Pain Management

Persistent pain (also known as chronic pain) is long-term pain that lasts for more than three months. It is a common problem with recent studies suggesting that one in eight people in the UK have persistent pain.

There are different types of persistent pain, many of which are not clearly understood. It can occur with certain conditions, after surgery, illness or injury, or sometimes it may have developed without an obvious cause. Even when a cause can be identified, there is often no cure.

Sometimes treatments are able to ease the pain but very often long term or complete pain relief is not possible.

Common effects of persistent pain

Living with persistent pain can be challenging. It can have many negative physical, psychological, and social effects. For example, people with persistent pain often have difficulties carrying out daily activities, including work, hobbies, and exercise.

This can lead to reduced activity and loss of fitness, loss of work and independence, financial pressures, and changes in mood.

For some people, the loss of confidence in their ability to do everyday activities can result in frustration, anger, anxiety, or, at times, depression. Sleep disturbance is a further common problem, adding to fatigue and stress. For some, life can become dominated by the pain.

An assessment by the team will determine which treatments are recommended for you. Not every type of treatment is appropriate for every patient. Your treatment plan will be specific to your needs.

In our multidisciplinary team there are:

Consultants in pain medicine

The pain consultants have expert knowledge of various pain conditions and treatments.

They carry out a medical assessment and help determine, with other members of the team, the most appropriate treatment to offer.

Specialist nurses

The specialist nurses provide information, support, education and treatments, such as acupuncture, which can help in the management of your pain.

They can prescribe medication, review your progress with any treatments you have received to date, and review your pain management plan.

Clinical psychologists

Clinical psychologists are specialised in the assessment and treatment of psychological distress. They are not medical doctors and do not prescribe drugs. They cannot make a person’s pain go away.

However, a clinical psychologist can help an individual to deal with the feelings which arise because of the pain. They have knowledge about the impact of being diagnosed with a persistent pain condition and the effect this can have upon quality of life.

They offer practical tools and coping strategies to help people deal with the challenges of living with persistent pain. They aim to help people adjust to living with pain and to reduce the impact pain may be having on their lives. Meeting with a clinical psychologist can enable people to feel more hopeful about their future despite the pain.

Interventions offered by clinical psychology include the group Pain Management Programme or, in some cases, individual pain management sessions. For more information on what to expect from a psychology appointment, please see our Pain clinical psychology leaflet.

Specialist physiotherapists

Some people tell us they have seen a physiotherapist in the past, which did not help as it was difficult or they were in too much pain.

Physiotherapy within the pain management service is different from general outpatient physiotherapy, the approach is less “hands on” and more focussed on helping you gradually and gently build up your strength, mobility and fitness, without causing flare-ups of pain.

Our physiotherapists use a variety of ways to help you get moving confidently and to exercise effectively and independently in everyday life. Physiotherapists in the pain team will work with you to make sure you have a clear understanding of how your body works and of how pain and movement relate to each other.

Keeping physically active is essential to keep your muscles and joints healthy, which has a positive impact on pain in the long term.

The Pain Management Programme (PMP) is a short course for people who are struggling to live with persistent pain. It is delivered in a group setting in which people learn about ways to limit the effect pain has on their daily lives. The PMP team includes a clinical psychologist, specialist physiotherapist, consultant in pain medicine and specialist nurse.

Please see our short video for further information and to hear from people who have attended the group.

Who is the PMP for?

The PMP is for people with persistent pain which remains unresolved by existing treatments. People attending the programme usually understand that their pain is likely to continue and they want to learn to cope with it more effectively.

They are not looking for a “cure” for the pain. Instead they are interested in developing a new approach to dealing with their pain and want to take practical steps to better manage their day to day lives.

Has your work and/or home life been affected by your pain?
Have everyday tasks become increasingly difficult?
Have you become less active?
Are you feeling frustrated and fed up that you are unable to live your life as you would like?
Do you feel stressed or sad at times because of your pain?
If so, it is possible that the PMP may help you.

What does the PMP involve?

The PMP involves attending two sessions per week over a four-week period.

