The following transcript is computer generated

Mike Dilke: Hi, I’m Mike Dilke and you’re listening to the Relaxback UK Show, the show that explores all kinds of health topics relevant to you, your family, and your friends. Each week, I talk to expert guests from a range of backgrounds to inform and entertain you.
This week’s topic is pain. We look at many different aspects, including how the weather might affect our experience of pain. Most patients who suffer chronic pain have very poor and unrefreshing sleep, and if you’re compounding that with hot nights, then that becomes more of a problem. Warmth is great if you’re on holiday, but when you’re trying to sleep at night in poorly air-conditioned homes, it’s not easy. There is a mood element or a change in mood that can occur for some people.
My guest is Dr. Simon Thompson, a consultant in pain management and neuromodulation. We also look at different treatments, including neuromodulation, which involves an implant.
I started the chat with Dr. Thompson by asking him about the fast reactions we have to a situation, sometimes before we’ve even felt any pain. Pain is both a good and a bad thing. It stops us from doing things that damage us, like sticking a finger in a fire. But something that has always intrigued me is how our body reacts so quickly before our brain even registers it. How do we do that?
Dr. Simon Thompson: That’s not just unique to the pain experience; that’s also hearing and sight. The more neuroscientists look into things like sight, the more they realize the brain is telling you what you’re seeing, and similarly with hearing. But I think the main thing you probably want to know about is the difference between acute pain and chronic pain.
Acute pain is protective. Chronic pain is defined as pain that has existed for more than three months. We use three months because that is the usual time for an acute injury to heal and settle down. If pain carries on for six months after you hit your thumb, it becomes a disease state because there’s no longer a need to feel that pain for self-preservation.
Mike Dilke: What about phantom pain? People who have had a limb amputated sometimes still feel pain in that limb.
Dr. Simon Thompson: Your brain projects a body image. You can take away the limb, but the brain is still going to project an inner image to your consciousness. Pain is a balance between excitatory and inhibitory phenomena in the nervous system. If you take away the peripheral nervous system through amputation, you can have uninhibited pain projection from the brain. It can ruin their lives, but we’ve gotten much better at understanding and treating it.
Mike Dilke: Is there a “pain center” in the brain?
Dr. Simon Thompson: We don’t really think of centers now; we think of networks. There are many areas of the brain associated with acute and chronic pain. You can tell someone you’re going to hurt their toe without actually doing it, and that experience can light up the same parts of the brain as if you had actually hurt them.
Mike Dilke: Do women have a higher pain tolerance?
Dr. Simon Thompson: We don’t really think in terms of tolerance, as it varies from person to person. However, many conditions are much more common in women. Chronic widespread pain from fibromyalgia, for example, is about 20 times more common in women than in men. It is often linked to nature and nurture—genetic predisposition and adverse childhood events can sensitize the central nervous system.
Mike Dilke: What about treatments like medical cannabis or opioids?
Dr. Simon Thompson: To date, there aren’t adequate controlled studies showing benefit for cannabis, and there are safety concerns regarding people’s ability to drive or look after children. Regarding opioids, we saw a massive problem in the US where pharmaceutical companies suggested opioids for non-cancer pain didn’t carry addiction risks. They do. I rarely initiate opioid prescribing; much of my work is supporting patients in tapering off them.
Mike Dilke: Tell us about neuromodulation.
Dr. Simon Thompson: Neuromodulation involves applying electrical stimulation to nerves. It usually requires an implant, which we do as a day case. We insert leads—which are about as floppy as a piece of cooked spaghetti—into the epidural space over the spinal cord. This creates an electrical field that turns off abnormal pain signaling. The power pack is about the size of a man’s watch and is placed under the skin. It’s very cost-effective for the NHS because it lasts about 12 years and often allows patients to return to work and get their lives back.

Mike Dilke: Pain is certainly subjective; that’s what everybody says. Generally speaking, can women put up with more pain than men? Because they have pain every month, they have childbirth, etc. Or do we men just complain a bit more? Is there any truth in this?
Dr. Simon Thompson: I don’t think in those terms, but there are a lot of conditions that are much more common in women. Chronic widespread pain from a condition known as fibromyalgia is about 20 times more common in women than in men. I don’t think we really think in terms of “tolerance” of pain, as that will change from one person to the next. The typical example is the soldier on the battlefield who gets shot in the leg but has to get himself to safety; there are various natural mechanisms that suppress pain in that moment. But it comes back to chronic long-term pain, and that is where belief systems and emotions come into the maintenance of the pain and the suffering.
Mike Dilke: So let’s look at that. We’ve got acute pain, like hitting your finger with a hammer—it hurts, and then the throbbing stops after a little while. What is the definition of chronic pain?
Dr. Simon Thompson: Chronic pain is pain that has existed for more than three months. Why three months? Because that’s the time for an acute injury to usually heal and settle down. Some people say six months, but three months is generally the definition.
Mike Dilke: If pain carries on for that long—say you hit your thumb particularly hard and six months later it’s still hurting—is that a design fault? Something has gone wrong because there’s no need to feel that pain anymore in terms of looking after yourself.
Dr. Simon Thompson: Well, the fundamental purpose of pain is for you to learn from the experience—to not do that again. If you’ve broken a bone, you don’t want to be running around; there is a withdrawal component. But you’re absolutely right. Looking at the underlying mechanisms of why people develop chronic pain, there can be several reasons. There is injury to the nerves—neuropathic pain—where you injure the nervous system peripherally with an injury or an operation, and even when the cause is removed, the pain continues. Then there is the arthritis of the knee or hip, which we call nociceptive pain. Now there is also something known as “nociplastic pain,” where there is a sensitization of the nervous system.
