Interview CP10

Age at interview: 48

Brief Outline: Neck, back and elbow pain gradual onset since 1981. Surgery: Elbow surgery. Treatments: corticosteroid injections in elbows. Pain management: Out patient NHS pain management programme. Current medication: co-proxamol occasional use, tramadol for flare-up.

Background: Care home manager; single.

Was scared to exercise but on the pain management programme learnt how to gradually increase the...

Back to the Pain Management Clinic... Their programme of exercises I think again I pretty well knew what to do but I think I got myself into a cycle of progressively doing less and less, getting stiffer and stiffer and it was difficult to say which was, what was pain caused by an injury or whatever or what was stiffness, that any use was going to cause me pain. 

So I managed to get myself moving a bit more and I think an awful lot was caused by stiffness. And also that however much I rationalise to myself that exercise wouldn't hurt me, there was the belief there that it's going to hurt me. I think finding out in a safe environment that it didn't hurt me and it was actually beneficial was very good as well. 

They also spent quite a lot of time with me trying to persuade me to pace myself because if I take something on that I like to finish it, come what may, and I come from the sort of old school 'Oh anyway if it's a bit sore never mind get on with it' kind of thing. Which was all very well because I was getting on with it and then days on end I was paying for it, so he taught me to sort of do things in little bits and build up to things so again I think that was a very helpful discipline and to have people there. The group there and also the psychologist and the physiotherapists to sort of, if you like, chivvy me on was, was good and to sort of check things out, try things out and get back to them and they would adjust things so'

Had been frightened that she might re injure her arm so protected it but now knows that exercise...

You said that you, you tended to protect yourself when you had an injury?

Yes.

What were you worried about when you were protecting that?

It is the fear that it would get worse and then it becomes a habit. You clutch an arm and I find myself involuntarily doing it, it becomes as I say a habit. If my right arm's sore then I'll put my left one out and that carries on beyond when I should be doing that. 

There's really no reason why I'm going to further injure it or even if I have an injury while the use of it, it's necessarily going to make that any worse. In fact non use, again I know this rationally, makes things worse because it stiffens more than using it but nevertheless that's what I believe and what my habits are. So that's what happens with that...

Is that something that you've learnt on the pain management?

I knew it before but there's a difference between rationally knowing and being convinced, in actuality I think that pain management clearly helped me a lot in that this was an irrational thought and that movement in fact would be better for it than non-movement because it's just going to atrophy it if I leave it. 

Also I know from my experience that I'm going to strain the other side. I think probably why I have problems on the left hand side because I protected the right much longer than I should have done. Yes, the movement might have been painful with the right side but I think my gnawing worry was that I would injure it further, to what extent I don't know, but I don't think that figured in it. It was just that you know this is sore I'm going to protect this from getting any worse. So the way to do it is not to use it.

Is that something you've changed now?

Yes.

Has learnt to gradually increase the length of time that she can walk the dog.

Well I used to walk miles and miles with the dogs and it came that I couldn't and was not really walking them at all. I'd bundle them in the car. I was frightened of injuring myself again which might have happened, might not have done, odds were that it wouldn't have done, so I started out just doing 5 minutes with the dogs and building up from there. So that I could do that more often and now I can walk for much longer periods of time with the dogs. 

Another example is fairly allied to that, I was saying at any other time I wouldn't walk any more than 10 minutes before stopping. I thought well, I don't need that, I'm not that bad, but it turned out that yes I did need that, that sort of discipline because I was feeling my back sore and stiffening in my neck was sore, I worked on that. 

So again I'd sometimes forget, but it's useful when I do remember to just... I mean you don't have to be overt about pausing but you can pause for a little while and then carry on again and carry on for quite a long time. So I think there's two quite sort of useful ones that I learnt and I wasn't particularly keen to learn them in the first place.

Describes treatment by a chiropractor for a frozen shoulder, which she thought costly but money ...

When I had the frozen shoulder I went to the GP and he gave me painkillers, again he reckoned it was too sore at that stage and too inflamed to do much with it and I got the Voltarol plus Ranitidine to try and take some of the inflammation out and then he said to me 'It could take about 2 years to clear up' at which stage I thought this is ridiculous, there must be something I can do to better that. 

So I asked around and there was someone I knew who'd injured their back actually cleaning the bath and had gone to a chiropractor and I asked around and I found out about which chiropractor and whether they'd a reasonable reputation, that seemed to matter. 

