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Transcript – Programme 7: Exercise and Improving Mobility

Get­ting back into exer­cise and improv­ing mobil­i­ty. Plus, fund­ing for pain ser­vices, and how can we best describe pain to a health professional?

To lis­ten to this pro­gramme, please click here.

Air­ing Pain vis­its the Fren­chay Hos­pi­tal Pain Clin­ic in Bris­tol where we hear from staff and patients. Paul Evans sits in on a con­sul­ta­tion with phys­io­ther­a­pist Pete Glad­well and hears the advice giv­en to one patient about how to increase her mobil­i­ty and exer­cise with­out caus­ing flare up. We learn about how to talk to your health pro­fes­sion­al and the dif­fer­ent ways of assess­ing pain. Also cov­ered is how well fund­ed pain care is by the health ser­vices, and the patients at Fren­chay tell us their sto­ries of liv­ing with and man­ag­ing pain.

Issues cov­ered in this pro­gramme include: Exer­cise, mobil­i­ty, pain ser­vice fund­ing, describ­ing pain, edu­cat­ing health pro­fes­sion­als, spinal injury, back pain, ver­te­bro­plas­ty, phys­io­ther­a­py, activ­i­ty, flare-up, acupunc­ture, mus­cu­loskele­tal, pri­ma­ry and sec­ondary care, joint pain and depression.

Paul Evans: Hel­lo and wel­come to Air­ing Pain, a pro­gramme brought to you by Pain Con­cern, a UK char­i­ty that pro­vides infor­ma­tion and sup­port for those of us who live with pain.

Pain Con­cern was award­ed first prize in the 2009 NAPP Awards in Chron­ic Pain and, with addi­tion­al fund­ing from the Big Lot­tery Funds Awards For All pro­gramme and the Vol­un­tary Action Fund Com­mu­ni­ty Chest, this has enabled us to make these programmes.

I’m Paul Evans. And in today’s programme…

Rose Mar­riot: Many of the patients that stopped by to talk, all of them were in pain, 90 per cent of them were not aware of pain clin­ics, prob­a­bly the same amount did­n’t know how to describe their pain to their doc­tors and they weren’t asked.

Evans: Rose Mar­riot is a nurs­ing sis­ter at Fren­chay Hos­pi­tal Pain Clin­ic in Bris­tol. Her straw poll tak­en at a pub­lic road show event, revealed a shock­ing lev­el of igno­rance and what peo­ple under­stand about their pain con­di­tions, their aware­ness of pain clin­ics and how to describe their pain.

Rose Mar­riot: So, they will go to the GP and say ‘I’ve got a bad back’ and the GP says ‘Ok then, you will take parac­eta­mol and what­ev­er for that bad back’. But what the patient has­n’t done is told them that they’ve got leg pain as well as the back pain and there will be dif­fer­ent types of pains, so one pain may be addressed, the oth­er one may be missed. I asked them about their pain, asked them to describe it and told them to go and tell their GP what they have told me. And I also, on a few occa­sions asked them when they saw their GP to ask if they could be referred to the pain clinic.

Evans: In this edi­tion of Air­ing Pain I’ll be try­ing to address these areas of igno­rance – igno­rance which I’m not ashamed to own up to myself, even though I’ve had chron­ic pain for some 20 odd years.

First­ly, and I found this incred­i­bly dif­fi­cult, how do we describe our pain to a health pro­fes­sion­al, or to any­body else for that matter?

Mar­riot: I’d want you to tell me the nature of the pain, for exam­ple, is it burn­ing? Is it sear­ing? Is it sharp? Where is it? And it’s impor­tant to be able to describe where your pain is and the qual­i­ty of the pain because that helps in the doc­tor being able to make a deci­sion of how to treat the pain. For exam­ple, dif­fer­ent types of drugs work on dif­fer­ent types of pain – you know, is it there all the time? Does it come and go? Is it sharp? Is it burn­ing? Is it aching? Peo­ple have very dif­fer­ent ways of explain­ing or describ­ing their pain. Some­times it’s good to be able to help peo­ple to sug­gest ways of describ­ing their pain.

