Foreword - Manage Your Pain: Practical and Positive Ways of Adapting to Chronic Pain - Michael K. Nicholas, Allan Molloy, Lee Beeston, Lois Tonkin

Manage Your Pain: Practical and Positive Ways of Adapting to Chronic Pain - Michael K. Nicholas, Allan Molloy, Lee Beeston, Lois Tonkin (2012)


The journey of those who suffer from chronic pain is long and often arduous. It starts innocently enough with a problem which seems just like any other, passes through a time of bewilderment, disbelief and disillusionment; visits desolate places of loneliness, anger and self-doubt, and even then seems to have no end. Sufferers’ struggling to come to terms with the reality of chronic pain know all too well the emptiest reaches of the human condition. Many such individuals talk of hitting ‘rock bottom’ at a time when they dare not admit to themselves that the doctors and medical systems in whom they had put such trust are apparently unable to help them. The rounds of consultations, the litany of explanations and the numerous worrisome treatments all take their toll, physically and emotionally. Sleeplessness and the side-effects of medications conspire to destroy concentration and add to the burden of fatigue. The inability to do things leads to stiffness and a decline in fitness. Inactivity leads to weight-gain which further dents fragile self-esteem. The chronic pain sufferer rightly wonders where it will all end.

How can it be, then, that I can recount hundreds of tales of people who have been down this awful road, but who have ultimately found a path out of the wasteland? Such people speak of a journey of self-discovery, which ultimately proved to be fulfilling because it provided them with an unbidden, but nevertheless ennobling, opportunity to learn more about themselves and the world in which they live. This journey has been described as the journey from patient to person, from avoidance to confrontation, from helplessness to control, from passive sufferer to active coper.

How have these voyagers managed this seemingly impossible turnaround? Have they found the miracle cure delivered by the all-knowing wise physician? Have they finally located the ‘last resort’ and had the winning operation? Alas! Not usually. They have, however, found their way through the desolation, by realising that the most important person on the road to recovery is the traveller him or herself. They have come to the painful recognition that if they are to get better they have to do this themselves. This realisation has not usually occurred in an instant; rather it has been a gradual awareness, like waking from a deep sleep. They have read and listened to other travellers who have made the successful journey, and perhaps been advised by those specialists in the field of chronic pain who appreciate where treatment is most fruitfully directed: giving people proper and detailed information and training in techniques to aid themselves best.

The acceptance that rescue from the all-knowing doctor is not going to occur and the dawning that they have to act themselves is perhaps the first step on the road to recovery. This is followed by the search for information about what this entails and how it is done. They ask friends and acquaintances, talk to their doctor, seek advice and surf the web. They start hearing about ‘pain management’ and at first find it a rather confusing notion. How can an illness that has stressed and taxed them to the ends of their sanity be managed? Besides the idea of improved management comes with the implication that up until this point in time they have been managing their problem badly. The truth is that many people do manage their pain less than optimally, but this should not imply fault or blame. If a person has never had a lesson they would not be expected to speak perfect French. They might have a few ideas but these could be improved considerably by a language course and practical instruction. It is clear that the ideas underpinning modern pain management techniques are now well proven and can dramatically alter the sufferer’s life for the better. What is more they can be taught by therapists and experts who are not themselves pain sufferers. Learning pain management skills can be achieved by attending a pain management programme or seeing an individual therapist, and such treatment may be required and recommended. For many people, however, an excellent starting point is a self-help manual such as this.

There are many such books on the market and for the expectant sufferer it can be difficult to make a choice. As a pain specialist who has been preaching the merits of interdisciplinary pain management for fifteen years, I can vouch that the search for a high quality comprehensive self-help manual stops here. I say this for a number of reasons.

Dr Michael Nicholas and colleagues are respected across the world for their knowledge and understanding of chronic pain and how it can be managed effectively. They run a comprehensive and excellent programme at the University of Sydney which achieves exceptional results and incorporates many effective and usable techniques. Their research has taught us much about the reasons why chronic pain develops and how it can best be treated. They have adapted the practical knowledge gleaned from their work with many hundreds of patients and distilled it into this book. The result is not a theoretical treatise but a usable handbook moulded by the real-life problems of pain sufferers. There is nothing quirky or alternative about the ideas in this volume: they are all based on the reality of everyday life. The pain sufferer who works through it logically and follows the recommendations will be able to reduce much of the fear and uncertainty that contributes so much to the distress and despair of chronic pain. They will find tips on returning to fitness and learn about pacing techniques. They will already know how easy it is to fall into traps of negative thinking, but here they will learn more about how such situations can be perpetuated unwittingly and how they can be challenged effectively by using cognitive techniques. They will find information about using relaxation techniques and tips on how to make a gradual return to meaningful and pleasurable pastimes.

We have to be realistic and accept that books such as this are not the only treatment that pain sufferers need. Were that the case, specialists like myself who run pain clinics could shut our doors and retire. However, the basic principles and ideas set out in this book are so important that they should be part of a treatment programme offered to all chronic pain sufferers. The road may still be a tough one and there may be pitfalls and diversions along the way, but the chapters in this volume serve as both map and guide-book for the persons lost in the wastelands of chronic pain.

The message is clear - there is life after chronic pain. The path out of the wilderness starts here.

Good luck!

Charles Pither FRCA
Medical Director
RealHealth Institute
London, UK

‘… but don’t wait for the light to appear at the end of the tunnel. Stride down there … and light the bloody thing yourself!’

Outback Sayings, Macmillan, 1996.