Resources for healthcare practitioners – Primary Integrated Community Services Ltd

The Nottingham Women’s Centre “New Changes” service offers support for women who may be struggling with things that can affect their health and wellbeing. This can include stress, low mood, relationships, domestic abuse, money worries, housing problems, work, training or feeling isolated.

The service is friendly, supportive and focused on what matters most to each woman. Support can be given in person, by phone or online.

Women can refer themselves or ask a healthcare professional or support worker to refer them. There is also a weekly drop-in session every Tuesday from 10am to 1pm at Nottingham Women’s Centre where women can speak to a caseworker without an appointment.

You can find out more or refer yourself through their website.

Xrays and MRIs may used to help make a diagnosis if clinical examination has not been sufficient, or to help inform a choice of treatments. They are not required for confirmation of a diagnosis or to commence treatment in most cases.

Xrays are a useful way of looking at the bones in the body and are a quick and painless test. However they do use a type of radiation and exposure to this should be limited to when necessary.

An MRI (Magnetic Resonance Imaging) scan is a type of scan that uses strong magnetic fields and radio waves to produce detailed images of the inside of your body, including bones and soft tissues. Within the pain clinic, we mostly commonly use these to investigate spinal pains but only when necessary. The scanner is a narrow tube which you lie within. This can be problematic if people are claustrophobic. As the scanner works, there are loud tapping noises and the bed may vibrate slightly. As it is a large magnet, you must have no metal in or on your person: this includes piercings, metal stitches, most pacemakers and implanted stimulators, metal fragments or shrapnel anywhere in the body. We will also not use MRI scans for pregnant people.

Please see the link for NHS guidance on when and when not to scan for spinal pain.

Degenerative Cervical Myelopathy Card

Cervical myelopathy is a serious complication of spinal changes in the neck causing compression of the spinal cord. This can lead to permanent nerve damage and disability in some cases.

The signs and symptoms may include;

Tingling and or numbness in the arms, hands and/or legs and feet
Clumsy hands e.g. knocking things over, loss of coordination
Loss of dexterity e.g. struggling with grasping items, handwriting, buttons/zips
Weakness or heaviness in the arms/hands or legs/feet e.g. dropping things or tripping over
Reduced balance causing unsteadiness or falls
Difficulties with walking and immobility e.g. legs feel heavy, stiff or weak

Worsening pain in the arms or legs
Recent changes to bladder function e.g. urgency, difficulty passing urine (incontinence/retention) or leakage

The link takes you to a symptom warning card which you can print.

This document is called a ‘decision aid’. It is for people aged 16 years and over with persistent primary pain. It can help you think about what options you might like to consider to help you live well with pain.

There may be one person, or several different people working together, to help you live well with your persistent primary pain. For example, your GP, pharmacist, other healthcare professionals, social care practitioners, social prescribers and wellbeing coaches. We’ll call them your health and care team.

You do not have to use all of this document – you can just use the sections which you think might be helpful to you.
You can complete this decision aid in your own time, and you do not need to complete it all in one go.
You might like to bring this document to your appointments and go through it with your health and care team. Having a good relationship with them, where you feel able to talk openly, is important in supporting you to manage your symptoms and will help you make the right decisions for you.

Download a pdf or visit the British pain society web page for the document

Hypermobility means that your joints can move further than most people’s. For many, this isn’t a problem and can even be helpful for things like dancing or gymnastics. But for some people, it can cause pain or injury because the muscles and ligaments around the joints have to work harder to keep things stable. This can lead to tiredness, aching, and a feeling like joints are loose or wobbly.

Having hypermobile joints doesn’t usually mean the joints are damaged. The pain often comes from how the body reacts and how sensitive it becomes. Many people manage their symptoms well with regular exercise, pacing activities, and support from a physiotherapist. In rare cases, hypermobility is linked to more complex conditions, such as hypermobile Ehlers-Danlos syndrome (hEDS).

How Hypermobile Joints Can Affect You

Some people with hypermobility might have other symptoms such as:

Ongoing joint or muscle pain (chronic pain)
Tiredness that doesn’t go away (chronic fatigue)
Joint instability or even dislocations
Dizziness or fast heart rate when standing up (like in POTS)
Digestive problems like constipation or heartburn due to hiatus hernia, reflux and chronic bowel inflammation.
Easy bruising, thin scars, severe stretch marks or slow wound healing
Bladder control issues due to pelvic floor muscle weakness or prolapse of the uterus or rectum.
Eye or vision problems in rare cases, like cataracts or detached retina.
Pain that feels worse during certain times in the menstrual cycle, possibly having heavy painful periods.
In very severe cases, people may break bones, have heart valve problems or rupture organs.

