Nick's Story
In the beginning...
I grew up in the North East of England in the 1980's at a time when work was scarce. Having taken a a look at my options and recognising there was little chance of finding long term employment close to home I decided that I would join the Royal Navy, something that I did in 1989.
As a commissioned Logistics Officer, I had enjoyed a career that took me all around the globe at a time when the cold war was coming to an end; I was lucky enough to serve in Hong Kong before the handover to the Chinese Government and served in several ships that deployed to both the Middle and the Far East. I was at sea during and after the Sep 11 event - something that saw the ship extend its stay in the Arabian Gulf from 3 to 7 months; I had also served in several other operational theatres including time on the ground in Iraq. Perhaps the best part of my career was the time spent working as part of several small teams in charge of large budgets, delivering real-time operational support to all the armed forces deployed around the world. In short, I was used to a very demanding, challenging and fast pace of life.
Then in 2008, getting ready to deploy again (this time to Afghanistan) I got injured, and life changed completely. Whilst working out on a cross trainer I managed to shred my inguinal ligament (in the left side of my pelvis) and at the same time damage the obturator nerve on my left hand side, again inside my pelvis. The military medical care that I received was excellent and the rehabilitation services (led by the Defence Medical Rehabilitation Service in Hedley Court) were also first class. However, and despite the best efforts of the military medical professionals, I was experiencing debilitating chronic pain that did not respond to any treatment.
As part of my military medical treatment I spent a great deal of time undertaking military rehab, all of which was excellent. However, when it became apparent that I had a chronic pain condition that was not responding to the interventions that had been tried, it fast became obvious that I was likely to be medically discharged. So, having been in the military medical system for some time and after 23 years in Royal Navy, a decision was made in Jun of 2012 that would lead to my medical discharge from the Armed Forces. As part of the discharge process I had enjoyed outstanding support from my last Medical Officer, who had a real understanding of the issues associated with chronic pain. Knowing that I was about to leave, he wrote a referral to the Royal National Hospital “The Min”, and I was lucky to get a place on the 4 week Residential Pain Management Programme that ran in Sep/Oct of 2013.
Coming from a culture where you were expected to keep going regardless of the situation, I did not see any need to change my behaviours toward the management of my pain. At first I continued to try to “manage myself” with large amounts of pain killers and just try to keep on going. As a result my pain became worse and worse, to the extent that I had stopped doing all the things that I had done in the past; I was not going out, socialising or doing any kind of activity other than “being in pain”. I avoided exercise and was living a very unfulfilling (and very painful!) life, where even the simplest tasks of daily living were not being completed. I would go for weeks without leaving the house and by the middle of 2013 I had also started to experience some other related symptoms, migraines, and episodes of “neurological dissociative symptoms”, something that has left me with a left sided weakness and tremor that is pronounced when I am anxious or tired. In short I was not really living, just existing and I had forgotten what I used to enjoy.
The bath bubble - the pain management programme
When I arrived I had no real idea of what to expect – my experience of military rehab had me wondering where we would go to work out, this type of rehab activity being generally focussed at improving physical measures, with a great deal of time in the gym and swimming pool. The Min however, turned out to be a completely different experience. Being placed in a small group of patients, all with their own chronic pain issues helped to start to find a new perspective on life. It was clear from day one that all those who took part in the programme had been living with pain issues for a long time, and that each of their lives had been significantly affected by their pain – often to the extent where even normal everyday tasks were challenging.
It was not easy. Having lived with something that I had almost completely internalised, having to talk openly and frankly about how I felt was not intuitive. I had to learn how to think in a new way in order to make sense of what was being said during the various sessions. This said, the way that we were guided through the programme was measured and individually targeted and fully supported by the pain team.
From a personal perspective I have learnt how to put my pain into the context of my everyday life – it will never go away, and until you embrace this thought it is very difficult to move forward. You must learn to undertake activity despite of your pain. Choosing how to spend your energy (I am constantly fatigued - pain and a fairly substantial drug regime do take their toll) is key to success as is developing a more measured approach to your pain.
The programme used several very powerful metaphors to describe pain, and the effect that it has on the way in which you live life or approach new situations. A great deal of time was spent talking about the way in which your emotions affect the decisions that you make, and this, combined with a great technique (Mindfulness) has allowed me to begin to more fully recalibrate the way that I approach my own feelings toward my pain. I do not think there was any group member who did not find the programme anything other than challenging. Having done some fairly difficult and challenging things in my former career, this was by far the most mentally and emotionally difficult thing that I have ever done. I found talking about how I really felt very distressing and it took some time for me to want to share my thoughts and emotions. However, it was not until I did this that I felt a sense of relief and, that I have begun to undertake more activity that is important to both me and my family.
One of the hardest things to have to change was the way I approached activity, having been immersed in a military culture where you do more by doing more, it has taken a great deal of mental discipline to learn to slow down to a sustainable pace of life – even if this feels sedentary. I have always had a love hate relationship with exercise and using the gym; I probably did not go as regularly as I should, (and probably still don’t!), but having now changed my approach to physical activity, I now accept that doing regular controlled exercise is better than shorts bursts of vigorous activity – I no longer look to push myself to my limits as this has a detrimental effect on my health and wellbeing and I can recognise when I am starting to return to old habits. As a result a more sustainable pace of life is emerging. Developing a better understanding of my relationship with my pain has also been a challenge, and I think one of the most important things that I took away from my course was the ability to understand the relationship between how my body feels and how to use this to make decisions to better manage my daily life.
All this said, it is very much an iterative process and I have learnt to become more flexible in the way in which I approach activity, and as a result my wellbeing and family life have improved. That said I still struggle to manage everyday tasks and have come to see that I must take things almost on a day by day basis. I still have debilitating episodes but have come to accept this as normal and while very unpleasant can work around them and still have some quality of life.
I would also recommend that anyone who attends does take advantage of the facility to allow partners or carers or any other significant others to attend some of the sessions. My wife came to four of the days and she has also learnt some new skills. Managing pain is about being open and honest about how you feel. While it was difficult at first – a greater understanding of how my issues can affect our daily lives has allowed us to make some positive changes to our daily routines. I would not profess to get it right all the time, but her understanding of the way I now approach my condition, is I think, one of the key factors to being successful with my pain management in the long term.
For those of you who have concerns about the programme, I would say that it is delivered in a compassionate, caring environment, where you are supported by excellent professionals. Without exception the team were excellent, they provided the right level of support when it was needed, as well as the right amount of encouragement and motivation to allow you to finish, what can be very emotional and reflective 4 weeks. The journey to discovering the new “Nick Richardson” is still on-going and it has taken some time to adjust to life with a condition that will be with me for the rest of my life. In many ways I am still unsure as to what the future holds, but I would like to think that I am now starting to do more of the things that are important to me and as a result improving my quality of life. This has a direct effect on those around me, who have their own things to worry about. One of the best things that the Min has done has allowed me to regain some of my former self. After several difficult years, both my children have said that Christmas 2013 was one of the best yet – Dad was up and about and able to have Christmas Dinner, I would not have achieved this without help from the team at the Min.