Mike Dilke: So the nervous system there has been “switched on” because it’s been hurting, and then for whatever reason, it doesn’t seem to switch itself off?
Dr. Simon Thompson: Exactly right. And what’s worse is it can also expand and involve other parts of the body within the nervous system. There are conditions like Complex Regional Pain Syndrome (CRPS) which might start with an injury to the thumb, but then the pain involves the whole forearm. Then there are things like fibromyalgia, which we think is a disorder of central inhibition, where they have projected pain to all four parts of the body. It affects 2% of the population. Nobody really knows why, but it’s likely nature and nurture—genetic predisposition combined with adverse childhood events that sensitize the central nervous system.
Mike Dilke: I’ve come across lots of different treatments for long-term pain. One thing that has cropped up is medication derived from cannabis. Is that something you’ve come across?
Dr. Simon Thompson: I come across it, but to date, there aren’t any adequate controlled studies that show benefit. However, there will be patients who report some improvement. Whether it’s a real effect, a placebo, or helping with anxiety, nobody really knows. We don’t prescribe it in the NHS because it hasn’t got the level of clinical evidence to support it. It’s not just its efficacy; it’s its safety. If you’re advocating medication that might interfere with people’s ability to drive or look after children, and the risk of these substances getting into the hands of young children, it’s a problem. There are plenty of private doctors who will provide prescriptions, but they are usually very expensive—around £500 a month.
Mike Dilke: Opioids are another painkiller used for a long time. That treatment comes with its own issues. I saw a statistic from a book by Bill Bryson that said between 1999 and 2014, 250,000 Americans died from opioid overdoses. That seems like a massive number.
Dr. Simon Thompson: It is a massive problem. There was a time, probably in the 2000s, when Purdue Pharmaceuticals and the like had some support from the American Academy of Pain Medicine suggesting that the use of opioids in non-cancer pain didn’t carry the addiction risks we all thought it would. So there was a big push initially to prescribe in non-cancer pain. Then there was pressure with the takeoff of day surgery and the idea that nobody should experience unnecessary surgical pain. Patients found it also helped their back pain and started asking for prescriptions to be continued. They then ran into huge problems with tolerance and addiction.
Mike Dilke: It doesn’t keep working, does it? It works on your pain for a bit and then stops.
Dr. Simon Thompson: Yeah. And often what you’re left with when a patient stops is opioid withdrawal, which is a massive stress response that makes pain much worse. I very rarely initiate opioid prescribing; a lot of my work is in trying to support patients in tapering off them.
Mike Dilke: You help them as a consultant in neuromodulation. What is that?
Dr. Simon Thompson: Neuromodulation is a growing area of medicine. In pain situations, we are applying electrical stimulation to various nerves involved in the pain experience. It usually requires an implant. By stimulating the nerves, you actually turn off the abnormal pain signaling.
Mike Dilke: Where do the implants go and how big are they?
Dr. Simon Thompson: The leads are inserted into the epidural space—people who have had children will have heard of that space for an epidural. We position our leads over the spinal cord to create an electrical field. The leads are about as floppy as a piece of cooked spaghetti. The power generator is essentially a computer in a can with a rechargeable battery, usually about the size of a man’s watch. It goes under the fat of the loin in the mid-back. You charge it up by putting a device over it, much like charging a modern phone.
Mike Dilke: Is it a cost-effective treatment for the NHS?
Dr. Simon Thompson: Yes. These rechargeable batteries last 12 years. When you take into account the cost of drugs, rehabilitation, or further surgeries, it has been shown to be cost-effective. We usually break even between two to three years. It’s been looked at by NICE (National Institute for Health and Care Excellence), and we wouldn’t have it unless it was cost-effective.
Mike Dilke: Does it turn people’s lives around?
Dr. Simon Thompson: That’s one of the reasons why I still do it. Seeing the patient experience when their lives were utterly blighted by pain, and now they say, “You’ve given my life back.” We get patients who go back to work and contribute back to society. The guilt that patients feel when they can’t contribute to their family life is massive, so seeing that change is very rewarding.
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Full Summary (300 Words)
In this comprehensive discussion on The Relaxback UK Show, host Mike Dilke and Dr. Simon Thompson delve into the physiological, psychological, and technological landscape of pain management. Dr. Thompson clarifies the distinction between acute pain, a vital survival mechanism, and chronic pain, defined as pain persisting beyond the typical three-month healing window. He explains that chronic pain often involves the nervous system becoming “stuck” in a sensitized state, sometimes expanding beyond the original injury site, as seen in conditions like Complex Regional Pain Syndrome or fibromyalgia.
The conversation critiques traditional and emerging pharmacological treatments. Dr. Thompson highlights the opioid crisis, tracing its roots to misleading pharmaceutical marketing in the 1990s that downplayed addiction risks. He notes that he now spends significant time helping patients taper off these drugs rather than prescribing them. Regarding medical cannabis, he notes a lack of robust NHS-level evidence and significant safety concerns regarding daily functioning and public safety.
The primary focus of the episode is neuromodulation (Spinal Cord Stimulation). This advanced treatment involves surgically placing “spaghetti-like” electrical leads into the epidural space. These leads are powered by a small, watch-sized internal computer that interrupts pain signals before they reach the brain. Dr. Thompson emphasizes that this is a highly cost-effective intervention for the NHS, typically paying for itself within three years by reducing long-term medication costs and hospital visits.
Beyond the clinical benefits, the podcast emphasizes the human element. Neuromodulation offers a path for patients with “blighted” lives to return to work and family life, alleviating the psychological burden of disability. While accessibility remains an issue in certain parts of the UK, Dr. Thompson highlights that for the 5-10% of chronic pain sufferers who qualify, the treatment is a transformative alternative to a lifetime of ineffective medication.