Types of Hypermobility Syndrome

Hypermobility can be part of different conditions, including:

Hypermobility Spectrum Disorder (HSD)
Hypermobile Ehlers-Danlos Syndrome (hEDS)
Ehlers-Danlos Syndromes (EDS) – a group of genetic conditions affecting collagen
Marfan Syndrome – a genetic condition that affects the body’s connective tissue
Osteogenesis Imperfecta – a condition that causes fragile bones
Stickler Syndrome and Pseudoxanthoma Elasticum – rare conditions affecting joints and other body systems

Managing Hypermobility

Management is different for each person, depending on your symptoms. Some helpful strategies may include:

Medication – to manage pain or anxiety
Physiotherapy – to build strength and stability around joints
Pacing – taking breaks and avoiding doing too much at once
Pilates – a type of exercise that focuses on control and muscle strength
Heat – using hot water bottles or warm baths for relief
TENS machines – for gentle pain relief
Relaxation techniques – to help with tension and stress
Supports or splints – for short-term help with joint comfort (used only when needed)

You may also benefit from help managing the emotional and lifestyle effects of long-term pain, such as sleep problems or difficulties with work or hobbies.

Many people with back and leg pain have heard these following terms applied to them, without full understanding of what they mean.

Referred pain: a pain felt in a part of the body remote to that of injury

Radicular pain: a kind of nerve pain but with no damage to the nerve.

Radiculopathy: this means loss of nerve function e.g. reduced sensation or power, however it is not necessarily a painful condition.

Please click to read more:

Pain Terminology – Referred Pain, Radicular Pain, Radiculopathy

Inflammatory arthritis is a condition where the immune system mistakenly attacks the joints, causing inflammation, swelling, stiffness, and pain. This pain often feels worse in the morning or after resting. With the right treatment, the inflammation can be managed, and symptoms can improve. Some people may also feel very tired, achy like they have the flu, or have other symptoms like skin rashes or tummy problems like irritable bowel syndrome. A Rheumatologist will diagnose this condition and may offer medications to help. Our service supports people to manage living with long-term pain in a similar way to other conditions.

There are different types of inflammatory arthritis, including:

Rheumatoid arthritis – causes pain, swelling, and stiffness in the joints.
Spondyloarthritis – mainly affects the spine and includes a condition called ankylosing spondylitis.
Psoriatic arthritis – involves joint pain and red, scaly skin patches.
Gout – caused by a build-up of uric acid crystals, often causing sudden, sharp pain in the big toe, but it can affect other joints too.
Lupus – an autoimmune condition that causes joint pain and inflammation in soft tissues.
Polymyalgia Rheumatica – leads to pain and stiffness in the muscles around the hips, shoulders, and thighs. People may also feel tired, lose weight, or have less appetite.

What is Functional Neurological Disorder

Functional neurological disorder (FND) is a neurological condition that causes problems with the functioning of the nervous system, how the brain and body send and receive signals, rather than there being any changes in the structure of the brain which is seen in many neurological disorders. It is often compared to thinking of the brain as a computer, in FND there is no damage to the hardware (or structure of the brain), it is the software, the computer programming that is not running properly.

Symptoms

FND causes a mix of symptoms that will be slightly different for each individual. Intensity and dominance of symptoms can also vary within the individual. Symptoms can significantly interfere with how a person functions and copes with daily life. Symptoms can appear very suddenly. Many people find that they can increase as attention is drawn to them, and reduce if they are distracted.

Seizure-like episodes
Problems with cognitive function which can include brain fog, memory loss, dissociative amnesia
Walking and balance difficulties
Dizziness
Speech difficulties, eg stuttering or trouble speaking
Problems with vision or hearing
Pain (including chronic migraine)
Extreme slowness and fatigue
Numbness or inability to sense touch
Bladder and bowel changes eg IBS and overactive bladder

Diagnosis

FND is classed as a rare disease, but an estimated 50,000-100,000 in the UK have FND. Between 60-75% of patients are female. FND is the second most common condition seen in Neurology clincis (the most common is headaches). A diagnosis is generally confirmed by a neurologist, or someone with specific expertise in diagnosing neurological conditions. Brain imaging (eg MRI and CT scans), and other neurological tests are normal in individuals with FND. A diagnosis is made with the presence of positive clinical features including functional limb weakness, functional movement disorders, functional or dissociative seizures and functional visual signs.

While there is no formal scan research studies using functional neuroimaging and neurophysiology (looking at how the brain works rather than what it looks like) show changes in the connections between different regions of the brain in people with FND, including regions involved in controlling movement, the sense of agency/controlling actions and controlling emotions and behaviours making it more challenging to regulate emotions and respond to stress

Pain

Pain can be located in any area of the body and may be in multiple locastions and vary from day to day. The intensity and type of pain may also vary daily without any apparent physical trigger.

