the world is around me, i am trapped in a room. it is often poorly understood, misdiagnosed. i don't think we are equipped as a society or as a healthcare system to deal with that. there is the toll taken by the medication that millions rely onjust to get medication that millions rely on just to get through the day. when i inner withdrawal, i want to hit my horses. it is like my subconscious was screaming, you are going to die. and, the new understanding of chronic pain that has restored how people think and talk about what they are experiencing. it is not something i can change, it isjust it is not something i can change, it is just something it is not something i can change, it isjust something i can coexist with. that is sort of what acceptance is, just finding a way to coexist. knowing that persistent pain is very different and complex means _ very different and complex means that you actually have the ability to change it yourself. i - yourself. i am dominic hughes, yourself. — i am dominic hughes, health correspondence with bbc news, investigating the story of chronic pain, a condition that

bbc research reveals affects the lives of millions and leave them living lives of pain. hello, i'mjennifer and i am a dental therapist for my dentist in saltaire in bradford. it was everything that i ever wanted. it was everything that i dreamed it would be. i don't think i have been in a happier place in my life. five years ago, jen was happy and successful. today, she is living a life dominated by pain. opioid patches, anti—inflammatories, nerve pain medications. it started with back pain, but eventually spread through her body. mid—december, i drove to work, and whilst i was driving, the pain through my back and right leg wasjust something i had neverfelt. it was how i would imagine being kicked in the back by a horse would be.

that really acute, direct force. and nowjust a walk to the shops is an endurance test. i know look terrible, ifeel terrible, but good days of having a full face of makeup on to go anywhere are long gone. i have managed to shower and have washed hair so, yeah, winning at life today. jen lives with chronic pain. pain that persists and may not even have obvious physical cause. she has a problem with a disc in her back, but the pain is now extended far beyond that. our bodies are designed to protect us and sometimes the system that protects us goes into overdrive. and is constantly identifying

us as having a sense of danger and there isn't, so, therefore, that pain signal continues. forjen, the process has transformed her life. i was and probably still am, to some degree, grieving the person that i was. because i am a shell of the person that i used to be. my life revolves around the pain and the medical appointments and ordering prescriptions and it doesn't matter how hard i try, or how much i wish, or how much i pray, it isn't, or most likely isn't going to change. i wish i could turn the clock back. but i also know that i didn't do this. i have asked this question, "was it something i did?" and it isn't anything i did.

millions share sharejen�*s experience of living with chronic pain — a life that now limited, a future filled with uncertainty. it makes me feel like i'm trapped inside my own body and fighting a war that i'll never be able to win. i sleep very little and i'm in constant pain all day, every day. unfortunately, there is no cure. it's relentless, it's 24/7. a sword—carrying ninja that just stabs into me constantly. we carried out a uk—wide survey which suggests that 26% of adults live with chronic pain. hi, stella. come in, grab a seat. for more than 20 years, specialist dr chris barker has developed his understanding of pain. hopefully i can go back into work and not having to use the trolley and that. chris argues the way that current health system is set up, fails to deal with the complexity of chronic pain. it's not something that is commonly talked about.

people kind ofjust get on with it and it gets to a point where people become incredibly disabled and distressed, and i don't think we are equipped, either as a society or as a healthcare system, to deal with that. pain isjust, you probably know yourself, pain is huge. the prevalence of pain is anything between 20% and 50% in the uk, and we know that it's massive. but while it's an issue affecting millions of people, chris says the mechanism of how persistent pain works is not well understood. for example, if we have pain in our knee, the senses in our knee may be sending normal information to our nervous system. that data reaches the spinal cord and the spinal cord will learn, do what it wants to do on that signal, and it may boost the signal, and it depends largely then on the decision—making process to turn that into a threat

signal or a normal signal. and a normal signal will feel like there is a normal thing, but a threat signal, the best way our brain knows to get our attention is to flag that with pain. chronic pain can be extremely debilitating, fatiguing and agonising. chronic pain has made me feel different. - i feeljudged. i feel misunderstood. i feel isolated. i feel so guilty for not being able to work, for not having a career, for not being able to build my own life my own way, and having to rely on others for support. it's a dull, intense, burning pain that can be anywhere in the body, or all over, and those days ijust ask, "who's got my voodoo doll today?" our survey told us that, of those who lived with chronic pain, nearly a quarter are taking some kind of opioid painkiller and more than 40% of this group started taking them five years ago. it's these drugs, powerful medication taken by millions of people, that, for some,

