“Of pain you could wish only one thing: that it should stop. Nothing in the world was so bad as physical pain. In the face of pain there are no heroes.”
― George Orwell, 1984
This post is about the complexity of pain and the observation that the doctors used by police pension authorities are not able to comprehend how the world of a previously fit and high-achieving police officer collapses once they are injured on duty. It shows that the consultants, GPs and clinicians of the former officer -who know of and have treated the individual – heavily out-guns the opinion of any given selected medical practitioner.
You haven’t had any contact with the police for years and now they want to reduce their financial commitment by reviewing your injury award . There has been no change, in fact you’re worse now than ever. You just want to be left alone to live your life. Or you are a serving officer struggling on long term sick leave and currently the victim of an UPP.
How can an occupation health doctor make a valid judgement on your health in a 60 minute ‘interrogation’ – don’t fool yourself into thinking it is anything but an inquisition: imagine Tomás de Torquemada assisted by the full incompetence of a HR department.
An injury on duty can involve both body and mind and quite likely both. A physical injury has psychological consequences. PTSD (Post Traumatic Stress Disorder), is caused when a person experiences an ordeal that causes physical harm or mental harm. The individual was either harmed, someone close to them was harmed, or they experienced events that was imprinted in their brains. In PTSD, there are two main parts of the brain that are affected and also where all the chemical imbalance in the disorder is located at. The two main parts are the Hippocampus and the amygdala.
The hippocampus is a part of the brain that is located inside one of the folds of the brain so it is not identifiable by the human eye but the way we can find it is that it is located at the temporal lobe which lies right under the temple of the human body. An important function that the hippocampus does is that it makes information into memory and stores it in the brain. So, for example, someone experiences a traumatic event in their life and they can’t forget about it even though they try really hard to. The hippocampus has taken this traumatic event that this person has and stored it in their brain as a memory which explains how PTSD works. This part of the brain can also send connections to the amygdala which then could explain the beginning of strong emotions triggered by specific memories or events. But it is not just for making memories. It also plays a huge roll in the making of creating new brain cells for the brain. The hippocampus may look intimidating but it can be affected very easily. Alzheimer’s Disease, Epilepsy, and little blood flow are just some of the injuries the hippocampus could have.
The other big part of PTSD is the amygdala. Like the hippocampus, it is also part of the limbic system and is also inside the brain just above the hippocampus and the lateral ventricle. This is the epicenter of emotional behavior, emotions, and also motivation. A lot of signals from the other brain parts go to the amygdala because it then makes those signals into emotion. The amygdala can produce components of emotion such as heart rate changes, blood pressure changes, and also respiration changes in the body. While the hippocampus makes memory, the amygdala takes those memories and combine them with emotion which could explain why certain memories produce certain emotions for us such as happiness and fear. This is where the “fight-or-flight” mechanism comes into play. Since so many alarm circuits of the human body are located in the amygdala, there is a lot of triggers that can activate the “fight-or-flight” response.
Sufferers of PTSD are prone to chronic pain and sufferers of the chronic pain of debilitating physical injuries are liable to suffer from PTSD-like chemical imbalances.
The author of this post has a physical injury that has also manifested itself psychologically. Chronic pain does that. A life not lived; a career cut short. Over time, to treat the condition, nociceptive prescription pain medication is supplemented with neuropathic medication. But we are still dragged in front of a SMP and demanded to explain ourselves. Questioned in a hour window on why we are no longer the high achievers we once were.
This video gives an interesting insight into pain but reveals a terrible dilemma. We are all individuals,and as IODs, all our circumstances are different. Herein lies one of the complexities that makes understanding and treating chronic pain so difficult.
Professor Lorimer has the advantage of being on the top of his game. He has a successful career in clinical Neurosciences. His lecture is factually correct. Experience doesn’t always match the explanation.
For the individual chronic pain is a reinforcing web of pain signals, personal history, seeking security in what you know (pain) and limited ability to envisage a future. It is life consuming and this is why the Regulations are there to compensate for work-related injuries.
SMPs are not equipped to understand how the brain creates and perpetuates pain. They will always fail to make a valid judgement on your health in an allotted 60 minutes. For this reason if you are ever unfortunate to go in front of a SMP, for whatever reason, go prepared. Make them understand the complexity of your illness.
2 thoughts on “Why Things Hurt”
Our brains are the part of us that is not well understood in medicine. I know from my own experience that a Neurologist or a Psychologist cannot pick up all problems of brain damage in particular. Fortunately, these days, PTSD is now recognised and acknowledged. There are now Neuro-Psychologists who have a better understanding and are, very slowly, becoming recognised by NHS.
As far as head injuries are concerned these would be the only truly qualified Consultants to perform Review examinations.
An Occupational Therapist is totally useless to assess anyone with PTSD or with traumatic brain damage. They deal only with Physical workings of the body, and not too well. The Regulations state that a QUALIFIED medical officer attends to IOD pension reviews.
An excellent blog.
Only those doctors who specialize in pain management can fully understand the psychological impact of pain.
Trying to explain this to a quack appointed by the police authority will be like pulling teeth – an “occupational physician” just won’t get it. It is far too complicated and specialised for them to comprehend.
As far as PTSD goes, a somewhat simplified but fairly good way of explaining the link with chronic pain goes like this –
Pain is transmitted from the site of the injury by our nerves, travels along the spinal cord and ends up in our brain – i.e. pain is transmitted through the central nervous system.
If the central nervous system is already in a state of “wind up” due to psychological factors such as PTSD, this can result in an amplified the pain experience which in turn then amplifies the psychological factors.
Et voila – a perfect storm.
Both conditions serve to heighten and maintain each other.
There is much evidence to support this and there have been studies into the prevalence of chronic pain in PTSD sufferers.
Sadly, I doubt many SMPs will have a clue about this.
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