Evans: Rose Mar­riott, who is a nurs­ing sis­ter at the Pain Clin­ic at Fren­chay Hos­pi­tal here in Bristol.

Patients who attend this clin­ic, all have chron­ic pain and they’ve usu­al­ly been referred by their GP unless it’s by a con­sul­tant in a dif­fer­ent area of the hos­pi­tal. Dr Cathy Stan­nard is one of the pain con­sul­tants here.

This is quite a big and busy pain clin­ic. We have six con­sul­tants work­ing here and a large team of health pro­fes­sion­als from dif­fer­ent back­grounds work­ing: we have a clin­i­cal nurse spe­cial­ist; we have a team of pain psy­chol­o­gists; we have sev­er­al pain reha­bil­i­ta­tion phys­io­ther­a­pists; occu­pa­tion­al ther­a­pists who work on the pain man­age­ment pro­gramme and a spe­cial­ist pain phar­ma­cist who comes and works with us here in the clinic.

We also close­ly work along­side oth­er dis­ci­plines, who come and con­sult here, includ­ing col­leagues from neu­ro­surgery and a team of child health spe­cial­ists for young peo­ple with pain and also an addic­tion med­i­cine psy­chi­a­trist for peo­ple who have a his­to­ry with sub­stance mis­use and also have pain.

We see a lot of what we would describe as the usu­al pain con­di­tions: neu­ro­path­ic pain, dia­bet­ic neu­ropa­thy, post-her­pet­ic neu­ral­gia. This is a very busy region­al, neu­ro­sur­gi­cal unit and we also have a large orthopaedic spinal ser­vice. And so the vast major­i­ty of our patients will have back pain and real­ly they will be quite com­plex patients with com­plex post-sur­gi­cal prob­lems. We would see a lot of patients who’ve had one, two or often many more spinal sur­gi­cal inter­ven­tions and still have per­sist­ing symp­toms and often we have to man­age patients in con­junc­tion with their surgeon.

So a lot of what we do is inves­ti­gat­ing and find­ing out if there’s new pathol­o­gy, scan­ning and mak­ing sur­gi­cal deci­sions along­side pain man­age­ment deci­sions. So that’s a big chunk and that’s to do with the type of hos­pi­tal that Fren­chay is.


Mar­garet How­dle: I had a crushed ver­te­bra in my spine. I had two oper­a­tions in a week. I’ve got two tita­ni­um rods in my back and then I had a lit­tle space in the spinal cord so I had to have a lit­tle cage which had to come right round. You had to do it from the front. And then I had that fit­ted in.

Pete Glad­well: And you’ve tried a ver­te­bro­plas­ty – or had tried it – and that had­n’t been helpful.

How­dle: Not really.

Evans: That’s Mrs Mar­garet How­dle, who’s kind­ly agreed to me sit­ting in on her con­sul­ta­tion with Pete Glad­well. He’s the phys­io­ther­a­pist here at the pain clin­ic at Fren­chay hos­pi­tal and we’ll be fol­low­ing their progress through­out the programme.

Inci­den­tal­ly, the ver­te­bro­plas­ty that they men­tioned: it’s a pro­ce­dure where an acrylic bone cement is inject­ed around the dam­age or crum­bling ver­te­brae in the spine and that repairs it and hope­ful­ly relieves the pain.

Now, one of our aims on Air­ing Pain is to find the answers to the ques­tions you’ve raised with us, so please do take advan­tage of this oppor­tu­ni­ty to con­nect with our experts via our mes­sage board, email and not for­get­ting pen and paper.

This is a good time to remind you that whilst we believe infor­ma­tion and opin­ions on Air­ing Pain are accu­rate, based on the best judge­ments avail­able, you should always con­sult your health pro­fes­sion­al on any mat­ters relat­ing to your health and well-being. He or she is the only per­son who knows you and your cir­cum­stances and there­fore the appro­pri­ate action to take on your behalf.

