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Tacking the ‘untapped frontier’ of chronic pain

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Dr Deepak Ravindran

By writing a book on how to deal with chronic pain, Dr Deepak Ravindran aims to help medical professionals and patients alike to better understand the issue.

A consultant is building on his experience of supporting people with pain by writing a book which will help others to develop a mindset to understand and overcome the issue.

Dr Deepak Ravindran has written The Pain Free Mindset, which brings together the experience and expertise of his 20 years working in the specialist field to increase understanding of chronic pain among patients and medical professionals alike.

Through developing a new mindset, says Dr Ravindran – which can help form a new perception and response to pain – a revised approach can be adopted which can potentially remove the need for medication or surgery.

Using the mindset acronym, Dr Ravindran demonstrates a range of areas in which positive change can be effected:

  • Medication – how to use it safely
  • Interventions – how to discuss with your doctor or surgeon
  • Neuroscience – how to better manage stress
  • Diet – what can be included in an anti-inflammatory diet
  • Sleep – the relationship between sleep and pain
  • Exercise – its impact on the brain and role in pain control
  • Therapies – what mind/body therapies are available.

Statistics help to show the impact of chronic pain in the UK, with up to 40 per cent of the population – around 28 million people – experiencing pain from conditions including fibromyalgia, nerve damage, arthritis and headache and migraine. It is also a symptom of Long COVID, more recent developments have established.

But rather than continual medical interventions, supporting people to take control of their chronic pain can secure better and longer-lasting outcomes, says Dr Ravindran.

“Pain is not always the indication or harm we have been led to believe. Pain is our body recognising the need to protect us, but there are options on other ways to react to it other than becoming over-medical and over-anxious,” says Dr Ravindran, a consultant in pain, anaesthesia, musculoskeletal and lifestyle medicine at the Royal Berkshire NHS Foundation Trust.

“Nociception occurs when chemicals are produced through injury, but when that is not present, then it could be that medical intervention is not useful. That’s when we see the overuse of surgery and overuse of drugs.

“Through this book, I wanted to bring out the complexity of pain but at the same time show that there is hope. There are so many ways of managing it, but it remains an untapped frontier for so many people.”

As well as the self-help aspect of the book, Dr Ravindran – who is lead for the Berkshire Long covid Integrated Service (BLIS) – also wants to tackle the gap in knowledge of medical professionals when it comes to chronic pain.

“In the five or six years doctors spend training, pain teaching can account for about 10 hours of that,” says Dr Ravindran, who completed a pain Fellowship at University College London.

“Both pain and nutrition are not taught well in medical schools, and I would suspect it is the same with other medical professions. There are a whole host of medical professionals who still have the same thinking and beliefs as in the 1980s and 90s.

“I’m an anaesthetist and I’d say 99 per cent of pain consultants come from that background. We do a lot of pain relief through epidurals in labour, nerve blocks in surgery, so it forms a big part of our work and interest. Beyond that, there are not many.

“I continue to see people coming to my pain clinic who have been sent by their GP or surgeon, and have been given advice or medication because they don’t know any better. Before I began my work in pain, I may have been in the same situation.

“But from my book, I want to help to change this. A new approach and mindset can be so important for people who have pain, as well as the medical professionals. This is a complex area, but one in which we can all benefit from greater understanding.”

  • The Pain Free Mindset is published on March 4. It is available for pre-order now at Amazon.

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New company launched to drive forward Parkinson’s research

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Up to £800,000 will be invested over the next two years

Charity Parkinson’s UK is to launch a new company dedicated to driving forward research into Parkinson’s disease.

Vivifi Biotech has been created to lead and plan preparations for a new trial into the role of the restorative protein glial cell-derived neurotrophic factor (GDNF) in Parkinson’s.

Launched through the charity’s drug development arm, Parkinson’s Virtual Biotech, up to £800,000 will be invested over the next two years as efforts continue to find a life-changing new treatment for people living with the disease.

Plans for a new trial build on the initial groundbreaking clinical investigations in GDNF, the results of which proved inconclusive but did show some signs that the treatment may have started to regenerate participants’ dopamine-producing brain cells.

“The unwavering passion and determination of the GDNF participant group has ensured that the potential of GDNF, and the role of patients in research, has never been forgotten,” says Paul Jackson Clark, director of engagement at Parkinson’s UK.

“They’ve tirelessly campaigned, fundraised and shared their experience with us, enabling us all to get to this monumental point.

“We now have the chance to see if we can find a life-changing new treatment that people with Parkinson’s desperately need. There are still plenty of obstacles but this announcement gives us the opportunity to move things forward together.”

Parkinson’s UK was the major funder of the initial trial, which investigated whether boosting levels of GDNF could slow, stop or reverse the progression of Parkinson’s.

Tom Phipps was a participant in the GDNF trial.

