Wales in Pain Week In Week Out

of every day. The pain is there all the time. Without pain relief and

the medication, I'm a wreck. painkillers aren't always the

answer. I was taking a concoction of tablets. And I thought, not one of

these tablets treats me. Tonight, we ask, with painkiller

prescriptions on the rise in Wales, why are we taking so many? How do

you say to someone who's sitting opposite you in pain, no, I'm not

going to prescribe for you? where can it end? It breaks my heart

to admit it. I'm an addict. And why isn't more being done to heal Wales

in pain? It's catastrophic for individuals. But it's catastrophic

for the NHS. Trying to put plasters were in Turkey. In better times.

When Terry was in good health and he was normal. His mind was better

then. They were happier days. Seems like a long, long time ago. He was

at least 17 stone by there. Still good looking. COUGHING.

Still good looking, yeah. 42-year-old Terry Williams lives

with his wife Christine in Pontypridd. The pain that torments

him began after an operation to remove a benign tumour. It caused

nerve damage in his back. After three months in hospital, they'd

sent me home. I'd lost all my stomach, large intestines. I weren't

able to speak, eat or drink. I had a bag on my neck catching saliva. The

trachy... An open wound on back from the MSRA, which they couldn't stitch

up. The consequence of all this is another problem. He has become

addicted to painkillers, prescribed by his doctors. Before, I'd never

take pain killer. If I had a headache, I'd take the dog for a

walk. A bit of fresh air. The only time I drank was at weddings,

funerals, parties. That was it. I was one of those squeaky clean boys.

Worked. Going from that to not having a life of any quality. And it

was all leading down because of these pain killers.

In Wales, one in three of us suffer with pain. One in eight are like

Terry, in chronic pain. It dominates and destroys lives.

It's Tuesday night, around midnight. Got a pounding headache. I can't

actually take any more painkillers. I've had my dose.

Trish suffers from chronic pain 24 hours a day. She's keeping a video

diary to show the effect this has on her life. It wasn't always like

this. And she can still remember happier times. Look, that's me. On a

motorbike. That's a fire blade. It's a super sports bike. Before the

pain, she was a Health and Safety Executive for a large corporation.

My symptoms, I suppose, really started to show in Christmas 2010. I

couldn't walk on my feet. It was just one big blister and swollen.

The toes has almost fused together. I've actually asked to have my feet

amputated to remove this pain. Trish is living with an incurable

condition. What she wants now is more support to help her manage the

pain. Aside from the human toll, pain costs the Welsh economy. The

latest figures show more than a quarter of a million working days

are lost on average every year. people in Waleshave chronic

non-malignant pain than they do diabetes. -- in Wales have. Dr Ann

Taylor is one of Britain's leading experts on pain management. You're

twice as likely to die if you have chronic pain than for any other

condition. But it doesn't have the resources and recognition things

like cardiac diseases, hypertension, respiratory conditions have. If you

don't intervene early enough in the acute pain phase, you're going to

end up with complex chronic pain that you're not able to cure.

Pain can be controlled in other ways. Hannah Spacey is proof of

that. She used to be bedridden. Now she's in training to climb Africa's

highest mountain. If someone had said to me four or five years ago...

Hannah Spacey, you're going to be doing a sports science degree and

climbing Kilimanjaro, I'd say, you're cowing crackers you are.

She has fibromyalgia, a chronic pain condition. She also suffered from ME

or chronic fatigue syndrome. I used to wear wrist supports with steel

bars in. Because my hands were so bad. And my muscles. And because the

pain was so severe and acute. I'd spend 20 hours in bed. And I'd be

sleeping for 20 hours a day. I'd wake up to go to the toilet and to

eat and go back to bed. When I started taking my medication, it was

just general painkillers. You take like co-codamal and ibuprofen. And

they wouldn't work. Then it would be try Tramadol. And something else and

something else. The pain wasn't getting any better. So they tried

tablets for nerve pain. In fact, she was taking up to 22

pills a day. At times, you'd think I'm going bonkers. I'm going mad. I

was on a concoction of pills. None of them are treating me. So why am I

taking them? It was a combination of intensive

counselling and physiotherapy that helped her manage her pain and

reduce her medication. Experts in Wales believe we're prescribing too

many painkillers. I think, if you look at the volume of prescriptions

overall, you have to question whether this is too high. You also

have to question, are they effective? Prescriptions for pain

relief have risen nearly 20% in just five years. It cost the Welsh NHS

nearly �50 million last year. But many see that GPs don't have much

choice, but to keep handing out painkillers. Baroness Professor

Ilora Finlay was a GP. She helped set up one of the first pain

management programmes in Wales. How do you say to someone who is

sitting opposite you in pain, no, I'm not going to prescribe for you?

