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 pulsetoday.co.uk/nabi