During this time, you will attend sessions with different members of the PMP team. A variety of psychological and physical coping strategies are introduced, which have been found to be beneficial in helping people to manage their pain-related problems. The PMP aims to supplement the range of skills that people living with persistent pain have already developed to manage their pain. It differs from many treatments in that pain relief is not the primary goal.

Sessions include:

Information about persistent pain and how it affects people’s lives
Ways of managing unhelpful thoughts about pain
Relaxation
Mindfulness
Guidance in setting personal goals and plans for the future
Instruction in exercise and pacing activity
Advice on dealing successfully with pain flare-ups

How can the PMP help me?

Improve quality of life
Improve confidence
Manage stress and low mood
Learn how to relax
Increase strength and flexibility
Improve physical functioning
Increase activity

After completing a programme, many people say that although their pain persists they can cope with it better. People often say they are more active, participating in activities that are important to them, which leads them to feel happier and less focused on their pain.

If this sounds like it might be helpful for you, you can discuss this option at your initial pain clinic appointment.

These leaflets, produced by The Faculty of Pain Medicine, contain information for adult patients on medications commonly used to treat persistent pain.

Anti-depressant drugs used to treat neuropathic (nerve) pain:

Anti-epileptic drugs used to treat neuropathic (nerve) pain:

Some people use medications bought from their pharmacy or supermarkets, these are called ‘over the counter’ medications.

These leaflets, produced by The Faculty of Pain Medicine, contain information for adult patients on procedures commonly used to treat persistent pain.

Learning to live life with persistent pain can be extremely challenging. People are often told they should “learn to live with it”, “get on with it”, or “just accept it”, but what does it mean to “accept” persistent pain?

‘Acceptance’ can be defined as a way of addressing a situation or experience that is unchangeable. It’s not the same as giving up, helplessness, defeat, or passive resignation, and does not mean that we ‘like’ the situation. Accepting that we have pain is very different to giving up all hope.

Persistent pain can often be associated with a struggle to remove the pain or suffering caused by the pain. It can be easy to become stuck on focusing on removing the pain BEFORE focusing on other aspects of life, or before other aspects of life can be enjoyed.

Acceptance of persistent pain involves dropping the struggle with our pain. Acceptance enables us to stop fighting the pain, to stop spending energy trying to push it away, and allows us instead to focus this energy and time on doing things that make life rich and meaningful for us. This does not mean we have to like the pain.

Acceptance is an ongoing process of learning to live life fully and completely, without trying to change the problems which are so often outside of our control. This requires taking action in line with what is important to us whilst still experiencing difficult life challenges, such as persistent pain.

Effective goal setting can be a really helpful way of motivating you to make changes that are important to you. When done well, setting and achieving goals can give you a sense of mastery or pleasure. It helps you to have something to aim for, keep track of how you are doing and see progress.

Ideally we want to set a SMART goal, here’s what SMART stands for:

Specific: This is saying exactly what it is we want to achieve, when we will do it, where we will do it, and how frequently we will do it. We need to be clear on exactly what actions we will take.
Measurable: How will you know when you have achieved your goal? Physical goals can be easily measured, while psychological goals may need more creativity in how they are measured and in knowing when we have achieved them.
Achievable: We need to be sure the goal is realistic for our current circumstances and abilities, as well as the resources we have available (e.g. time, money, health).
Rewarding: We also need to be sure our goals are in line with what is personally important to us. The positives and benefits of achieving our goals usually help to motivate us further. If our goals are not that meaningful to us, we may not feel interested in continuing working towards them.
Time-framed: It is important to set a target of when we want to start working on our goal and when we want to have achieved it by, in order to avoid it ‘drifting’ on and on.

So that is how to set a SMART goal!

Mindfulness is about paying attention:

On purpose
In the present moment
Non-judgmentally

Being mindful helps us to train our attention and increase our awareness and acceptance of the present moment. It is very normal for our minds to wander. Through mindfulness we can take more control over our focus of attention and choose what we want to focus on, in the present moment, rather than passively allowing our attention to be dominated by things that distress us.

We practice mindfulness by noticing our thoughts, feelings, physical sensations, sounds, smells, textures – anything we might not normally notice, without judgement, moment-to-moment. The skills involved in mindfulness are simple, but because it is different to how our minds normally behave, it takes a lot of practice.

