Jane and Naomi’s back pain stories

Jane and Naomi were each referred by their GPs into the Primary Care Pain Service in Nuneaton and Bedworth Primary Care Network.

The pain service is delivered by specialist Health and Wellbeing Coaches working in conjunction with Physiotherapy Pain Practitioners. The coaches work individually with patients focussing on different aspect of the pain including activity, nutrition and interpretation and understanding of the individuals’ pain.

Following her work with the pain team, Jane said, “I would just like to thank you for all the help and motivation you have given me over the past few months. Your encouragement has given me the incentive to work with my GP to reduce my pain medication. Your help with nutrition advice has motivated me to lose a little weight each month which is down to a lifestyle change. I am so pleased that my quality of life has improved to such an extent that I am now walking and performing tasks that, before my treatment, I would never have attempted”.

Naomi had been suffering with pain in her back for 40 years, she had seen several different doctors and had numerous investigations; in 2020 she was told she had a bulging intervertebral disc.

Naomi had become very inactive and had badly disturbed sleep; if she walked anywhere, she had to have a break every 100 metres to recover. She wanted to start being more active, to use her exercise bike, to go out more in her car and take her grandson to the park.

Understanding the pain

Naomi had several beliefs about her pain and its causes that were unhelpful for her and had become barriers to her doing the things she wanted to do. To start with, the pain team discussed these beliefs and fears with Naomi, and she began to be more confident to move her back knowing that this would not cause any damage.

We were able to explain that the finding of a bulging intervertebral disc is a very common finding in adults aged over 40 years and in a majority of cases causes no pain and is not a serious finding.

Naomi said, “From the very beginning you changed my thought process by giving me the understanding and confidence to work through my pain” An important element of our approach is to work with patients to identify realistic, achievable goals. These are nearly always personal to the patients interests and vary widely between patients.

Naomi’s goals included “to walk more, get into the car easier, play with my grandchild”.

Naomi’s starting point for walking was that she could not manage a distance of more than 100 metres without having to stop for recovery. The Health and Wellbeing Coach taught her pacing techniques and reassured her that although she was experiencing pain, she was not damaging her back. Within a few weeks, she was walking further without the need for breaks and by the end of the programme Naomi had walked over 2 miles. In her words: “I recently went on a trip and without a car – walked 2 miles, I am now walking and performing tasks that, before my treatment, I would never have attempted”.

Our approach is to support patients with regular contact, but also to give them responsibility to make the necessary changes. Our overall aim is for patients to have an improved quality of life, greater independence, and to be in control of their pain rather than their pain controlling them. At the start of the programme, Naomi had a Patient Self Efficacy Questionnaire (PSEQ) score of 39 out of 60. Patients score themselves throughout the programme, with a rating of 0 (not at all confident) to 6 (completely confident) for a range of criteria.

By the end of week 6, Naomi’s score was 56, showing fantastic overall improvement in her wellbeing. At the end of the programme Naomi told us: “I am very happy so say my quality of life is better, I know that, with the tools you have given me, I will be able to sustain these new life changes.