They have to get the patients out through the door. I know what it's

like to have a waiting room full of people and the pressures. But I also

know that, when I was a GP, I didn't understand about chronic pain

management. And there aren't very many chronic pain services around

for patients. The BMA accepts that GPs are under

pressure to prescribe pain killers, because they're often short of time

with their patients. There's been a 50% rise in consultations in the

last 15 years. Prescribing painkillers might be one way of

clearing busy waiting rooms. But in Wales, prescription drugs are free.

So is this another reason why the numbers are going up? If you can get

it for free, rather than having to pay for it over the counter, you

will. One of the problems, I think, is you can get more if you get it on

prescription. And some of them, you become tolerant. But you also can

become dependent on them. And that can become a physical dependence.

Then, when you try to stop them, you get withdrawal, or a rebound.

Terry was prescribed a morphine-based medicine. But the

pain was so bad, he started abusing it. What I was using in a month in

the beginning, I was using in just over three to four days. Maximum.

All on prescription. I couldn't go without oral morphine for two hours.

Sometimes not that long. Take it once and, ten minutes later, have to

take it again. Even though she'd say, you've just taken it. No, I

haven't. This is the same one. His addiction led to erratic

behaviour. A danger to himself and others. I'd just go for quiet ride

in car. And then, somebody would cut me up. Before laugh it off, and say,

oh... They do it then, I'd chase them. He's just a different person.

Somebody I just didn't know. A stranger. I'd never thought

something like this. This medication he was on for so long could have

such a bad effect on his moods and change him completely. I even went

to a shop, local shops. Never done anything like this before. I put

extra painkillers in my pocket and tried to walk out of shop. I got

arrested for it. Now I've got a police record saying shoplifting for

painkillers. I'm not classed as a junkie. But I see myself as one.

Life revolved around painkillers for Hannah from Treharris. Until she

came here to this pain and fatigue management centre at Bronllys near

Brecon. I started coming off my medication at Bronllys. It's great,

because you get to sit with the nurse and run through your

medication. And you also find out what your medication is actually

for. Which is interesting. And you think, oh, really! That's what it

actually does! Hi! You're still looking well!

Hannah exemplifies what we want for people coming off the programme

here. It wasn't easy. She didn't have an easy ride. I don't think of

myself as ill. I feel pain, but I don't think about it. I don't bother

with it. Bronllys is the only residential centre for pain

management in Wales. It was set up 20 years ago. It costs health boards

�5,500 a patient for a three week programme. Pain and fatigue may not

necessarily kill somebody. But it can certainly end their lives. And

that's the real issue is to try and get that life back. Get them back

doing the things they value in life. A programme here consists of a

package of treatments. It includes physiotherapy and counselling to

help those taking part to manage their pain. And so they don't have

to rely solely on their medication. Seven years ago, Ian injured his

spine playing sport. After a week at Bronllys, things are looking up.

Before he came here, he relied on pills and his crutch.

The lovely crutch. That's where it's been. I haven't touched it since we

got the poles out. And that's where it's staying. I'll take it home with

me. And I'll probably burn it if I can. He hopes his treatment here

means he can get his life back to the way it was before the accident.

The main goal I've got. Basically getting on to bike rides with my son

again. It's something I've always wanted to do at the weekends. That's

the main goal, really. And then, become a family again. Ian is

already making progress. Before it was like this. The whole shoulder,

and weight and way of walking. In that kind of what I call the Herr

Flick style of walking. LAUGHTER. It's being able to stand up again. I

think it's making me feel a hell of a lot better just by doing that.

Hannah says the Bronllys approach has been key to getting her back on

her feet. Although reducing her medication has been difficult.

don't think, when you first turned up, that you were quite ready to

give it up. You still had a belief in it? Definitely. That was one of

the best decisions I made. Because all the other symptoms, you get

it... It's not worth taking tablets in my instance. Bronllys tracked a

group of patients after they left the programme to see how effective

it had been. They found their use of opiate painkillers reduced by 25%.

