>Hello,
>Most of you seem to be miles ahead of me in insight and command of language.
>Perhaps that's why I'm an anaesthetist (but there you are, at least I do know
>one big word!).
>
>I run a NHS Pain Clinic and since it is becoming more and more obvious that
>you can't cure pain by deadening nerves (except with cancer), 95% of my time
>in the clinic is spent grappling with people's narratives and trying to help
>them work out ways of understanding what the pain means in each case, and ways
>of coping with it and learning to enjoy life despite pain. I wish more GPs
>were
>like Nigel but mostly they expect that I will "fix" the patient in one
>session.
>
>
>My big steps forward were reading about Motivation Enhancement in
>"Psychological
>Approaches to Pain" by Gatchell and Turk, and joining the BSMDH (Br Soc of Med
>and Dental Hypnosis). John Launer's workshop (at the Cambridge meeting) on six
>hints beginning with C were the  best "nuggets" I brought away and am busy
>trying
>to incorporate those into my practice.
>
>When I've had psychologists sitting in with me in the clinic they all are
>amazed
>at how many patients I see who they think would benefit from cognitive
>behavioural
>input. What I'd like to learn is how to help the patient bridge the gap
>between
>a presentation with only physical symptoms on the agenda to an understanding
>that psychological factors are relevant without implying that "the pain's all
>in your head".

RESPONSE

Dear Judith,

I think this is a terribly important question -- and of course part of the
solution would lie in making "more GPs like Nigel" as you imply above  --
but it would be very helpful if you would describe for others what you've
already learnt about this in terms of eliciting and then "grappling with
people's narratives and trying to help them work out ways..". It sounds as
thoiugh you've already got a practice which it would be helpful for others
to hear in detail about.

The notion of 'pain narratives' and the notion of 'biographical narrative'
need to be related, perhaps. The origin of some of the pain and the
'meanings' of pain may lie earlier on in the biography of the individual
before the pain actually began. Have you found this at all, or anybody else?

By the way, 'cognitive behavioural' therapy might not always be the best,
since it does not always attend to emotional sources in the most sensitive
way possible. There is 'narrative therapy' and other approaches to a
holistic person-centred approach which a lot of pure psychologists are
unhappy and uncomfortable with.

Best wishes

Tom


END OF RESPONSE

 Then I could refer them to said psychologists and get stuck into
>reducing my 10 month waiting list.
>Judith


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Tom Wengraf
24a Princes Avenue
Muswell Hill
London N10 3LR
UK

(44)/(0) 20  8883 9297 / 8444-4322