Managing FND

Due to the range of symptoms, there is no single treatment for FND and s range of specialties may be involved in helping manage FND, including neurology, physiotherapy, psychiatry/psychology and occupational therapy.

There is no recognised medication to treat FND, although medication may be offered to help relieve symptoms such depression.

Physiotherapy can be useful to help with movement and motor symptoms with the focus being on “retraining the brain” rather than being focused on exercise.

Strategies such as pacing can be helpful to manage symptoms, including the impacts of pain.

Resources

FND Hope is a charitable organisation promoting awareness and support for individuals and carers affected by FND. The website has more detailed information about FND:

What Is FND – FND Hope International

This is a series of self-help videos developed by therapists at University College London Hospitals NHS Foundation Trust

Functional Neurological Disorder (FND) videos : University College London Hospitals NHS Foundation Trust (uclh.nhs.uk)

Symptoms of menopause and perimenopause may overlap with Fibromyalgia, ME/CFS. For example reducing oestrogen levels can cause:

Dry eyes, itchy ears, tinnitus, restless legs, pins and needles, Carpal Tunnel Syndrome (pain, numbness and tingling in fingers/ hand).

Musculoskeletal changes like increased joint pain and stiffness, decreased muscle tone, strength and endurance onset of, or worsening Osteoarthritis.

Cognitive changes and impaired brain function: brain fog. These changes are temporary but for some can be profound. They include difficulty learning or remembering things, problems with concentration, and word retrieval.

Temperature regulation changes such as hot flushes, sudden feelings of hot or cold in your face, neck and chest which can make you feel dizzy.

Variable blood glucose levels post menopause. You can experience bigger and more frequent blood sugar dips and slower processing of glucose in the body during the evening.

Difficulty sleeping: this may be difficulty falling asleep or staying asleep. It is not uncommon to wake feeling unrefreshed making you feel tired and irritable during the day.

Fatigue. It is common to have reduced energy levels causing difficulty meeting physical, mental/cognitive, social, emotional or sensory demands in the day.

Headaches and migraines that are worse than usual.

Mood changes: increased anxiety and depression.

Further resources

Book: ‘Menopausing. The positive roadmap to your second spring’. By Davina McCall and Dr Naomi Potter

Overview | Menopause: identification and management | Guidance | NICE
Menopause – NHS

The Menopause Charity – Menopause Facts, Advice and Support

Factsheets – Menopause Info

British Menopause Society | For healthcare professionals and others specialising in post reproductive health

Women’s Health Concern | Confidential Advice, Reassurance and Education

Panorama – The Menopause Industry Uncovered – BBC iPlayer

Perimenopause and Menopause

Laura Clark – The Menopause Dietitian – Master your midlife through menopause

We are the leading gynae cancers charity – The Eve Appeal

5-Minute Kitchen Workout: Quick Fitness Routine / Dr Chatterjee

NHS England » Headspace

Get a prescription prepayment certificate: If you’ve been prescribed hormone replacement therapy (HRT) – GOV.UK

Cauda Equina Syndrome (CES) is a set of symptoms resulting from compression of the spinal nerves at the tail end of the spinal cord. These nerves are responsible for controlling bladder and bowel function, as well as sensation in and around your genitals, back passage, bladder and bowel.

When these nerves become compressed it can affect their function, and urgent medical attention is needed. Fortunately, it is rare, occurring in one to three in 100,000 people.

If you have suddenly developed or noticed a rapid change in 2 more of the following symptoms within the past week attend A+E immediately.

-Loss of feeling or pins and needles between your inner thighs or genitals

-Numbness in or around your back passage or buttocks

-Altered feeling when using toilet paper to wipe yourself

-Increasing difficulty when you try to urinate

-Increasing difficulty when you try to stop or control your flow of urine

-Loss of sensation when you pass urine

-Unaware of leaking urine or recent need to use pads

-Not knowing when your bladder is either full or empty

-Inability to stop bowel movement or being unaware of leaking

-Loss of sensation when you pass a bowel motion

-Change in ability to achieve an erection or ejaculate

-Loss of sensation in genitals during sexual intercourse

Cauda Equina Warning Card

The cauda equina warning card has been developed to serve as a reminder of what to do in case you develop any symptoms of CES. It is recommended to print a copy and keep it in a safe place, in case your symptoms deteriorate. The card is available in a range of languages.

Cauda Equina Warning Credit Cards

Category: Resources for healthcare practitioners

Further resources

If you have suddenly developed or noticed a rapid change in 2 more of the following symptoms within the past week attend A+E immediately.

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