Postby hannah » Sun Nov 12, 2006 8:45 pm

Rosie, You sound like you have found a kind of 'passsive assertiveness' (:lol:) ideal for your situation - Well done :clap:. Your 'Them' and 'Me' made me smile, because it can be so true in all sorts of parts of life, but joking aside I hope your next week goes well, keep the useful bits and filter out the surplus and ridiculous.

Emma, all the best tomorrow, keep up the Pacing!

Best of luck to you both, Hannah
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Postby sanguine_emma » Mon Nov 13, 2006 10:57 pm

Hi all

Well my pain rehab group session today turned into a 1:1 session! everyone else was either sick, couldn't get time off work or couldn't park (the NOC is notorious for having no patient parking). So it was me and the physio (C). It was actually a fabulous opportunity for us to discuss things, because most of the time my answers to questions are different from those of the rest of the group. We talked about doctors, treatments and drugs, all of which was good mainly because it reinforced some of the conclusions I had come to myself. I don't have any problems in that line - I'm happy with my diagnosis, I'm not in pursuit of a non-existant cure, and I'm fine with all my medication.

As a child I was just told told to get on with things - not in a nasty way but just because no-one had any idea that anything was wrong. I was picked on and bullied for all of my childhood and teenage years (I think I was a bit of an odd child!) while this is not related to my EDS, it instilled a deep-seated fear of being different. When I wound up doing stem cell work in my last job I was so happy and enthusiastic and eager to do well that I pulled out all the stops. We were hideously under-staffed, so I developed a habit of rushing around working as hard as I could. At one point, I was so exhausted that I effectively suppressed my own immune system such that I got wiped out time after time by what should have been trivial bugs. I was in incredible and constant pain. I got signed off with exhaustion, at which point I should have learned my lesson, but for the first time I actually felt that people valued my contribution, and I was hooked. Somewhere I got into the habit of thinking that people wouldn't value me if I didn't give 200% all the time. Now I've moved to Oxford, I'm happily engrossed in a job that gives me more responsibility, and less physical effort. And the people I work with are my friends. This over-doing is partly a character trait which will always be with me, and partly a hangover from the old days when I lacked confidence and security. I would say I'll always tend to over-do, but it's done me good to examine my motives and give the secret unhelpful thinking the heave-ho. I'm not an insecure teenager anymore, I'm a successful married woman of nearly 30. C was really pleased with my epiphany, and I'm very grateful to her for telling me every single week that I don't become a less valuable if I say no sometimes... It takes a while for information to enter my head it seems!

In the exercises, I was allowed 5 mins on the bike to class as one of my CV sessions for the week :lol: . We also did wobble boards and C showed me what to do with my gym ball (I've had one for ages with no idea how to use it), and it was really good, and really relevant to me. I feel... empowered.

Tell you what though... I'm tired now. Time for an early night I think! Hope all the other course-goers are having good weeks.

Emma xx
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Postby Mari » Sun Nov 19, 2006 9:12 am

Rosie, Hannah, Emma,

How did your courses go this week?

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Postby hannah » Sun Nov 19, 2006 2:43 pm

Thanks for asking Mari, it's really nice to know you guys are following along.

Actually, it went quite well!

The talking part was great, about relationships and how they are affected by chronic pain.
I did the excersises I decided to do :), but we added on a load of new stretches aimed at the hips. I tried some, trying to be cautious, but I think I overdid them, and as they are one of my most bendy parts, I still didn't feel a stretch! I won't be doing them next time.

I did have an 'assertive moment' in hydro. We were told to do sit to stand exercises on a bench thing in the pool, but my hips were giving warning signals so I point blank refused (I did try and say why, this tends to help them accept that I am not just 'chickening out'). It took a bit of persuasion, but I think she understood.

A big positive was that the physio asked me if she could have a copy of the thing I'd written about my problems with the SIs and share it with the others in the group because she thought it was really good, clear working out of how best to manage a situation. It did my self esteem no end of good :lol: and helped me stop the 'maybe it is all in my head after all' that haunts many of us from time to time.