Now, we’ve had a lot of ques­tions relat­ing to mobil­i­ty, exer­cise and the role of the phys­io­ther­a­pist in pain man­age­ment and we’re hop­ing that our eaves­drop­ping on Mrs Howdle’s con­sul­ta­tion with Pete Glad­well will go a long way to answer­ing some of your questions.

Glad­well: We see peo­ple with per­sis­tent pain prob­lems who often have a lot of impact of that pain on the rest of their lives. And the most obvi­ous area for most of my patients is that affects their mobil­i­ty, it caus­es all sorts of prob­lems, it slows them down. And as a result of that they can lose some phys­i­cal con­di­tion and that makes the prob­lem even hard­er to man­age then.

Part­ly I can help them by try­ing to find a bal­ance of move­ment and rest that works for them as an indi­vid­ual. A num­ber of my patients I’ll find will tend to push them­selves with activ­i­ties until they can’t do any more, until the pain has reached the pitch that they can’t car­ry on at that stage. But some­times the recov­ery time then can be quite slow and then of course whilst they’re recov­er­ing, if it is a slow process of recov­ery, they can’t move around as much. And if it’s two or three days of recov­ery – or even longer some­times – then phys­i­cal­ly they’ve lost some of their ground at that stage.

Evans: Is that what some peo­ple will describe as ‘boom and bust’?

Glad­well: I know it as boom and bust. It’s known in the trade as activ­i­ty cycling as well, with that increase of activ­i­ty and then decrease in activity.

Evans: So, how do you stop peo­ple ‘boom­ing and busting’?

Glad­well: Part­ly it’s to find out whether they feel it’s a fea­ture for them in their lives? Is it part of how their pain behaves? And if they recog­nise it, prob­a­bly they’re half way to stop­ping it already. And then it’s try­ing to find some way for them to work out how much to do on a giv­en day, so they don’t over­do it, and then have the reper­cus­sions for two or three days afterwards.

Glad­well: Ok. It’s nice to see you again, but what would you like to cov­er this after­noon? I don’t know if there is any­thing in particular?

How­dle: Well, I am hav­ing a bit of dif­fi­cul­ty in walk­ing Pete. Now, can I get up and show you what I mean. I seem to be as though I am stiff and when I’m walk­ing it is so I can’t get one foot before the oth­er. Do you see what I mean?

Glad­well: Yes, I can see that. You’re hav­ing dif­fi­cul­ty lift­ing each leg as you go.

How­dle: It’s all of a sud­den hap­pened and I’ve been doing my exercises.

Glad­well: Over­all, it sounds like things are a strug­gle at the moment.

How­dle: They are, I’m afraid. And I would like some­thing to improve it.

Glad­well: My job’s made slight­ly eas­i­er here because all of my patients have met up with one of the pain con­sul­tants, so I’ve already got infor­ma­tion about what their diag­no­sis is, about how long they’ve had a prob­lem for, what treat­ments they’ve tried, what they’re cur­rent­ly trying.

So I’ll be think­ing about a slight­ly dif­fer­ent agen­da here – about ask­ing first of all how I might be able to help. I’m always inter­est­ed to know what my patients would like from me, so that’s a lit­tle bit of agen­da set­ting, if you like. And then to catch up with what they are doing phys­i­cal­ly and what the pat­tern of that phys­i­cal activ­i­ty in the week is. So I’d be look­ing to see whether there’s any signs of boom and bust in their pat­terns, whether they’re cur­rent­ly exer­cis­ing… or often the peo­ple I see have tried exer­cis­ing, it’s been prob­lem­at­ic, so a lot of my time is spent on unpick­ing ‘what went wrong?’ And how can it be done differently.

Glad­well: You’re keep­ing going with exer­cis­ing even though it’s difficult?

How­dle: Uh huh.

Glad­well: So, you’ve got the acupunc­ture to try lat­er on?

How­dle: Yes, it usu­al­ly works.

Glad­well: So the main prob­lem you’re hav­ing at the moment with walk­ing is being able to lift your feet? Part of that is about your pos­ture with the changes with the surgery. It makes it hard­er for you to shift your bal­ance. Part of it is about being able to bal­ance on one leg.