Levels of depression halved as well. But although the treatment often

works, Bronllys still has empty beds. If someone wants to come and

see us and take part in the residential programme, then they

have to go through a variety of funding panels. And, at the moment,

often those funding panels are turning people down. And saying, for

various reasons, they're not willing to pay for people to come up to see

us. As a result, we have places going begging.

A consultant who specialises in pain relief is Mark Turtle. He treats

patients at hospitals in Carmarthenshire as well as Bronllys.

He's frustrated that the funding process is preventing more people

being referred to the programme. Every person who comes in through

the door, I know exactly what they want, but can't supply it. Not only

am I impotent as supplying what they want. But there's an added

challenge. Because here's a facility which I feel will benefit them. And

I can't offer them that. He belives the Bronllys approach is better than

the one he often has to use for patients. He wants all health boards

to adopt it. I'm ending up by doing injections on people where I don't

believe that is really the best way of managing them. Having said that,

I have people on the waiting list who have to wait for a procedure for

two years. Two years, if you are in chronic pain, it's a long time.

That's a lifetime, isn't it? It is, but I suggest the whole thing is

wrong because these people have problem they're going to be living

with their whole life. So relying on strategy which makes them better for

a short period time, is the wrong strategy. Is that what we doing in

Wales at the moment? Yes, we are. Health boards say they offer a range

services in their own areas. They should follow a set of directives

for pain management. Five years ago, Dr Taylor helped write those

directives for the Welsh government. They were intended to offer a new

approach. We in Wales led the way, when we had the chronic pain

directives where we got an agreement from the government to say, yes,

it's a chronic condition in its own right and deserves its own

documentation. The directives set targets to get patients the right

services at the right time from the right person and in the right place.

The then Health Minister Edwina Hart demanded 100% compliance from all

health boards. A key directive was to help GPs provide a better service

for patients in chronic pain. There's some really good local

examples where it's worked exceedingly well. For example, in

Brecon the psychologists, the physio and others will go out and work with

the GPs to enhance their skills locally. Swansea has a good

community-based service run by a GP with special interest and there's

some isolated good practice in North Wales as well. But on the whole?On

the whole it's not throughout and I think GPs still struggle with

managing chronic pain patients so they'll refer them on.

Recording her video diary, Trish has had another sleepless night. She

says she's in constant pain. I don't know what to do with myself at the

moment. I haven't actually got strength to get up to go and get

painkillers. Following a year of appointments with various

specialists, Trish was refered to a pain clinic at the University

Hospital of Wales. It's like a pharmacy in here, it's a whole

chemist as far as I'm concerned. I had an illness of chronic pain,

something they couldn't identify, which made it hard for them, which I

appreciate. Trish says she at her first appointment she was simply

given a new painkiller and told to come back in four months. But that

appointment was cancelled. You get excited to have an appointment only

to fall flat on your face because they've cancelled the next one, and

the next one, and the next one. Eventually Trish did get to the

clinic 11 months later. Now she's waiting for another appointment, and

in the meantime, she's still taking painkillers. We asked Cardiff and

Vale Health Board about the cancelled appointments. They said

they couldn't comment on individual cases and asked her to contact them

directly to discuss her concerns. In Wales, patients are meant to be seen

at pain clinics within 26 weeks, but that target's not being met in some

areas. We've discovered the latest figures which show that of those

treated in March, one in three patients had waited longer. That's

not good enough, according to Professor Ilora Finlay. We know that

if you deal with acute pain well and quickly enough, the chance of them

developing chronic pain is less. This was one of the key aims of the

directives sent to our health boards five years ago. Professor Finlay

wants pain management to be a priority for the NHS in Wales.

need to have somebody whose a champion, somebody who is going to

provide the leadership who is going to say, yes, let's fight this

corner, this cause, and get that set up. There has been a bit of a vocal

voice in some trusts in some areas in Wales, areas that have pain

management programmes, but it's patchy and there really hasn't been

at a national level leadership over chronic pain.

