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GPs go forth

Comfortably numb

Dr Shaba Nabi

Most pain is probably sending us a message. If I accidentally put my hand on the kitchen stove, the burning makes me pull away. Similarly, if I have been hunched over my laptop for too long, my back pain lets me know I need to get up and walk around for a while. So why, as a society, do we want to expunge all pain and aim for a sanitised existence that is comfortably numb but potentially worse for our health?

In a bid to tackle this tendency and its consequences, Public Health England is due to publish its review of the evidence surrounding prescription drug dependence this summer. No doubt this will be another stick to beat GPs with, even though much of this prescribing comes from postoperative admissions, psychiatric services and pain clinics.

But I can tell PHE right now what the root cause of this problem is: that we still view physical and mental health as separate entities, rather than integrating them and treating people holistically. Conventional drug-dependence clinics, accustomed to treating people with heroin addiction, are out of their depth when faced with someone who has a background of chronic physical pain. And single-disease super-specialists have little training in psychiatry or drug dependence.

And herein lies the irony. General practice is the only specialty that incorporates both physical and mental health in its training programme, but there are not enough of us and we are expected to achieve the impossible within 10 minutes.

Until we have timely psychology, physiotherapy and social support, the only option is to prescribe drugs that might become addictive

Yet even if we were to suspend reality for a minute and enter a world where highly skilled GPs had the time to take a biopsychosocial approach to pain, there would still be problems. Until we have timely psychology, physiotherapy and social support, the only option is to prescribe drugs that might become addictive.

It is for this reason that GPs fear the consequences of refusing requests for these medications; they are anxious about patient complaints in a landscape where there is nothing else on offer. So, investment in physical and mental health training isn’t the only solution; we need consistent support services and social prescribing.

The horrors of prescription drug dependence are well articulated in Cathryn Kemp’s memoir Coming Clean: Diary of a Painkiller Addict. This book gave me a deeper understanding of the connection between mind and body, and how the two need to be addressed simultaneously.

Ultimately the message is that we cannot hide from persistent pain but must adapt to it, learn from it and grow with it. This is one of the key components of the excellent online resource Live Well With Pain, to which I often direct patients.

Finally, I will leave you with a quote from Kahlil Gibran’s collection of essays, The Prophet: ‘Your pain is the breaking of the shell that encloses your understanding.’

Dr Shaba Nabi is a GP trainer in Bristol. Read more of Dr Nabi’s blogs online at

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Readers' comments (6)

  • Cobblers

    I think you have missed a trick Shaba. I agree with your comments on the physical and mental side of things but there is the spiritual as well.

    I note with extreme distaste that those who profess to care about doctors and patients (the GMC) are teeing up a second Fitness To Practice procedure on Dr Richard Scott. You may recall in 2012 when he was cautioned for using his Christian beliefs to help troubled souls.

    That Richard uses his faith to try and heal people is unremarkable and should be encouraged. I speak as an atheist in this matter. It has long been a truism that Vicars or Imams could do a lot of the work in practice that sees troubled souls. Even the WHO agrees. If the patient is willing why not use every avenue to try and heal (all in 10 minutes)?

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  • David Banner

    Excellent article (as always).

    There is a current vogue for discharging surgical patients with a bottle of oramorph and an expectation from these punters for more from their GP.
    This oramorph madness has spread to A&E discharges, especially for unexplained abdominal pain.
    Even children are being sent home on tramadol, codeine et al.
    And don’t get us started on Pain Clinics, who have given up any meaningful intervention, just a cheery note to titrate up the opiates and pregabalin, and goodbye.

    This breathtaking nihilism from secondary care is crushing our King Canute efforts to stem the tide of analgesic pharmageddon. Sadly there will have to be many more avoidable deaths (and sued GPs) before any meaningful action is taken.

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  • ‘Your pain is the breaking of the shell that encloses your understanding.’

    Well said ! Totally agree ! Excellent article !

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  • "Your pain is the breaking of the shell that encloses your understanding".

    I said that to a patient the other day and within a day I got a complaint.However, they did have multiple liver mets.

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  • key phrase here is 'suspend reality'. GPs go into battle with bows and arrows against crack troops. NHS General Practice is a failed model. (and I totally agree with David B re opiates)

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  • Agreed it is about to go... BoJo said he would sort the 3 week wait to see a GP by investing in new hospital departments.

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