is posing an additional danger. i get this overwhelming rage. i never thought i could be capable of murdering somebody, but when i'm in withdrawal, i could murder... i want to hit my horses, which is so against who i am at core. but if i ever did that, i wouldn't... that would be it. these are the terrifying feelings that withdrawing from opioid painkillers can stir up. niki is devoted to her horses. they are perhaps the most precious thing in her life. just thinking she could harm them is devastating. that shows just how difficult and dangerous this process of withdrawal is. i woke up one morning and ijust wanted to die. i couldn't access any feelings

of love and i realised this is withdrawal. nikki has been prescribed powerful painkillers including the highly addictive drug fentanyl, because of a rare and excruciatingly painful nerve condition which started 20 years ago. it is as if somebody stuck a cattle prod to the side of my face. it's extraordinary, overwhelming pain. i literally hit the floor and it basically destroyed my life. opioid painkillers, including codeine, fentanyl and morphine, are a huge benefit to some people but they are generally only recommended for short—term pain. niki has learnt pain management techniques which means she can now cope without taking fentanyl but she has been left with a dangerous dependency that leads to withdrawal when she reduces her dose. this is the patch that i am on, the fentanyl patch. the patch is actually these orange—y bits? yes, and you can see this one is a whole one and i've cut

off little bits. this is not the proper way of doing it. they want you to drop down by a whole patch. there is no real exit strategy for these patches. in a bid to withdraw safely, niki shaves off tiny slithers from her fentanyl patches, less than a millimetre at a time. every time i reduce my opioids, my pain increases as i go through the withdrawal process. and then it decreases and i feel so much better each time. and i think that one of the things that would help is for medicine to be a little bit more supportive and a little bit more humble about the way they treat people in withdrawal because we aren't the ones writing those prescriptions. they are. gps argue that access to treatments and therapies that offer an alternative to medication are patchy. in the meantime, for some patients, painkillers

are the only thing that brings immediate relief. but for lorraine, that relief from pain meant she lost a decade of her life. its relentless nature in her arms, legs and neck, captured in her diary. it became a little bit too much to keep writing this down because every day just seemed the same. she also knows the fear of feeling she was dependent on prescription painkilling drugs. in her case, morphine. it's like my subconscious was screaming, "you are "going to die." "you are literally going to die if you don't do something." i didn't know that i was slowly overdosing. like, it's like a silent killer. so with the help of her gp, lorraine has gradually weaned herself off morphine. i've got family who i love and adore and life is for

living and there are so many reasons for us to be here. no matter how much pain i'm in, no matter how bad it gets, to be able to hold my grandkids and hold my kids and kiss them, that's why i did it. a leading pain expert has looked at our nationwide survey which suggests millions of people are being prescribed drugs that are potentially addictive and may not actually be improving their condition. prescribing is the easy thing to do and the whole system is set up to support prescribing. we have prescription pads, we have pharmacies where people can collect things. but the other things that people with chronic pain can benefit from — physical activity programmes, programmes to help people with their mental health, community support, peersupport — all these sorts of things aren't so readily available, and even when they are available, they are not well—connected in with health services. and actually, we need a whole social change,

so we need a change in society where we think these are the normal things that we should be providing, where those of us who go to our gp with a problem connected with chronic pain, that actually we aren't surprised when somebody wants to talk to us about something other than medicines. people tell me i look well when they see me, when i'm wearing makeup and my pain level is a level four. but they don't see me when i'm flaring, when i'm in agony, crying because i can barely move and my medication isn't helping. i had to change my personality and become more selfish - so i can manage my time, energyand pain. - it's exhausting. it's another place — - everything looks the same but everything's different. i never know when the next flare up will come and i know that there will be lots of things i'm not able to do because i am in pain. in our survey, nearly half of those who lived with chronic pain said it impacted on their daily life — simple things like doing the shopping or going to work.

libby has lived almost half her life with pain. a serious problem with her thyroid developed when she was agedjustii, leading to chronic pain that profoundly affected every aspect of her childhood and her teenage yea rs. now she is studying at university but that's only possible because of a combination of medication and other therapies. you have to find a way of balancing the benefits of the medication, side—effects it creates, the risks that it creates and also quality of life. so at the minute, with the medication i'm on, the side—effects are minimal to none, or if i do have them, they kind of blend in with the other symptoms i have because of my chronic fatigue. the risks aren't particularly high and it's majorly improved my quality of life because if i didn't have the medications that i'm on, i wouldn't be able to function.

