With many years under her belt working as a hospital senior medical officer and GP specialising in chronic pain, Dr Naomi Bowers is keen to share her experience, and explain why she believes it’s such a rewarding field.
Training in chronic pain
Naomi first started working in the chronic pain space as a senior medical officer at the Princess Alexandra Hospital in Woolloongabba, Queensland.
“I’ve always been interested in chronic pain. When I saw a job advertised with the persistent pain team, I was really drawn to it as I wanted to learn more. I was successful in getting the SMO position and worked there for two years,” she explains.
“For the first year, I concentrated solely on chronic pain patients, but for the second I did a mixture of chronic pain and general practice. I was very lucky to work with an absolutely amazing multidisciplinary team there.”
“Over my years training and practising in the area, I’ve found that while you need to have knowledge about medications, there’s a huge psychosocial element involved. You can’t help patients without honing in on that. They just don’t get any better.”
Why she loves it
Naomi has a large chronic pain patient caseload at her general practice, and she wouldn’t have it any other way.
“You’ll never find a more grateful bunch of patients than those with chronic pain. They’ve often seen multiple health professionals and have felt like they’ve not been heard or believed, with some told it’s all in their head. During our consultations, I’ve had so many tell me that this is the first time anyone has taken their pain seriously,” she says.
“While some registrars and GPs might be a little scared of the chronic pain space as they don’t feel that they can make a difference, it’s not the case. Even if I can’t find a physiological cause, I can still make a big difference in a patient’s life. I might not be able to take their pain away, but working together to find ways to dampen their nervous system, we can make really big strides with their mental health. This has a huge impact on them day-to-day, and I find that incredibly rewarding.”
The reasons behind chronic pain
For chronic pain patients, Naomi says while there is obviously a physical element, the cause is often elusive.
“We do scans and nothing shows, we do blood tests and nothing shows. It’s quite difficult for patients when we can’t find any physiological reason for their pain,” she says.
“But the physical is never the whole story. It’s important to take a holistic approach and look at their prior experiences leading up to the pain. In doing so, I’ve found that around 90% have a trauma background. This was particularly prevalent at the hospital persistent pain service, as we saw many patients who had been in refugee camps, as well as those who suffered domestic or child abuse.”
“For those that have a previous trauma history, it’s important to explain the link between the nervous system, the brain and pain. The nervous system is very good at protecting us and sometimes it over protects and produces pain, even though the reason for the pain may no longer be there.”
Most common pain presentations
When it comes to chronic pain presentations at GP clinics, Naomi says lower back pain takes the number one spot, while fibromyalgia (widespread muscle aches and body pains with no apparent reason) is also very common.
“In addition, I see a lot of women with pelvic pain and endometriosis. The rates have seem to have skyrocketed over the last decade,” she says.
In next week’s blog article, Naomi shares her top seven tips for assessing and managing your chronic pain patients.