Assembly member William Powell is asking the Health Minister to

intervene and investigate whether Welsh health boards really are doing

enough for people in chronic pain What we need now is an urgent review

of the 2008 study and to check actually what is happening on the

ground, because the message coming from clinicians and patients I've

spoken to is that things are not moving in the right direction and we

need to turn that around. We need an urgent review of the 2008 study. We

need to check what is happening on the ground. Things have not been

living in the right direction and we need to turn that around. We're

looking for action from the government on this under the new

minister and we'll keep a close eye on it and pressure up. In the area

where Terry lives there is no pain management programme or psychologist

available. But he was referred to a pain clinic at the Royal Glamorgan

Hospital in Llantrisant. He hoped they would find a solution. They

knew what was causing it but whether they could treat anything for it

they weren't sure. I said, I'll try anything. I tried acupuncture in the

beginning. I tried Botox, which my wife was jealous over. It was easing

the pain but it wasn't getting down to the right spots. We tried

everything we could think of. They said, might settle down in time, see

how it goes, get back to us if you get more problems. I have been

crying out for help for years. We don't know who to speak to. You need

a referral, then you'd have a referral and "not our department".

In pain and with an addiction, Terry has felt overwhelmed at times.

either going to kill myself or somebody. I said to the doctor,

we'vegot to do something. It was way out of control. Because I've wanted

to drive that car into brick wall numerous times and it's all down to

prescription medication. It's controlled my life so much nothing

else mattered. All Terry has ever wanted is to ease the pain, but he's

ended up addicted to his medication. Now he has to find help with that

too. If you were on street drugs, there is help out there.

Prescriptions, not so many places do it. Even though still addiction,

it's a lot harder to get help with it because it's on prescription.

Terry is now getting treatment at a drug rehabilitation clinic in Cwm

Taf run by Dr Sakhuja, who is Chair of Addictions for the Royal College

of Psychiatrists in Wales. He feels that pain serve -- sufferers should

not end up in rehabilitation. matter of raising awareness amongst

all clinicials when they are starting to look at prescribing long

term opioids and being aware of the issues with potential addiction much

earlier on and getting the pain teams involved much earlier on.

even though Terry is now getting help with his addiction, the pain

goes on and he wants it to stop. Even though I got over addiction

part still on painkillers and I'm having to take other medication to

stop the cravings. Terry's local health board, Cwm

Taff, say they won't discuss individual cases but they will

investigate the issues he has raised in this programme. They tell us they

are about to roll out a community based service that will lead Wales

in its approach to pain management. The chronic pain management

directives were introduced to help people like Terry suffering with

chronic pain. Two years ago health boards audited their own performance

on pain services, and four out of seven said they were fully

compliant. But Mark Turtle, President of the Welsh Pain Society,

says the assessment criteria was flawed. There were a series of

questions, and each health board had five different boxes for compliance.

If in your particular health board you had instituted a small scale

pilot scheme for example, for community services, you could tick

that box compliant 100%. That would not have given any genuine idea of

about what was given in that health board. My view on it would be that

the audit is flawed because of its methodology. It would have been

impossible for that audit to give A genuine representation of spread of

services throughout Principality. asked the Welsh government about Mr

Turtle's concerns. A spokesman said many audits take the form of self

referral in the first instance and another had been done by a health

agency which showed steady progress. But what does the doctor who helped

write the directives think of the health board's performance?

message to the Health Minister would be, it's becoming more and more

catastrophic, catastrophic for individuals and catastrophic for the

NHS, because no-one is taking a steer on this, really, and without

that steer, patients are going to continue to suffer and use huge

amounts of healthcare resources and that's money we can ill afford to

spend putting plasters on big holes. Health Minister Mark Drakeford

declined to be interviewed for this programme, but in a statement said

health boards have been encouraged to establish robust community pain

services and he recently commissioned a new audit to

establish what progress they've made in the last two years. For Trish,

the suffering goes on. She's still waiting for her next appointment at

the pain clinic. But Hannah's conquering her pain. Next it is

Kilimanjaro. Life's great now, life's brilliant. I'm doing what I

love. When I look aback at the last six years, I think, that was

dreadful for anyone to go through. Specialists in this area want

services to improve faster in Wales for the sake of hundreds of

thousands of patients in chronic pain. It is an iceberg and the

problem is we can't avoid it any longer because the side effects of

chronic pain and the cost to society of people not functioning are too

great. Terry's struggle with pain goes on. He is back on the waiting

list for the pain clinic, 15 months after asking for more help. He is

still hooked on painkillers and he wonders if life will ever be normal

again. I'll just burst out crying sometimes because its changed my

life so much I don't want to live. I've gone through so much and we're