How­dle: Dr Stan­nard said it’s the muscles.

Glad­well: Hmmm, I’ll just get you to stand on one leg for a moment. Keep your­self safe. Use the table if you need it. How does it feel to stand?

How­dle: Oh, I’m a bit hesitant.

Glad­well: Do you know why? Do you know what makes it feel dif­fi­cult to do?

How­dle: I don’t know really.

Glad­well: You’re using your hands a lot to do the work, aren’t you?

How­dle: Peter I don’t think I can do it with one hand, I think you’ll be all beat­ing me up if you do!

Glad­well: Ok, have a sit down when you’re ready. That’s giv­en me that bit of extra information.

How­dle: I wob­ble a bit.

Glad­well: Yes, I was won­der­ing about that.

How­dle: I do wob­ble a bit.

Glad­well: One of the chal­lenges, if you’ve got a long term pain prob­lem and you’re try­ing to work out an exer­cise pro­gramme, is about how much to do and how much to move, because by def­i­n­i­tion, most of the peo­ple I work with, are find­ing it painful to move.

So exer­cise may not be a com­fort­able process for them, but yet if they don’t move around and don’t exer­cise, they can get weak­er and stiffer and often as the result, the pain can actu­al­ly get worse by doing less. So it’s about try­ing to find a bal­ance with­in that and part of my job is unpick­ing the efforts that peo­ple have made with exer­cise in the past.

I’m try­ing to work out a lev­el that they are hap­py to work at and we often use some­thing that’s called a ‘base­line’ for that. And that might be about some­body work­ing out that they can do three rep­e­ti­tions of an exer­cise today. And they might, if they’ve got that right, be able to do three tomor­row and three the next day. But after a week or two they might be able to build up to four. And that’s a real­ly basic part of exer­cise and reha­bil­i­ta­tion, but it’s often over­looked and it’s often thought that the health expert ought to know what a patien­t’s base­line is, but my feel­ing is that the patients are bet­ter at work­ing out their own lev­els and their own baselines.

I would be ask­ing the patient how much do they feel con­fi­dent to man­age on a dai­ly basis. And I think, a lot of peo­ple will want to push them­selves. There’s a sense, that push­ing your­self is the right thing to do. So, if I ask some­body how many of an exer­cise they can do, they may say ‘Well, I can do 10.’ And if I ask the ques­tion, ‘do you think you will be doing 10 tomor­row?’ Some peo­ple say: ‘hmm, I’m not sure if I can man­age 10 tomor­row’. So my next ques­tion then would be: ‘How many do you think you can do today and still feel rea­son­ably con­fi­dent of doing the same tomor­row?’ And that’s get­ting close to what their base­line might be.

Evans: Of course the real­ly dif­fi­cult thing is that some­body who has been fit and active, you tell them ‘walk 50 yards today or 10 yards today’, when they real­ly want to run a mile.

Glad­well: That’s a big area, isn’t there? And that’s get­ting into the psy­chol­o­gy of pain man­age­ment and reha­bil­i­ta­tion real­ly. And I sup­pose, every­body knows that you’ve got to start some­where. But the chal­lenge for that per­son is to hold back when they know they could do more today, but it’s actu­al­ly about look­ing after tomor­row and tomor­row’s mobil­i­ty by doing less today.

We use a range of exer­cis­es here. We have a range of stretch­ing exer­cis­es that cov­er the arms, the trunk and the legs and we encour­age peo­ple to do those in a slow and relaxed man­ner, so they’re get­ting con­trol of move­ment. And we have a set of strength­en­ing exer­cis­es as well that cov­er right the way through the body. So it’s a gen­er­al exer­cise pro­gramme that many peo­ple will be famil­iar with, because at the moment there is no evi­dence that a spe­cif­ic exer­cise pro­gramme is any bet­ter for most of us with most chron­ic pain prob­lems than a gen­er­al exer­cise programme.