There was however a wierd thing that might be HMS related :? I know quite a lot of us get dizzy patches, this might be related. Can anyone help?
In hydro, I felt mostly OK, but was struggling to make my ankles keep me walking in a straight line, and my legs kept on kind of 'giving up'. I don't think it is a muscle weakness thing, because it is so intermitently random, more a lack of messages getting through. (this has happened before ).Anyway, part way through, I would have collapsed if I hadn't been able to grab the rail. I am told I went rather white and completely blank. I spent the next half hour or so feeling rather dizzy/faint.

I was kneeling in the shallow end talking at the time, and didn't feel dizzy/shaky before. the only slightly unusual was the lack of coordination (as in, even less than usual). Any ideas?
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Postby sarahh » Sun Nov 19, 2006 6:09 pm

Hi I have been thinking about pain management classes but I don't know how to go about it. Do I need a refferal?

Thanks

Sarah x
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Postby Mari » Sun Nov 19, 2006 7:32 pm

Hannah,I was wondering, do you have Autonomic Dysfunction with your HMS? I don't, but my niece does, and when she used to have hydro she used to feel really ill. Since then Dr Hakim in UCLH told her she shouldn't do hydro because the heat from the water causes her veins in her legs to dilate. Too much blood goes to her legs and she'll feel faint. 9I think I've remembered that right!)

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Postby sanguine_emma » Sun Nov 19, 2006 9:34 pm

Hi Sarah, yes, you need to be referred. I don't know if GPs can refer you to a pain management course, I was referred by my rheumatologist. Good luck, and if you get referred, don't forget to tell us how you get on.

Mari, you're so thoughtful! What a star. It's my last session tomorrow. I will miss everyone. It was a bit of a rollercoaster, but I have to say that the overall experience has been really useful. I completely agree with what everyone else has said about exercises and the fact that the course assumes that all your pain is chronic in origin therefore doesn't really relate to damage. It's really important to communicate clearly and assertively (yay hannah :clap: ), and it's also really important that the leader is willing to hear what you've got to say (I fear poor rosie has an uphill struggle there :( ). I think part of the problem is that the group format means it does tend to be a bit 'one size fits all' at times, so you have to be pretty canny about weeding out the things that are either irrelevant or unwise. I found that my impromptu one-to-one last monday was really helpful (not that I'm recommending kidnapping the rest of the group in order to get one!). In some ways I've learned almost as much from the things that weren't relevant to me as from the things that were directly applicable, and the whole process has led to a deeper understanding of myself and my relationship with HMS. My major learning points from the course have been:

My pain is real (really real, not just a bit real).
Over-use is a Bad Thing and should be avoided.
Over-use is a way of taking out my frustration on my body, and that sort of thing really has to stop.
Over-use is a form of denial.
Activity 'baseline setting' is just about impossible if you live in the real world.
Pacing can and should be done in all activities, regardless of how important I perceive them to be.
People will still like me if I say no sometimes.
I am not afraid of exercise or pain (the course assumes you are), so this means I have to be extra careful not to damage myself.
I have a good attitude towards HMS and I am not anxious about it, nor am I in pursuit of a non-existant cure.
Shopmobility scooters are a way of shopping without crippling myself, and there's just no need to feel guilty about using one.
Gym balls are fun, but if you do too much in one day you won't be able to walk the next day.

I do just wish we had a bit more time. It's taken me this long to really get the hang of what it's all about, and two hours a week for six weeks really isn't all that long. I wish we had more time to go into the finer points of pacing, and do a little bit about relationships and how to deal with telling people about your pain.

Hannah - sounds a bit like autonomic dysfunction to me. Hot water makes me dizzy sometimes too. And I do get exceedingly unco-ordinated after exercise, like my legs belong to someone else :?

How's things Rosie?

Love to all,
Emma xx
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Postby Rosie » Sun Nov 19, 2006 10:09 pm

Hi all

I will try to bring you up to speed on my PMC, now it is over. Most of the course was really good. The first week was mainly taken up with intoducing new ideas and then building on them slowly. During this time we were assessed and appointed our key workers (counsellors) and had our first session with them. The second week was the most intensive, and week 3 was more about looking forward to how we would change things once we went home.

