Pain Management

 

The service specifically manages adults over 18yr old with persistent/chronic pain as a diagnosis for which biomedical intervention is either inappropriate or has proved ineffective. This must be associated with a known or suspected musculoskeletal disorder (of non-malignant and non-inflammatory origin) where pain is the primary factor (if there are multiple health diagnoses).

Pain management and psychosocial interventions have the best evidence base in allowing people with chronic pain to manage better and return to improved function.

The Pain Management team are supported by the medical team, most commonly for specific patient education on safety of medication during pain management courses.

 

Definition of persistent neuro-musculoskeletal pain (non-malignant):

An unpleasant, conscious experience that emerges from the brain when the sum of all the available information tells us that the body needs protecting, which broadly:

• Lasts for more than 3-6 months
• Is unrelated to the healing mechanism
• Is associated with significant emotional and physical implications
• Neurophysiological in nature (associated with central sensitisation)

Persistent pain can significantly affect overall wellbeing and has a number of biopsychological implications.

Outline of Pain Management Services:

• Interdisciplinary care involving Psychology, Physiotherapy and Occupational Therapy
• Individual and/or joint assessments to determine suitability for a Pain Management Programme
• Short-term, time-limited interventions where group intervention is not appropriate to support self-management of pain

 

The Pain Management Programme is structured in accordance with British Pain Society guidelines:

• Interdisciplinary leadership including specialist roles as listed above.
• Includes neurophysiology education of pain and stress, psychological frameworks of compassion focused therapy and acceptance & commitment therapy, activity management including values-based goal setting, sleep management, medicines management.
• Once-weekly sessions in community venues totalling a minimum of 30 hours in group work plus variable numbers of individual and joint appointments as required by the individual.

 

How to refer:

1. Ensure patient meets the inclusion and exclusion criteria (see below)

2. Provide full disclosure of:

• Mental health status (current and past), addictions, ongoing health/social care support, psychosocial history
• Full medication history including co-morbidities and medication
• Any previous interventions
• Proposed referrals to other teams

3. Ascertain if patient is activated for the pain management approach to self-management

4. Refer via RAS

 

Red Flags:

• Severe mental illness
• Unmanaged suicide risk
• Substantial unexplained weight loss
• Symptoms or signs of inflammatory joint disease or connective tissue disease
• Symptoms or signs of cardio-respiratory disease
• Clinically significant lymphadenopathy
• Widespread or progressive neurological symptoms
• Acute trauma
• Signs of cauda equina syndrome
• Unremitting night pain