Arthritis, bad back, migraine... How you CAN BEAT PAIN
Unmissable series starts today
DR HELENA MIRANDA has had sciatica in her right hip and leg for the past ten years; she’s a lifelong migraine sufferer, has arthritis in her left knee and neuropathy (nerve damage) in both of her feet.
Aged 51, and a single mother to two teenage boys, Dr Miranda has also been working in pain research since 1999, but she says a Damascene moment came during a therapy session six years ago when she realised she, too, was a chronic pain sufferer.
‘I’d had sciatic pain for many years, but I was working like crazy so I ignored it,’ she says. She took daily doses of ibuprofen, paracetamol and occasionally, codeine, with little effect.
And like Dr Miranda, between a third and half of us live with daily pain — it’s the most common reason people see their GPs — yet it is frustratingly difficult to treat.
Indeed, doctors have turned to opioids such as morphine and codeine — highly addictive painkillers that are useful in acute pain, but which have little effect on chronic pain (defined as lasting longer than three months).
A review published in the British Medical Journal in 2013 revealed that opioids are ineffective in 90 per cent of cases of the most common kinds of chronic pain, yet prescriptions rose by 20 per cent to 1.7 million a year between 2009 and 2017, raising concerns about over-medication with drugs that are not only addictive, but can also cause crippling withdrawal symptoms and side-effects.
After years of struggling with chronic pain, Dr Miranda vividly remembers a lightbulb moment in 2007 when she came across a brain imaging study that showed volunteers who’d received exactly the same pain stimulus to the same part of the body displayed a completely different reaction in the brain and reported a huge variation in the intensity of pain, because each person’s brain interpreted the signals differently.
And, she says, she’s now managing her pain well thanks to a series of pain-easing techniques she has learned through her research. These techniques are set out in her new book, Living Well Despite Pain, which will be serialised next week in the Irish Daily Mail as part of our month-long Good Health For Life series.
The strategies offer hope for those who struggle with chronic pain that medicine has failed to ease: while there’s no ‘miracle cure’, Dr Miranda offers tips that, when combined, can significantly reduce it.
There are 18 of these strategies — all of which she has personally tested — that form what she calls a varied toolkit for good pain management.
HER message is one of empowerment. ‘You are born with an inbuilt ability to make yourself feel better,’ she says. ‘It’s important to remember that you haven’t lost this ability, despite suffering from long-term pain.’
Central to her approach is the concept that all pain is real — even if doctors can’t find an obvious physical cause, but wherever it’s felt, it’s actually experienced in the brain. Mood, quality of sleep, and stress levels, as well as longterm pain itself, all have an effect on our nervous system and on our perception of pain — as do our childhood experiences.
Her ‘tools’ (including pet therapy) help by stimulating the body’s own pain-relieving systems. If there is anyone who understands the mechanism of pain and its mysteries it is Dr Miranda.
A physician and pain researcher at the Finnish Institute of Occupational Health in Helsinki, she has spent the past 20 years trawling every last piece of research on the subject while living with almost constant pain herself.
In the book, she brings together for the first time information from more than 400 research papers, and talks about strategies that have helped her. But she agonised for a long time before deciding to share her own story.
‘Doctors do not normally reveal their personal lives to patients,’ she tells me in her home town of Helsinki, Finland, where she has a private GP practice.
‘I worried that it might reduce my credibility as a pain professional. But, actually, I want to show people that this process takes time.
‘You will go through the same emotions I have: from denial to sorrow and anger and, finally, acceptance. For me, it has meant getting re-acquainted with the competent, courageous person within me, before pain began to gain ground.’
Thanks to her practical strategies, which include walking in the countryside, swimming, baths and saunas, as well as reducing her massive work load, she says she now enjoys prolonged periods when pain doesn’t hinder her life.
As well as the significant improvements in her own life, she’s seen ‘hugely rewarding’ changes in her patients, who have used her strategies. ‘After a few months, they become less frustrated, defensive and afraid,’ she says. ‘They become calmer, braver, more active, more self-efficient and take more control over their own lives.’
She’s clear that medication will always have a place in chronic pain management alongside her strategies. ‘I could not survive without migraine medicine,’ she says.
‘Tricyclic antidepressants [a form of antidepressant also used to treat chronic pain] increase the
pain threshold and help patients sleep better. I occasionally use one of those myself.’
But she believes a pain revolution that ‘will bring understanding, comfort, hope, and courage to people who live with pain’ has started.
At the heart of this revolution is the twin notion that all pain is experienced in the brain and that chronic pain alters the brain’s structures.