we asked libby to keep a record of an average day to see the impact her condition has on her everyday life. i have just woken up from a really bad night of pain. it was like a combined nerve pain and muscle contractions. i'm used to it, so i'm just going to go about my day. walking around from place to place is creating a lot of pain, especially in my joints, but it's kind of flaring up the nerve pain from last night. i got a teddy because i'm a child. i am still in a lot of pain, but at least i am in pain with a teddy now. it's been a really, really good day, but unfortunately all my good days come with quite a lot of bad days afterwards. my leg just feels so twisted, like it is being pulled

so tight that it's burning. trying to get to sleep for hours, i am exhausted. as the years progressed and things got worse, there were a few moments where i couldn't really think about the future. because i couldn't imagine things getting better. it'sjust something i can coexist with, and for me that is kind of what acceptance is, it's just finding a way to coexist. because i don't think i will ever find peace with it, i am sort of trapped in a body that is painful to be in. there is no nice way of putting it, it is just a bit, it sucks. 0h, absolutely, yeah. like many of those we spoke to, libby has struggled at times to get the right kind of help. what's your pain been like? but she has now got access to the nhs clinic run

by dr chris barker. the techniques she has learned, along with careful use of medication, allow libby to live with her pain. but there are millions who are waiting for this kind of specialised care. one word to describe chronic pain? going to go with two — a bad employee, just constantly messing everything up. it is a real condition that thousands of us suffer with daily. but because it is invisible, we are often dismissed as drama queens and fakers, sometimes even by medical professionals. from an active 40—year—old to a tablet depending - 50—year—old, who if didn't take tablets would not pull- the sheet off her head. our survey suggested that of those living with chronic pain, 23% were on a waiting list for either pain management clinic or surgery. dr barker's clinic is one of relatively few specialist centres dealing with chronic pain. chris leads a team of physiotherapists, psychologists, pharmacists helping people better

manage their pain. it's started easing off a little bit. - focusing notjust on the physical causes, but also on how the brain interprets and reacts to pain. trying to keep an open mind... i think the understanding we have of pain will take a long time to filter through, and attitudes will change as well, i think, when we understand that pain is something that is modifiable, and we can make changes to it, and we can be empowered to do those kind of things. it may not completely get rid of pain, but when we understand how to deal with this in a different way, i think we will be in a much better place. you feel a bit uncomfortable today, don't you? yeah. should we have a look at that, and try and get you more comfortable... crosstalk. i can see how you are holding yourself. relax you posture, butjust breathing in, coming forwards, yeah? thinking about pain in a new way, reframing our understanding of chronic pain, can transform lives. people like bernie... want you to stand up, yeah? ..whose approach to how

she manages her pain has been helped by the all—round support the clinic office. i think i am of the generation where you think, you take a tablet and it will go away, which it doesn't. it takes some of the pain away but obviously the condition is still there. now i am learning how to cope with that without the tablets — and i still have to take the painkillers, but other things as well as well that help it. it is, i am getting on a little bit now, i'm not the oldest person in the world, but i want to be able to enjoy the rest of my life rather than have it be controlled by pain. laughter. one constant theme we have heard from the thousands of people who have told us about their experience of living with chronic pain, is how isolating it can be. so patients at the merseyside clinic have organised a support group, a place where stories can be told, experiences shared. laughter is the best medicine. it's so easy to sit at home, think "i can't be bothered," take another pill and fall asleep. that is one way to go. the other way to go

is to perhaps pop into a group similar to this, sit down and basically have a laugh, because while you are laughing you are certainly not crying. i describe it as tinnitus of the body, because it is always there. it is here we met luke, who has lived with chronic pain for a decade now. his life changed in an instant when aged just 13, he woke one morning in excruciating pain. when he first came to the group, he was the youngest member. i was really, really nervous because i was really worried it was going to be like an aa meeting, like, "hello, my name isjohn, and i suffer from pain, i've lived with it for 35 years", but it is not that at all. and it is this incredible support network of people that just understood me on a level i didn't think anyone could ever understand me. the group has played a big part in helping luke better

understand his pain. oh, the reason i am feeling pain is because oh, my nervous system is doing this, or my brain has decided that any sensation it's going to register as pain. and itjust — knowledge is one of the biggest tools when it comes to pain, and this place helps with that massively. that was a good shot. luke lives at home with his family. it has been tough at times, a 23—year—old who had dreams of going to university. the world around me is advancing and i am trapped in a room — that's the killer, and it feels like all my friends are now all in university and finding jobs. there is a period where you go through the five stages of grief. because you have a completely different life now. it was hard for my family, i know, because it is something i have thought about, is they watched their healthy young child just deteriorate in a manner that is unforeseen and unexplainable. and i know that was really, really hard on them, because i could tell

by their faces. the mums and dads, they don't, they have to be strong for their kids, but you catch them looking sad, and it is, yeah, fully understandable. but again, through sessions i had with the pain team and the pain clinic, they were again able to learn and understand, and now wejust have this incredible understanding, and our own support that those faces don't appear as often. i call this piece that i have composed, "living with chronic pain." plays piano ballad. but despite everything he has been through, he has kept his sense of humour. bangs keyboard. he laughs. it is all about what you can do, not what you can't do. so the one i always use the example of, is reframing of achievements. that was the biggest, like, lightbulb moment for me, is, you know, the london marathon, some people,

that is their massive achievement, they have run the london marathon. that's not going to happen. so my achievement is, i've got out of bed today. that's a win. i have managed to get down the stairs, that's a win. i've left the house, that's a win. nikijones is also notching up some wins. in september 2021, she took part in a charity bike ride around lincolnshire, even while withdrawing from fentanyl and managing her pain. the aim was to raise awareness that we can change the way we think and talk about pain, to live with it rather than be ruled by it. there's a massive misunderstanding of pain. we think hurt equals harm, and of course, persistent pain is very different.