For the exercise part, the stretches were demonstrated on the second day, with a chance to try one or two, by the third day we were led through the stretch program, and on day 4 we did the stretches and had the circuits demonstrated to us, and on day 5 we did the stretches and circuits. During week 2 we recorded all our circuits and then calculated our baseline, and on week 3 we worked to the baselines, with discussion about how to grade up the exercises, and what kind of exercise to move to next. For me, this was the least useful part of the course, as there was no opportunity to adapt the exercise program for my condition.

There were also daily relaxation sessions as well, and over the three weeks we were led through various techniques, starting with how to breather. I found these sessions very good. As a group we were all willing to try anything, so we got a lot out of this, even if some of us regularly fell asleep. The emphasis was on finding a technique, or preferably techniques, that worked for you, so you could use them whenever you need a bit of chill time.

There were session on medication given by an experienced pain management nurse. We looked at the various types of painkillers, how they work within the body, the possible side affects, and given individual time with the nurse to discuss our own medication. She also talked about timing the doses of various medications, and some of this was new to me. This part was also excellent, and although there were suggestions that she would help us to reduce medication if we wanted to, there was no pressure to do so.

The psychology sessions were also very good. We looked at how we perceive ourselves, and how we appear to others, unhelpful thoughts and how to change them, methods of communication and whether they were effective, assertiveness and a couple of other things. I found these sessions very useful, and they do challenge you to look at your own behaviour, assumptions and thoughts.

The OT on the course covered a number of topics. In particular, she looked at pacing, pacing, and more pacing, flare up and set back plans, the benefits of exercise (we came up with 52, a new record), and goal and task setting. She also got us to estimate our tolerances for various activisties, and then how to measure and calculate out actual tolerances. This was a bit of an eye opener for many of the group, and some found it rather depressing, but it did focus our attention well. These sessions give you a number of useful tools to help you practically manage your pain, and I found most of the ideas very helpful.

All in all, I think the course was well structured, and well run. It is led by a team, with no one person in charge, and this works well too. The day begins at 8:30 with stretches, and finishes anywhere between 3:30 and 5:00. You are expected to attend all sessions and this was probably the hardest part of the course for me as my fatigue has been really bad recentle. I did find that it got easier as the course progressed. The individual counselling sessions are also useful, and the key workers (psychologist, OT, nurse, physio/OT, assistant psychologist) counselled 2 from the group. We were assessed during the first few days and allotted the key worker that they felt was appropriate for our individual needs.

The individual elements of the course gradually fit together to give the whole picture (like a jigsaw), so as the course progressed there was more and more overlap between the various sessions. There was also a fair amount of discussion time allowed for in the last week, and we made the most of this. The course is planned so that we went home at weekends, and this gave us time to reflect on various ideas, and maybe try a few things out, as well as seeing our families. We also had 2 activity afternoons, where we had to plan an activity out. We went shopping in Hay for the first one, and went to the health spa for the second. It was an opportunity to try out some of the planning and pacing techniques, with a post mortem afterwards to look at anything that you would do differently next time.

The best part of the course for me was being within a group of people with pain as our common factor. (No need to explain!). The course is residential, and the staff go home as 5:00 p.m, so you spend a lot of free time with the other group members. As a group we seem to gel very quickly, with very little friction. Yes, there were minor differences, but the tolerance levels were very high, as was respect and appreciation of other people. Over the three weeks we bonded deeply, to the point where we didn't really want to go home, and many tears were shed on the last day. Pain management courses, when they work well, are like a journey leading to a new stage of your life. OK, this may be a cliche, but there is truth in it as well. I think I have learnt a lot from it, as well as having an enjoyable time, and made 9 new close friends but I do wish there was a PMC for people with HEDS/HMS.

Hope this has answered some of your questions.