But some peo­ple do real­ly well with some forms of exer­cise and that’s an indi­vid­ual mat­ter. So if some­body real­ly enjoys swim­ming and they do well with it, that’s going to be an impor­tant area for them to work on. Oth­er peo­ple real­ly enjoy walk­ing and that’s an area that they can man­age well, oth­er peo­ple branch out into tai chi or they make a start with a gen­tle yoga class. It’s about that indi­vid­ual find­ing some­thing they think they will enjoy. So for some­one who wants to get back to bet­ter walk­ing the dog, for exam­ple, then walk­ing’s a per­fect exer­cise for them, but they may do well to fit in a bit of strength­en­ing and stretch­ing work to improve their walk­ing as well. Where­as if some­body actu­al­ly wants to improve their bal­ance, they may want to be look­ing at tai chi, they may be inter­est­ed in oth­er forms of move­ment that just chal­lenge their bal­ance gen­tly, but in a safe way.

I’m fair­ly broad in what I think peo­ple should be think­ing about with exer­cise. I think that’s impor­tant, because there are so many forms avail­able these days, and so many ways in which peo­ple could explore move­ment. It’s nice to have that scope really.

I’m won­der­ing about a cou­ple of rel­a­tive­ly easy exer­cis­es to help you with your mus­cles and your bal­ance togeth­er, but you would start off in a stand­ing posi­tion, hold­ing on. I’ll give you a quick demon­stra­tion and the first thing is just to shift your weigh from leg to leg and then in the same posi­tion, so that you’re safe hold­ing on, shift your weight slow­ly onto your toes and slow­ly back­wards. And you’re get­ting two sets of mus­cles work­ing there that are real­ly impor­tant when you’re try­ing to shift your weight and to stand on one leg.

How­dle: And will that help the mus­cles in my back?

Glad­well: It will. They’re, you’re always work­ing those mus­cles as you’re doing that, shift­ing your weight, leg to leg. How does that feel to do?

How­dle: It’s quite, it is easy.

Glad­well: Good. And do it to music?

How­dle: Yes.

Glad­well: And then very gen­tly for­wards over your toes and lean­ing back a lit­tle, so you’re not going up on your toes but just much more tak­ing your weight for­wards and then back.

How­dle: Do I lose… lift my toes?

Glad­well: You don’t need to for this. It’s just much more about trans­fer­ring weight for­wards and back­wards. And as you’re doing that you’re using your trunk mus­cles and leg mus­cles togeth­er to coor­di­nate and that might help you a lit­tle bit out when you’re try­ing to stand on one leg and lift to walk because all those mus­cles that sta­bilise your trunk and your legs will be toned up.

How­dle: Yeah.


Stan­nard: It’s inter­est­ing because I guess if you talk to patients in the wait­ing room, the per­fect out­come would of course be that they would leave the ser­vice with­out hav­ing pain. If you exam­ine the data for the effec­tive­ness of pain inter­ven­tions, that’s prob­a­bly not going to hap­pen. And I think most patients will have pain in the longer term, they may be sup­port­ed, they may have peri­ods where they have less pain, but they are going to have pain that’s per­sis­tent in the longer term and that reflects almost, I guess, the deci­sion to refer the patient here in the first place.

Dr Cathy Stan­nard, Con­sul­tant at Fren­chay Hos­pi­tal here in Bristol.

Now, at the start of this edi­tion of Air­ing Pain, we asked why such a high per­cent­age of peo­ple with chron­ic pain were unaware of spe­cial­ist pain clin­ics like this one? Could that be because the health pro­fes­sion­als in pri­ma­ry and sec­ondary care treat clin­ics like this as the end of the line for peo­ple in pain. A last chance saloon, if you like.

Stan­nard: I think it’s seen unhelp­ful­ly as being a last chance saloon. Par­tic­u­lar­ly, actu­al­ly by sec­ondary care spe­cial­ists, who will maybe oper­ate or car­ry out oth­er inter­ven­tions and then feel that when they’re a bit of attempt­ing to con­trol the patien­t’s symp­toms has­n’t worked, it is now pain clin­ic or bust. I think that’s maybe not a very help­ful framework.

