Pain is a complex condition that is rarely solved simply by an operation or a course of pills. It often confounds conventional medical approaches and requires emotional as well as physical solutions.

Amputees can experience a range of pain symptoms; from Phantom Limb Pain (PLP) and associated pain in the back, neck and shoulders, to pain from their stumps and wounds. The feeling is rarely capped at the dictionary’s definition of ‘unpleasant’ and is more often enduring and corrosive.

Two clinics are pioneering a more holistic approach to dealing with pain; examining both the physical and psychological impacts, and devising tailored strategies to mute or dampen the jagged edges that can destabilise a patient no matter how successful their surgery and wound care might have been.

“We need a paradigm shift in how we think of pain. We are not going to be able to completely rid of someone's pain, but we can help people be people."

“Our role is to help people cope with intractable pain, which can be a problem for amputees. Broadly speaking, we look at the physical and emotional components of pain, discuss them and devise techniques to manage them,” says clinic boss Dominic Aldington, a pain specialist and consultant anaesthetist who served in the Royal Army Medical Corps for 24 years.

“It is very important that our help is holistic because pain is a holistic problem. It doesn’t just ‘hurt’; it can ruin a patient’s life and the lives of everyone around them,” Dominic adds. “We listen and work out what the problems are, as well as how big they are. It is a case of teasing out the emotional components; the anxiety and the worry. It is incredibly important to understand what pain does to us; how it makes us miserable, isolates us socially, stops us sleeping, and generally frustrates us. Those elements are not usually accounted for because when you see a doctor, they tend to go straight for the drug cabinet. But no drugs are going to address these issues completely and many veterans find it comforting that I have served and so have an understanding of what went before.

Dr Aldington established the pain clinic at Headley Court and now runs pain clinics for veterans at the Chelsea & Westminster Hospital and the King Edward VII Hospital in London. Both are free for veterans.

Twenty years of experience 

With more than 20 years of military experience, including postings to Northern Ireland, Kosovo and Iraq, he has a wealth of knowledge from having treated Service personnel across the full spectrum of pain. 

“Pain is defined as an unpleasant sensory and emotional experience that bothers us. It limits us and that is crushing. But, really, we don’t have enough words for pain,” Dominic says. “One of the problems for amputees is that everyone assumes there are attributable issues. Someone might be missing a leg but they could well get back and neck pain simply because of the changes to the way they walk or sit. We need a paradigm shift in how we think of pain. We have been taught to believe our drugs work, and if a patient leaves with a prescription for a painkiller they are initially happy. But remember the ‘Mars Bar Approach’; if the tablets don’t help you work, rest and play you probably shouldn’t be taking them.”

Dr Aldington, who is chairman of the Medical Advisory Committee for COBSEO and the Surgeon General’s Advisor of Veterans’ Health, believes a fundamental change in how we view pain is needed to promote better coping mechanisms.

It is never as simple as taking a pill 

“It is never just as simple as taking a pill,” he says. “Pain is a problem because the person in pain lets it become one, but that is a tough concept to embrace, particularly when the route we have always taken is that if there is pain, there must be a pill for it.

“Pain is very complex but there is usually something we can do at the clinic to help; it is the helping ‘you’ that is important. We are not going to be able to get rid of someone’s pain but we can help people be people. I think we’re bad at recognising the spiritual element – we should not be looking at pain as just physical.”

The Veterans’ Pain Clinics, which operate on a referral basis from a GP, consultant, charity, Regimental Association, or self-referral use a ‘pain inventory’ to assess the all-round impact of the pain, as well as a medication review and guidance to new pathways that can involve talking therapies, online courses and intensive five-day programmes on management techniques.

“The feedback from veterans has been good and if they are prepared to travel to London, it is clear their medication isn’t working and a fresh approach is needed,” says Dominic. “Outcomes are difficult to assess as I’m not there to reduce pain. I’m there to help people cope with pain better so that it becomes less of a problem. 

“I warn my patients that I don’t have the authority to tell them what to do. I tell them what the issues are and what solutions might work to allow them to deal with the pain better. We look at the impact someone’s pain has on the wider aspects of their life and then we form a plan. People with pain experience misery and frustration from not doing the things they want to – it is not necessarily the amount of ‘ouch’. If you could do twice as much with the same amount of ‘ouch’ then your life would be significantly improved. That is the change of thinking we need to work towards.”

Find out more

To find out more about the Veterans’ Pain Clinics visit www.kingedwardvii.co.uk/the-charity/veteranspain-clinic. You can contact the The King Edward VII Hospital clinic on 020 7467 4370 and The Chelsea & Westminster Hospital clinic on 07595 532042 or at martin@supportingwoundedveterans.com