Health: For sale: one wheelchair: Roger Dobson reports on a clinic that helps people to live with chronic pain, and to break their dependency on drugs

Russell Lowe's wheelchair is for sale. Mr Lowe, a former soldier, still has the severe pain that has dogged every minute of his life since he became an IRA victim in 1971, and he will always be in pain. But now he can live with it. He is one of a handful of people who have been taught to 'understand' the chronic pain that racks their bodies, and to come to terms with it.

Mr Lowe, now 45, was badly injured when a booby-trapped telegraph pole fell on him. The pole had been sawn through and then disguised with pitch and tar. Fishing line had been stretched across the road. When the wire was tripped the pole fell. Mr Lowe, who had been a keen athlete, suffered serious spinal injuries.

Pain is a leading health problem, which costs the NHS pounds 350m a year; 7 million people visit their GP annually because of back pain alone, yet pain management is neglected in the NHS, with only two clinics offering in-patient services.

There is no cure for chronic pain which dramatically impairs patients' lives and takes a high proportion of NHS costs, both in drugs and GP time. Pain management has a low priority, although about 5 per cent of the adult population have a level of chronic pain so severe it affects their employment and daily lives.

The management method was pioneered by Dr Charles Pither, of St Thomas's Hospital, London, and he oversees the work at the new Pain Control Clinic at Bronllys Hospital, in Wales, where Mr Lowe was treated. The centre is housed in a ward at a former fever hospital, and was set up by the Powys NHS Health Trust.

In this unlikely outpost in the foothills of the Black Mountains the patients cook their own food, clean the ward, make their own beds, and come and go as they please. Conventional medical wisdom had written off most of these patients, consigning them to either a wheelchair or a regimen of painkillers, or both, for the rest of their lives.

At the clinic they are taught in small groups, for a month at a time, how to control and manage their pain. There are no promises of cures, no pledges that the pain will go away or even get better. Twenty- three patients have been through the centre since it opened in April. Two who were pushed in wheelchairs and one who arrived on a stretcher have all walked out unaided. The centre takes up to eight patients at a time, referred by their own health authorities or GPs.

'When you arrive they give you a medical book, tell you the name of the tablets you are taking, and suggest you look them up to find out what they do, what the side effects are and how many you will be taking for the rest of your life. You look it up and you think, 'My God, what am I taking that for?' ' says Mr Lowe. 'You realise that you don't want to be doing that any more.'

The treatment does not focus on the site of the pain, its cause or its nature, but on the difficulties it is causing the patient.

A multi-disciplinary team including a doctor, psychologist, anaesthetist, physiotherapist and nurse treats patients individually and teaches them physical, psychological and practical techniques to improve their quality of life.

Mike Frost, the centre's clinical director, says: 'Our aim is to reduce physiological distress, improve the patient's function, reduce depression and reduce or eliminate the drugs the patient is taking by developing their own psychological coping strategies.' Mr Lowe, one of the first patients to complete the course, says: 'They tell you that with your help they can do something. They explain about an injury, how it repairs itself, and why you still have pain from that injury. The pain is tangible, it's very real, it's there. But the damage is a scar and it's the scar that is causing pain, not the injury. The scar is not going to go away. It's rubbing, chaffing and trapping nerves, tendons, ligaments.'

For many, recognition of the existence of their pain is the first step forward. Ken Bailis, aged 47, one of the clinic's latest graduates, says: 'The first thing they tell you is that your pain is real. This is very important because, sooner or later, after years of pain every minute of the day you begin to think it is all in the mind. The course did not make the pain go away, but I can deal with it much better now and my whole attitude has changed.'

One of his psychologists on the course, Amanda Williams, says: 'The most important thing is to tell the patient we believe them, that we know the pain is real. Some doctors still believe in the old medical rule that if you can't see it on an X-ray, it can't be real.'

During the four-day-week treatment - the patients go home at weekends - a programme of physical activity is worked out. Some people become stiff and weak simply because of inactivity brought about by a fear that movement will aggravate an injury or condition.

During the month, dependency on sticks, wheelchairs and collars is gradually reduced, and patients are weaned off a whole range of drugs, from hypnotics and tranquillisers to anti-depressants and painkillers.

One of the key ideas taught is pacing. 'Patients with chronic pain may feel good one day, they work flat out, and they spend a week in agony,' says Mr Frost. 'As a result they feel they have no control over the pain, and they take more medication and become more dependent. We teach them to pace themselves, to take breaks and, by reducing the peaks of pain and regaining control, patients become able to plan their lives successfully.'

A second goal is to encourage positive thinking. Pain patients are often critical of how able they are, compared to how they used to be; about the cause of their pain, and about the implications. The patients are helped to recognise these thoughts and challenge them. Their families are also involved in the therapy.

'We are very pleased with what we have done here since we opened. Powys NHS Health Trust is a relatively small, rural authority, but we are in the forefront of pain control in the UK,' he says. 'Our philosophy here is helping people to control their pain and rule their lives, rather than letting the pain rule them. It is easy to consign someone to a wheelchair, but it is very difficult to get them out again.'

Pain management could be the only hope for chronic sufferers. Russell Lowe has come to terms with the fact that there is unlikely to be any hi-tech solution to the problem.

As he waits for a buyer for his no- longer-needed powered wheelchair at his home in Swansea, he is also looking for retraining and a job.

He recalls the last diagnosis he had from a consultant shortly before he found out about Bronllys.

'My GP told me that the consultant's verdict was that there was no hope, that I would be on painkillers for the rest of my life. One of these days I must just walk around to his clinic to show him . . .'

Pain Control Clinic, Powys Healthcare NHS Trust, Bronllys Hospital, Bronllys, Brecon, Powys LD3 0LU, 0874-711255.

Input, St Thomas's Hospital, London, SE1 7EH, 071-922 8107.

National Back Pain Association, 16 Elmtree Road, Teddington, Middlesex, TW11 8ST, 081-977 5474.

(Photograph omitted)