So I went there just a few days after the doctor's visit and he took x-rays. I'm not sure I was terribly keen on the prospect of x-rays, but well it seemed necessary. He didn't seem to think he would find anything tremendously out of the ordinary but nevertheless to rule out any physical sort of problem that would be dealt with more appropriately some other way. And he found that as far as the right shoulder was concerned it was out of place, but no sort of discernible damage. That the base of my neck has rather more degeneration than usual for someone of my age and at the base of my spine also there was a bit more degeneration than he would have sort expected to find again for my age. Offended me thoroughly by saying that the state of the bottom of my neck was more consistent with somebody who's spent a lifetime boxing or playing rugger, neither of which I think were my preoccupations. 

But however had I had a whiplash injury and I wasn't aware of anything like that I mean it could well be I don't know. Then he, for the first week I went five days a week and he spent a few minutes very gently manipulating the shoulder back into place but very little and progressively managed to work it back into place over about two weeks. Dropped it down to four times, the following week and thereafter it was three times a week for a few months just tiny little adjustments to move things back into place and to get them to move more normally. 

Also got me a neck traction device, sort of wedge of foam with a tension sort of strap that goes across the forehead and pulls the neck back and stretches the neck out. Again that was quite difficult to use to start with, it's really quite painful and I could only stand a few minutes but I worked it up to 20 minutes a day and that made quite a difference in the way that my neck felt and it's actually quite soothing to use that so my neck feels sort of compacted and all sort of squashed down and to pull it back is actually quite soothing so... 

It was about 3-4 months when... or I went three times a week and then it went down to once a week after that. And then it went down to monthly, 5 weekly and that's just to check on things, or more frequently if I've got an acute injury again that I go more often and if anything is out of place he manipulates it back into place. He also suggested a series of exercises and to stretch the sort of... and to use the joints and so on. So that's, that's about the chiropractor.

Was the chiropractor... did you have to pay for that?

Oh yes, yes. It was fairly expensive but on the other hand he got the shoulder moving, he gave me rather more hope at that particular time. I got back to work so in the way of things I think it was money well spent. And nowadays it's not too expensive once a month, every five weeks and he discounts anyway for a lot of the appointments so it's nowhere near the cost of an individual appointment.

Talks about things that she does to make housework and cooking easier.

Things like housework are really quite hard and things like cleaning the bath, the natural inclination is to bend over and do it. Again its adjusting, maybe kneel down to do that but sometimes my knees won't bend properly so it just has to be left that day and lived with. 

It's probably not that filthy dirty anyway, but using the hoover has been quite difficult. It was suggested that I pull it backwards and that again, because if I push it forwards then my back turns very sore. But pulling it backwards for a little while, is easier for some reason it doesn't seem to strain so much and doing a bit at a time rather than the whole lot. I watch about, I can't lift or carry heavy things, I try to watch doing that and there are ways and means of splitting things into two or three loads rather than the one. 

I still forget on occasions and pay for it. Cooking again smaller quantities rather than big pans which I can't manage.

Says her employers and colleagues have been very supportive and she can adapt her routine to suit...

How about your employers of the care home. How did they react to your problems that you've had?

Oh, they were very supportive. I am very fortunate. The organisation I work for is an extremely supportive organisation, I work shifts and obviously in the one house which I particularly like working in I couldn't so, work there anymore because physically I couldn't do nightshifts and that was required because of the high needs of the clients, so they transferred me to another house where, as I say, the clients had high needs in other areas in terms of living their everyday life but it was advice. 

I physically didn't have to do anything very much which was just as well because at that stage I couldn't. The last few years I've got a managerial post and I really, I'm not employed as a support worker anymore but there are occasions when I have to when I don't have a staff but I can sustain the odd shift on duty but I can't go back on back to it so again, I think if that was too difficult and I was actually damaging myself I mean they are careful, I have had a bit of flare up at the moment, my line manager has asked if working was making that worse and if I said 'Yes', then they would no doubt look to offer me somewhere else. So I've found them very supportive.

How about your colleagues, the other people that you work with, have you found they have reacted to your pain?

Again, very supportive but I try not to make very much of it anyway. Some people, they know I have various problems, but I try and keep them to myself. Apart from that I manage the house it's not for the workers to have to carry me so they do though on occasions. 

So I'm very fortunate again because I can order my own day providing I put in 37 hours per week, I can order that pretty much as I wish. So again that's probably an ideal world to be in and if I want to get up and move around I can. 

If I feel too bad in the morning then I just stay at home and go in the afternoon. On occasions I have to, you know if I've got meetings or so on or something urgent to do. But apart from that I'm in a very lucky position.