‘Doctors are beginning to understand that pain is not the same thing as tissue damage, and that chronic pain is not necessarily a result of nerve damage,’ she says.
‘The central nervous system’s own pain-control system releases pain-relieving chemicals which block pain signals before they reach the brain. It’s this system which is damaged in some people. They feel pain, but it’s not coming from damaged tissue; it’s happening because the
body’s natural brake system isn’t working.’
After her light-bulb moment in 2007, Dr Miranda spent four years learning everything she could about how the brain interprets pain and what we can do to affect that. Then she was desperate to start treating patients again.
‘I naively assumed this knowledge had spread to clinical practice,’ she says.
But when she began a job as a doctor with a major bank, she was horrified to discover that nothing had changed, other than that opioids were being prescribed even more than before.
‘That was the moment when developing practical pain management and educating patients and professionals about pain became my mission,’ she says. Her ‘tools’ aim to switch on the body’s own pain-relief system.
THIS is a bundle-of-care approach — each step on its own will make only a small change, but combined the impact can be significant. ‘I’m not saying if you do yoga you’ll see 70 per cent reduction in your pain, but you might get 5 per cent,’ she says.
‘If you play your favourite music, you may get another 5 per cent. But by combining the methods that work for you, you’ll reduce your pain to a level where you are enjoying your life again.
‘It’s likely the pain will still be present in some form, but the less you strive to be completely painfree, the better you will manage your pain. It’s about making peace with the pain and rebuilding your life. We can do that by teaching the brain to feel safe rather than be on high alert.’
As part of her approach, she asks patients about their experiences as children. Was their childhood happy? Did they have headaches or growing pains. Did their parents suffer from pain?
‘We have to recognise that these events have an effect on the way the nervous system develops and processes pain,’ she says.
‘For many people, acknowledging this is a relief. They’ve had doctor after doctor unable to find a reason for their symptoms, and they’ve begun to wonder if they’re going crazy.
‘We know from long-term studies that neglect and abuse affects the way a child’s nervous system develops, and these children often develop chronic pain symptoms as adults.
‘But there may be other triggers: a serious car accident, a traumatic divorce, the breakdown of a relationship, which can all contribute to the nervous system becoming sensitised.’
Dr Miranda’s own childhood was difficult: ‘My mother was very demanding and my father was an alcoholic — we were fed and clothed, but I never felt loved or heard,’ she says.
She pushed herself hard at medical school, partly to achieve acceptance from her mother, who she says remained indifferent to her daughter’s success.
‘I have recognition, acceptance and reward from my work, and I worked hard to get it,’ she says.
It helps, too, that her patients are living better lives as a result of her patience and empathy. But she has not found it as easy to embrace her own message.
‘It’s still a struggle,’ she admits. ‘It’s a lifetime challenge for me to talk nicely to myself and respect myself — not for my achievements, but for who I am. Many pain sufferers take care of everyone else, but themselves.’
Does she think she would have been such a good pain doctor if she hadn’t suffered from pain herself? ‘I think you can be a good gynaecologist if you’re a man. Or a great paediatrician if you don’t have kids. So, of course, you can be a good pain doctor if you don’t have chronic pain, but for me it’s a bonus because I can go inside a patient’s head.
‘I know what it feels like when you’re in agony and a doctor just tells you to lose 30kg.’
She has personal regrets. She wishes she’d treated patients kindly and holistically more often. ‘I told a nurse with a grossly swollen knee that she wouldn’t be able to kneel again. That kind of negativity is damaging.’
For Dr Miranda, even conducting a long interview can be tiring. ‘After this I will get a headache,’ she says. ‘But getting enough sleep, avoiding alcohol and taking nutritional supplements — coenzyme-Q10, vitamin C and magnesium — mean that they happen far less often.’ She has long ago let go of the thought that she might experience a painfree day herself.
She describes a pot in her head filled with pain, frustration, tiredness and anxiety, an image that will resonate with other pain sufferers: ‘Sometimes you have to add only one more thing and the pot spills over. But acupuncture, a bath and sauna, walking my dog, being held by another person, all make the pot bigger.’
I ask her what is the single thing that pain patients can do to help themselves.
‘I’m going to sound traditional,’ she says. ‘But it’s moving. Move your body without fear and, especially, with pleasure.
‘Do things you love. If you hate swimming, don’t do it! Close the curtains, put on your favourite music and dance. The key issue is to make things you love a priority, because when you suffer from chronic pain, you lose the ability to feel joy.’