and it is basically the brain's become confused, and it's giving you pain where it's no longer necessary. but knowing that pain, persistent pain is very different and very complex, means you actually have the ability to change it yourself. and that is actually enormously empowering. also there, dr chris barker, reflecting that for many opioids and other drugs still play a very important role in helping them cope. i think the issue of opioid use is massive, both for clinical and for the individual who is on opioids, from those two perspectives. from the person on opioids it is a very real thing, and if i was on opioids for persistent pain, i would feel really uneasy about somebody taking away those drugs that i think may be giving me some benefit. and that is why i think in the most recent guidelines, it is really clear we should be having conversations

with people about this, not just taking them off medicines. and i think when we have those conversations, confidence in people can be improved to be able to make those changes. clinically, i think we all need to get better at communicating with people and being collaborative with our patients. three, two, one! everyone we met during the making of this film stressed how there is notjust one story of chronic pain. every person's experience is different. so too is how they cope with it. applause. i said, you know, if i do this, if i actually get off morphine, i want to go to bala lake in wales, i want a campfire, and i would really love to get tipsy, you know, and just sit there and just take it all in and say, "you know what?" "i had so much thrown at me, and i am still here, i am not down, i'm still here, i'm still fighting. and i did it." all our lives have been changed in a split second, and like any life change it is confusing, it is weird, and you...you learn to manage it.

i would hope that it won't take other people quite so long now, to be able to put the things together to help them manage it as effectively as i can. i think i maybe just hope that the phone will ring i and there'll be something new, or i don't know, maybe - that is wishful thinking, i but i think if i haven't got hope, then there's no point. it's not the life i used to have, but it's a life. and that's the thing that i always try and focus on, a life with pain is still a life. hello. the weather's been all over

the place in the last few days. yes, we've had some sunshine, some warmth, too, but also big thundery downpours, particularly in northwestern england and in northern ireland recently. now, on the satellite picture, you can see the motion of the cloud — it's mostly coming in out of the south and the south—west. so that's where the warm weather is coming from, too. and here are the thunderstorms we've recently had — now most of them have died away, we still have a little bit of rain here and there, but i think through the early hours of tuesday morning, it is a mostly dry picture out there with clear spells, a bit of residual cloud, that's pretty much it. oh, and mistand murk forming in the countryside, too. now, the temperatures early on tuesday will range from around eight celsius in aberdeen to 12 in norwich, london, and along the south coast of england. now there is rain in the forecast for tuesday, but it'll be mostly affecting western areas of the uk. so, here it is, this weather front — in the morning, maybe just about fringing cornwall into western parts of wales, and spreading northwards. but notice how this

area of rain expands during the course of the day, progressively getting wetter around these western areas. but further towards the east, the weather will be dry, hazy sunshine at the very least, and sunny closer to the north sea, and look at the temperatures — 26 in london, and easily into the low—to—mid—20s in yorkshire, as well. and then, tuesday evening, that rain will reach wales, the north—west of england, and move further north into scotland, as well, and there could be some thunderstorms returning to southern parts of the uk, as well, tuesday evening. here's a look at wednesday's weather map — still dominated by an area of low pressure and these south—westerly winds pushing in very volatile weather systems, difficult to predict, really. but the thinking is that on wednesday, we'll see a return of thundery showers quite probably to south—western parts of the uk, whereas further east and north, it should be sunnier. but look at that, northern ireland closer to the weather front — so there's likely to be some rain, too. and here's the outlook from tuesday onwards, just about into the weekend —

it will be changeable, staying on the warm side with sunny spells, but always a risk of showers with thunderstorms.

welcome to bbc news. i'm david eades. our top stories — ukrainian wounded soldiers are driven away, after being trapped in the azovstal steel plant siege. it's been under fierce attack for weeks by pro—russian forces. ukraine's president calls them hereoes. we have a special report from the front line in the donbass in eastern ukraine, which has seen the heaviest fighting of the last few weeks. mcdonald's is pulling out of russia in response to the kremlin's war on ukraine. permanent closure for more than 800 restaurants.

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