Talk­ing to col­leagues in pri­ma­ry care, they would very much feel that we would pro­vide a use­ful input in help­ing patients under­stand and man­age their symp­toms, opti­mis­ing ther­a­py, maybe offer­ing oth­er inter­ven­tions, but then prepar­ing them to go back into pri­ma­ry care and move on with man­ag­ing their pain. So, we are not real­ly a last chance, we’re I think an impor­tant focus in help­ing draw strands togeth­er to sup­port opti­mal man­age­ment in the longer term.

If you look at the like­li­hood of a patient hav­ing per­sis­tent symp­toms, usu­al­ly most def­i­n­i­tions of chron­ic pain for research pur­pos­es would be a time-based def­i­n­i­tion, for exam­ple, a patient who’s had pain for 3 months or 6 months. But, actu­al­ly, the research sug­gests that’s the like­li­hood of symp­toms per­sist­ing is not just based on the inten­si­ty of symp­toms and not based on the dura­tion of symp­toms, but all sorts of things, like the degree to which the pain inter­rupts, the mean­ing of the pain to the patient and so on. So in a way some pains are chron­ic from a very ear­ly stage and I think if one can iden­ti­fy and recog­nise those groups, one can then give strate­gies for sup­port­ing self-man­age­ment in the longer term.

And I think in a more direct impact of us see­ing patients late is we’ll often see patients – and it’s a great frus­tra­tion – who will have got to the point where there’re about to lose their jobs, their ben­e­fits are threat­ened. They will have no salary and no income and actu­al­ly this is the start of doing a piece of work which should improve their qual­i­ty of life and maybe get them back into the work­place, but we come in at the time when it’s all almost – not too late, it’s nev­er too late – but it would be hope­ful for that patient if they did­n’t have the uncer­tain­ty of finan­cial dif­fi­cul­ties and so on, before they came here.

Evans: So, is this a fund­ing issue? Sure­ly mon­ey gained by the exche­quer by keep­ing some­body with chron­ic pain in reg­u­lar work could far out­weigh the cost of treatment?

Stan­nard: Absolute­ly, and I think this is big pic­ture stuff and I think this is where strate­gi­cal­ly, nation­al­ly, the pain com­mu­ni­ty are try­ing to make pol­i­cy­mak­ers under­stand that the eco­nom­ic bur­den of pain is heavy and com­plex. And I absolute­ly agree that to return some­body to tax­pay­er sta­tus very, very quick­ly recoups any spend I guess on pro­vid­ing health­care sup­port for that.

But we have to be real­is­tic in the envi­ron­ment we work with. And in our own ser­vice we are sub­ject, as are all oth­er ser­vices across the local area, to hav­ing to make effi­cien­cy sav­ings and the need to reduce spend by reduc­ing the num­ber of patients that come to sec­ondary care. It’s going to have an impact on us and on patients. And I guess the chal­lenge is to make the impact on patients of that type of ser­vice recon­fig­u­ra­tion, min­i­mal, and to sup­port inter­ven­tions, if you like, in pri­ma­ry care, which can give the patient the same sort of sup­port in mov­ing on with things as we would give here. And that should be pos­si­ble to do but it’s about think­ing about things in a dif­fer­ent way.

But I do very much agree that there needs to be, across social care, Depart­ment for Work and Pen­sions, all the sorts of impacts of some­body hav­ing, liv­ing with chron­ic pain on them and their car­ers and their fam­i­ly and their work… the finan­cial equa­tion is very com­pli­cat­ed. And I think we are a lit­tle bit ham­pered. We sus­pect strong­ly that bring­ing some­body to a pain ser­vice and help­ing them func­tion opti­mal­ly with their symp­toms would have those sorts of ben­e­fits in terms of get­ting peo­ple back to work or doing what they want to do, but we don’t have those finan­cial, if you like, cost effec­tive­ness data, I think because, because it’s quite a com­plex thing to work out.

So we can say that we think it’s a good idea but I think there’s a need to col­lect those data, there is a start being made on col­lect­ing those types of data on the cost effec­tive­ness of pain ser­vices, but we don’t have those data yet.