:bye:

Rosie
Diagnosed HEDS December 1st 2005. DD1 (20) HEDS and scoliosis (now corrected by surgery), diagnosed June 2006. DD2 (18) mild HMS. Son (11) some hypermobile joints, poor muscle strength and seems to be developing scoliosis as well, woopee!
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Postby sarahh » Sun Nov 19, 2006 11:30 pm

Hi thanks for the info I will speak to my rheumy when I see him.
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Postby hannah » Sat Dec 09, 2006 11:33 pm

Well, I have now finished my course, and feel that overall, it has been very beneficial. learning how to pace, and gradually build up exercises, steadily strengthening my body. And not least, the friends I made on the course, I intend to keep :D

One thing I learnt was that if I take time to explain things fully to a physio, (easiest in writing) then my treatment suddenly becomes a whole lot more appropriate :dance:

I think that every time one of us HMSers goes on a pmc we educate the physios that little bit more, and the next person will be able to be helped that little bit more.

Thanks to the physios for helping me to the best of their ability, and to the others on the course for putting up with me, my oddities, and my 'assertive moments' (transalated as polite strops :oops:) and thanks to everyone on here who answered my many questions, so that I could get the most out of the course :sorry:

Hannah
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Postby sanguine_emma » Sun Dec 10, 2006 12:28 am

Hi hannah - glad you feel good about your PMC course too. I have completely over-done it this weekend (didn't take long :lol: ) but now I sort of realise what I'm doing. I know it's going to be mad in the run up to christmas, and I have a good idea what to expect from my body. I also know that I have a choice, and that if I don't want to take the stick from my body, I need to stop torturing it!!

Today I have finished my christmas shopping, and sung Handel's Messiah. Tomorrow I'm singing at church then going to someone's Christmas party. But... here's the difference. We only had a little bit of shopping to do so I made sure we didn't spend all day in town, and we had a leisurely lunch break in the middle. When we got home, I had a sleep and allowed the ever-dependable OH to ply me with dinner. Then we went to church for the messiah, and I took painkillers BEFORE it bacame agony, and I took a cushion with me for the pew. Now I'm off to bed in the knowledge that although I've had a mega day and I'm completely exhausted I haven't actually been wasting energy. There's a long way for me to go before I stop grinding myself into the ground entirely, but I've definitely made a start!

Emma xx
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Postby hannah » Sun Dec 10, 2006 12:24 pm

Well done Emma :clap:

Definitely a step in the right direction!
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Postby gila » Sun Dec 10, 2006 2:05 pm

it's great to see how you all turned the 'somewhat stressful' experiences during being on the pmc into great steps forward afterwards.
go. girls, go!
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Postby sarahh » Sun Dec 10, 2006 4:08 pm

Well done hannah and emma am proud of you both.

:clap:

Sarah x
Hms December 99, Dormant Lupus Sept 07, Back Pain, Raynauds, RLS, Fibromyalgia June 08, EDs Aug 08, Marfanoid features Aug 08, Dyspraxia age 5
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Starting Pain Management This Week!!!

Postby nat05 » Sat Sep 01, 2007 4:53 pm

Hiya,

Im starting an out paitents course this week (on tues) and just wondered what experiences other people had had or any general advice. Im quite nervous as will be the youngest there by 5 yrs. The Psychologist managed to get me on last minute as she wanted me in a group with people 'my age'. The youngest is a bloke aged 28 and another is 32. The rest are 50 and older.

She was suprised at my level of pain for age (23) and expained im going to have to approach the course differently from the group due to complexity of condition compared to them. I was suprised to hear she has a hypermobile knee, so immediately i knew she understood and was great in the assessment when she asked what type of pain i had and wasnt dismissive of the many different ways i described it, that it moved etc.

Im slightly worried about the psychological effect it will have as they are going to have to get the same amount as an inpatient course in 6 weeks of two half days (sqeezing 100 hrs into 30). Im an emotionally fragile person and have an 'extreme' level of anxiety and 'severe' depression (from questionnaire i had to fill in). I know i need to lead a more structured life and have to be realistic about the future and what i want from life.
Its just difficult to have to see how in 3 yrs iv gone from playing sport regularly, cycling everywhere, cooking full meals, doing chores for mum and silly little things like not being shattered all the time and having a stack of meds.

Any advice would be much appreciated. Iv also decided to chronicle my course as i think it will help me and possibly others. Ill remember how i felt and advice given by the team. Im excited and apprehensive but feel things are finally moving along now.

Nat
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Powered by fairy dust - could explain a few things now i think about it tho!
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