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'The Cycle of Despair'

Visit the Doctor for Pain Relief

Doctor recommends Ibuprofen, Paracetemol, Diclofenac. Patient seeks alternative and self-refers to Physiotherapist.

Patient visits Physiotherapist

Physiotherapsit produces transient improvement but always relapses within a day or two. Costs around £30 per session. Patient seeks alternative and self-referred to Osteopath or Chiropractor

Osteopath or Chiropractor

Manipulation of back, limbs, neck and skull bones, muscles. Improvement achieved in some patients but usually relapses if treatment ceases. Costs around £40 per session.

Return to Doctor

Advice depends on how empathetic the GP is. They refer for a Catscan or MRI scan to 'get a grip'.

The patient may now worry they have a brain tumour and begin to become clinically depressed.

Stronger painkillers may be prescribed.

Patient is referred to ENT/Oral Surgery Specialist

ENT dept. tells patient 'It is not an ENT Problem. Go back to your GP'. Oral Surgery Dept. may diagnose TMD but typically treats with a soft mouth guard (a chewy gum shield which usually makes the problem worse) and/or exercise advice.

Return to GP

Amitriptyline or nortriptyline as an analgesic or antidepressant. Most patients find these make them feel uncomfortable and they can increase night-time bruxism (grinding).Selective Serotonin Reuptake Inhibitors e.g. seroxat – paroxetine,Codeine or opioid-based analgesics. Referral to neurologist. Chronic pain has a mode-altering effect and the patient becomes depressed. Marital, social and work problems.

Patient is referred to Counsellor or Psychiatrist

Some counsellors understand that although there may be an emotional component to the patients problem, there is a physical problem as well. Pain clinics lack the expertise and experience to address the physical problem and consequently denies the validity of the problem. They may treat the symptoms, not the cause.

Return to GP and repeat all over again

Real life consultations with patients