Ronn Watt: I’ve had pain for the last 25 years. You can’t allow it, for it to win, you’ve got to win, not the pain.

Evans: Ron Watt is a patient at the Pain Clin­ic at Bris­tol’s Fren­chay Hospital.

Watt: Pains are twofold: one of them is where I’ve had pain in all my joints and all of the mus­cles in the body. That is tied in with long stand­ing chest dis­ease which I have had, actu­al­ly, since childhood.

Evans: Twen­ty-five years is a long time to have pain. How has it impact­ed on your life?

Watt: Oh, I think a great deal. You’ll have to ask my wife that.

Mrs Watt: I think depres­sion as a result of not being able to do things because it hurts to do it, not hav­ing an answer, not hav­ing a treat­ment for this. It’s some­thing you’ve just got to learn to live with and that’s very hard, espe­cial­ly when you’ve worked with­in the NHS, as he did, and nobody can come up with any answers. So, it impacts on our lives, we tend not to go places, because he can’t, because he’s in too much pain. I tend to do a lot of the things on my own, like gar­den­ing and house­work because a) his chest dis­ease is such that he can­not do these things, but also the pain pre­vents him from doing it.

Evans: Those are the prac­ti­cal things that you can’t do, how does it impact on you mentally?

Mrs Watt: I get very angry and he knows that. And I also was a nurse, so there­fore I should know bet­ter. But I’m sor­ry, when you are at home, you’ve giv­en every­thing to the out­side world and when you are at home, sud­den­ly every­thing is annoy­ing and I get quite cross about it and he knows I do, unfor­tu­nate­ly. It’s very dif­fi­cult to hide. When you’ve banked on going some­where or you’ve been invit­ed some­where and you can’t go, because he’s just not fit to go.

Evans: How’s it impact­ed on you mentally?

Watt: Anger. I get it at myself, because I can­not do what I want to do, not at the out­side world. I think it’s very, very easy to ask your­self ‘Why me?’ And of course I always say ‘Why not? What makes you so special?’

Evans: Are there any positives?

Watt: Oh yes! Gosh, I’m alive, what more do you want?

Mrs Watt: No, there are pos­i­tives, on the good days we do every­thing togeth­er and there­fore we go out.

Watt: Yes, I have a wife. She is my best friend. Of course there are pos­i­tives. We have a nice house, we’ve got a nice car, nice fam­i­ly. Loads of pos­i­tives! And that’s what you always have to look for, you’ve got to look for those, because it’s very, very easy to think ‘Oh dear, why me?’ And you know, the glass is always half emp­ty – it is not it’s half full. It’s always gonna be like that.


How­dle: So you want me to try to it with one hand?

Glad­well: Well, when you’re ready, but I’m not quite sure you’re ready yet.

How­dle: No, I’m a bit wobbly.

Glad­well: Hmm, you are and if you prac­tise and the exer­cise gets too wob­bly, you don’t actu­al­ly get bet­ter at doing the exercise.

How­dle: No.

Glad­well: That’s one of the things about bal­ance exer­cis­es. That when you’re try­ing to build up your coor­di­na­tion, if you push your­self too much and try to wean off sup­port too much with your hands, the exer­cise just gets wobbly.

How­dle: I have been going upstairs more, you know. I think, ‘well, I’ll just go upstairs twice’, then I go up and down, but com­ing down, that is still a bit difficult.

Glad­well: Do you go down fac­ing for­wards or fac­ing the stairs?

How­dle: Yes, I go down fac­ing for­wards. Should I try doing it backwards?

Glad­well: Do you know about that version?

How­dle: No.

Glad­well: For some peo­ple, they will find it eas­i­er, it’s a very indi­vid­ual thing really.

How­dle: The only thing about that, I would be fright­ened of not putting my foot on the stairs.

Glad­well: Yes, that’s the trick. That, if that’s an issue, you’re bet­ter fac­ing forwards.

