Pain patients can only rejoice at the recent concept of pain clinics. They have largely overcome the major problem of pain being treated by the well-intentioned but tunnel-visioned approach by each medical specialist.
For example, Ted:
‘I had this awful pain across the bottom of my eye and down my nose. There’s a sizzling noise on top of my head and in the morning my left hand has pins and needles all over,’ said Ted, 66, who had been a foundry worker for 30 years.
Two years earlier, Ted had been referred to the pain clinic. He had been struck on the face by a bolt that had spun out from a galvanising machine like a high-speed missile. The bolt hit him in the face fracturing his cheek bone and causing severe lacerations. There was damage to the nerve just below the eye, leading to a neuralgia — or severe pain in the face due to damage of one of the main nerves to the face.
Consequent surgery had failed to remove the pain and in fact led to Ted suffering from severe depression which had been initially treated by his general practitioner.
‘Since the accident, I am very tense. I’m always fighting at home. I’m hard to put up with. The operation I had only helped in one way. Before the operation, my right nostril was always dry and blocked. But after the plastic surgeon operated on my face, my nose got better. But I still had the pain.’
Ted’s initial laceration had been sewn up and a plastic surgeon had confirmed there was nerve damage. But Ted’s pain was unremitting and he was totally incapable of coping with it. When Ted came to the pain clinic, he was very depressed because he had not worked for two years.
After examining him, it was decided to try a combination of medications because there was no suitable physical treatment. Also, he was too depressed to respond to psychological treatment. Ted was started on an anti-depressant, Surmontil, to control his pain and depression. He was also put on the anticonvulsant medication, Rivotril, to modify his experience of pain.
To his delight, Ted became pain-free on this combination. His depression stopped and he improved enough to get a job as a part-time cleaner in a school. This worked well until the school council decided that he had become too old and he was retired.
The pain team was also delighted with Ted’s progress at the clinic. The alternative suggested by insurance company doctors handling the Workers’ Compensation case, was that he should have had an alcohol block — carried out by injecting alcohol into the affected nerves causing the pain area to permanently block or damage the affected nerves.
Alternatively, he faced the more drastic step of severing the facial nerve causing the pain. This would have led to a permanent degree of numbness over the side of his face. The medical team argued strongly against this to the insurance company stating their belief that Ted’s personality change was also entirely secondary to his pain condition and, with proper medication and care, this personality change would be reversed.
By the time he finished at the pain clinic, he was a happy man. His marriage was back to normal and he had settled his claim for a very small amount of money. He was content to be rid of the pain and walk away from a nightmare episode in his life.
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