“My outcome was as positive as I could have wished for, I feel the trial brought me some time and has delayed the progress of my condition,” he says.

“The trial participants have always believed in GDNF’s potential,” said Parkinson’s UK in their announcement.

“So have we and the other organisations involved in the trial.

“Some participants tell us they’re still experiencing the benefits, years on from undergoing this experimental therapy. We’ve been working with them since the end of the trial.

“Together, we want to make sure we’ve explored every option.”

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Community rehab

Music group launched to support BAME community

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Leicester Musical Memory Box is launching its online music project Geet Sangeet

A music group established to support people living with dementia, memory loss and brain injury has received funding to launch an online project for the South Asian and BAME community.

Leicester Musical Memory Box (LMMBox) was founded in July 2018, and since that time has grown from one group in the city to six, providing interactive music sessions for people of all ages and backgrounds, including a group specific to the South Asian community.

The group – which has two staff members who are fluent in Gujarati, Hindi, Punjabi and Urdu – aims to provide the local community with a supportive network and a safe space to explore the unique challenges that a brain injury may bring to individuals, as well as their families and carers.

The new online music project is named ‘Geet Sangeet’ – translated as ‘Songs Sung Together’ – and will incorporate music and cultural references specific to the South Asian community, led by group leader Beena Masand from LMMBox.

Each session will begin with gentle exercises to warm up the body and brain, followed by singing and discussion about various music, songs, and media.

Attendees will also receive their own ‘musical memory box’ in a bag to help increase the interactivity of the sessions.

The project has received funding from the new Local Connections Fund, and is in collaboration with Headway Leicester.

Music has proven benefits for people with memory problems or a brain injury, including enabling people to connect with past experience and enabling freedom of expression, confidence and independence.

Attendance at the groups also helps to improve mood and reduce feelings of social isolation.

“We know we are providing a vital service to our members and receive enquiries regularly,” says Kyle Newman, group leader and co-director of LMMBox.

“In spite of the lockdown, we are thrilled to be able to once again provide a culturally specific group for the South Asian community.

“We also know that the group leader needs to come from that community and have the music and cultural knowledge to be able to engage participants effectively.”

“We are delighted to collaborate with LMMBox and reach out to more people across Leicester who have been affected by brain injury,” adds Mary Goulty, service manager at Headway Leicester.

“There is a clear need for a support service within the BAME community and that’s why we launched our BAME group last year, which is providing a vital lifeline to brain injury survivors we support and their families.”

To contact LMMBox, visit www.leicestermusicalmemorybox.co.uk

For support with brain injury in the Leicester community, visit www.headwayleicester.org.uk.

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Art Therapy offers an emotional outlet for those living with a Traumatic Brain Injury (TBI)

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Masks not only allow us to hide our true feelings but to also express them without fear of judgement.

Being able to ‘hide’ one’s true self, may be a way, for others, to truly ‘show’ themselves.

For this reason, Chroma therapists began delivering Art Therapy sessions online to those living with a Traumatic Brain Injury (TBI) in an attempt to help them express their emotions in a creative, non-threatening way.

A TBI can have devastating effects upon a person’s mental health, as well as physical, with emotional issues caused by significant, sudden changes in appearance and abilities.

Studies have found Art Therapy to be effective in helping TBI patients with emotional expression, socialisation, emotional adaptation to mental and physical disabilities, and communication in a creative and non-threatening way.1

Self-expression is fundamental in processing the effects of a TBI. Take a look at the image below.

On the left is the base mask. During the process of art therapy, across a number of sessions, the participant talks, reflects and begins to create ideas or metaphors which then get placed onto the base mask. Often this depicts the face he presents to the outside world, in contrast with the dual parts of to his inner personality including a bright peaceful side and a dark, tumultuous side.

Based on the sessions, Chroma therapists are better able to gauge the patient’s feelings, discuss the final piece and help the patient begin to process their emotions.

In effect, art therapy offers a creative gateway to communication and used in this way, tries to enable the participant to externalise their inner thoughts and feelings.

As a therapy, it has been shown to help reduce feelings of stress, promote creativity and imagination as well as increase self-expression, confidence and communication.

Chroma began delivering these sessions as a way to allow clients to reveal thoughts and feelings about themselves which they may find hard to express, or may not even be aware of, and which may be being expressed through more difficult behaviours.

They also create an opportunity for greater communication, allowing therapists to gain a deeper understanding of the client’s thoughts, anxieties and feelings.

Being able to express themselves creatively helps the client reveal their true feelings, which in itself can be cathartic – a relief to release their emotions, in a personal, safe space.

Chroma continues to deliver these sessions online to help reach as many TBI sufferers across the UK as possible in an attempt to help them begin to process their emotions concerning the effects the TBI had upon them, with the outlook to help improve their mental wellbeing which in turn will help promote a positive outlook to life and rehabilitation outcomes.

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