I can offer a range of things, but there are cer­tain things that I can’t do. So, in terms of man­ag­ing boom and bust, as we’ve talked about, that’s one of my areas. I can help peo­ple with exer­cise; I can help peo­ple with goal-set­ting; I can help them to man­age any dis­rup­tion to their sleep because of pain; I can help them to learn basic relax­ation tech­niques that help with mus­cle spasm and help with sleep; I can offer advice about mobil­i­ty aids; I can’t get rid of the pain for the vast major­i­ty of my patients and, of course, that’s what every­one wants.

How­dle: Pete if this is where I am, it’s dif­fi­cult. I would have to have you to help me, because I don’t think I dare do it. I can get you to there.

Glad­well: Ok. Could I ask you for a favour, could you turn the chair around a lit­tle bit? Some­times with exer­cise it’s about adapt­ing it and mak­ing it work in a way that works for you at your cur­rent lev­el. So that’s… now, I’ll just get you as you were with one hand on the table and this should, if you turn towards me, give you a space to step for­wards and back in, but well sup­port­ed. Do you get a sense of how this might help?

How­dle: Yes, I do because I can feel it. I can feel it in my back.

Glad­well: Well, good luck with those and we will catch up, it’ll prob­a­bly be in the New Year.

How­dle: Yes, right. Thank you, Pete.

Evans: My thanks to Mrs Mar­garet How­dle for let­ting me sit in on her con­sul­ta­tion with Pete Glad­well. I hope that some of the ques­tions you’ve put to us, con­sid­er­ing exer­cise, phys­io­ther­a­py and pain clin­ics have been answered in this pro­gramme from Fren­chay Hos­pi­tal in Bris­tol. And we’ll be vis­it­ing oth­er pain clin­ics around the UK in future pro­grammes. But in the mean­time if you want to put a ques­tion to our pan­el of experts, or just make a com­ment about the pro­gramme, then please do via our blog, mes­sage board, email, Face­book or Twitter.

In the next pro­gramme, we’ll be look­ing at work issue for those of us in pain. Is work good for us? And for those of us who are unem­ployed, how do we get back into the work­place when our con­di­tion might not make us the most attrac­tive prospect to a new employer.

But, until then…

Glad­well: Any­body lis­ten­ing to this will know that long term pain throws a span­ner in the works – it cre­ates chaos. And when some­body starts to get things tick­ing over again, that’s a good part of my job.

Mar­riot: One of the things that does give me a lot of plea­sure is the end of an acupunc­ture course. We’ve had quite a lot of patients that have con­sid­er­ably improved with their pain and it’s enabled them to move on and go back to work, do the things that we want them to be able to do after it. But I think the best thing about the job is being there for peo­ple – let­ting them know that we under­stand that they are in pain and are there to try and help them. A per­fect out­come I think here would be some­one who has pain which is tol­er­a­ble, which inter­rupts what they want to do to a min­i­mal degree, and that we would sup­port patients in under­stand­ing and man­ag­ing their pain, so that they could achieve the goals that they want to achieve.

How­dle: Well I’ve got to say that every­body at the pain clin­ic has been most help­ful – from Dr Stan­nard, to my acupunc­ture and to Pete, even the girls on the desk – they have been so help­ful. And it’s love­ly to see a kind word and a smile. It makes all the difference.

Watt: It’s very, very easy to think ‘Oh dear, why me?’ And you know, the glass is always half emp­ty. It is not, it’s half full. It’s always gonna be like that.


  • Dr Cathy Stan­nard, Pain Spe­cial­ist, Fren­chay Hos­pi­tal Pain Clin­ic, Bristol
  • Dr Pete Glad­well, Phys­io­ther­a­pist, Fren­chay Hos­pi­tal Pain Clin­ic, Bristol
  • Rose Mar­riot, Pain Nurse, Fren­chay Hos­pi­tal Pain Clin­ic, Bristol
  • Ron Watt and Mrs Watt, Patient and wife, Fren­chay Hos­pi­tal Pain Clin­ic, Bristol
  • Mrs Mar­garet How­dle, Patient, Fren­chay Hos­pi­tal Pain Clin­ic, Bristol.


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