There are two different ways we can practice mindfulness: formal practice with the use of guided exercises or informal practice with mindfulness of everyday activities.

Informal Mindfulness

Mindfulness can be practiced informally throughout the day by bringing mindful awareness to everyday activities.

Mindfulness in your morning routine

Pick an activity that constitutes part of your daily morning routine, such as brushing your teeth, shaving, making the bed, or taking a shower.

When you do it, totally focus attention on what you’re doing: the body movements, the taste, the touch, the smell, the sight, the sound, and so on. Notice what’s happening with an attitude of openness and curiosity.

For example, when you’re in the shower, notice the sounds of the water as it sprays out of the nozzle, as it hits your body, and as it gurgles down the drain.

Notice;

the temperature of the water, and the feel of it in your hair, and on your shoulders, and running down your legs.
the smell of the soap and shampoo, and the feel of them against your skin.
the sight of the water droplets on the walls or shower curtain, the water dripping down your body and the steam rising upward.
the movements of your arms as you wash or scrub or shampoo.

When thoughts arise, acknowledge them, and let them come and go like passing cars. Again and again, you’ll get caught up in your thoughts. As soon as you realize this has happened, gently acknowledge it, note what the thought was that distracted you, and bring your attention back to the shower.

Mindfulness of domestic chores

Pick an activity such as ironing clothes, washing dishes, vacuuming floors—something mundane that you have to do to make your life work—and do it mindfully.

For example, when ironing clothes, notice the colour and shape of the clothing, and the pattern made by the creases, and the new pattern as the creases disappear.

Notice;

the hiss of the steam, the creak of the ironing board, the faint sound of the iron moving over the material.
the grip of your hand on the iron, and the movement of your arm and your shoulder.

If boredom or frustration arises, simply acknowledge it, and bring your attention back to the task at hand. When thoughts arise, acknowledge them, let them be, and bring your attention back to what you’re doing.

Again and again, your attention will wander. As soon as you realize this has happened, gently acknowledge it, note what distracted you, and bring your attention back to your current activity.

It is very common to experience difficulties getting to sleep or staying asleep. There are some really simple easy things that you can do to help get a better quality of sleep.

Try to:

Keep to a pattern of going to bed. Have a routine that tells your body it’s time to sleep. Go to bed and get up at regular times.
Ensure that your room is a good environment for sleep e.g. not too light, hot, cold or noisy.
Try not to worry about getting enough sleep.
Get some light exercise during the day; avoid exercise late at night.

Avoid:

Make sure you don’t drink anything with caffeine in it four hours before bed (that includes some soft drinks such as coca cola).
Smoking last thing at night. Smoking is a stimulant, so treat it like caffeine.
Drinking a lot of alcohol – the quality of the sleep won’t be as good.
Clock watching – put your attention elsewhere.
Looking at phone or computer screens just before bed.

You can find further information on the following websites:

The British Pain Society has information leaflets that you can download, as well as a list of addresses and links to other websites.

Pain Concern provides information and support for pain sufferers, those who care for them and about them, free factsheets and leaflets to help you manage your pain.

Action on Pain is a national charity that provides practical help and support to people living with or affected by persistent pain. The charity is run by a team of people who have direct experience of living and dealing with long-term pain conditions.

Pain Toolkit website provides tips and skills to support people with managing their pain, including downloadable booklets to work through.

Live Well with Pain contains resources to help people experiencing persistent pain get on with their lives, including “ten footsteps” to living well with pain.

Some people find it very difficult to practice mindfulness. It might be useful to remember that mindfulness is not about making negative thoughts go away; it is just about noticing the thoughts you are having and trying to bring your attention back to the present moment.

We cannot be mindful all the time. It is okay for our minds to wander but it is helpful to be able to notice when the mind wanders onto things that are not so helpful, and then choose to refocus our minds even for a short time.

There are two different ways we can practice mindfulness: formal practice with the use of guided exercises or informal practice with mindfulness of everyday activities.

Attached below are some formal practice audio files containing guided mindfulness exercises to help you practice.

Focus on an object