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Chronic Pain Service

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Introduction to the Pain Service
You have been referred to the Chronic Pain Service. This is a multi-disciplinary service consisting of Pain Consultants in Pain Management, Health Psychologists, an Advanced Nurse Practitioner in Chronic Pain, dedicated secretarial support and schedulers. Some or all of these different disciplines may be involved in your care. A questionnaire will be sent to you to complete and bring to
your appointment. Please bring a list of your current medications.

If for any reason you are unable to attend your appointment, please let the Pain Office know as soon as possible so another patient can be given your cancelled appointment slot. It is your responsibility to make sure that you attend all the appointments that you have been given, if you do not attend you will be automatically discharged. When you first attend the Pain Clinic you will be assessed by the Consultant and a treatment planned for your care constructed.

This will probably consist of one or more of the following treatments:
• Further Investigations
• Advice
• Medication
• Injection Treatment
• Physiotherapy
• Acupuncture
• Psychology
• Transcutaneous Electrical Nerve Stimulation (TENS)
• Pain Management Programme

Chronic pain can be complex and it is not always possible to achieve complete relief. In spite of this, it may be possible to improve your quality of life, and intervention plans are based on your individual needs and can consist of several approaches. Where relief of pain is not possible, then our aim is to provide appropriate support and advice to help you manage and cope with your pain – we may not provide a cure for your pain. Having completed a course of treatment we will discharge you back to your GP with all the information they need to manage your ongoing needs. If there are any questions you have regarding your appointments, please refer to the Useful Telephone Numbers section within this booklet (see page 16).

What to expect from your first Outpatient Appointment with a Consultant
The Consultant will ask you for details of your pain history including previous medical advice, results of any investigations previously done, treatments given and their effectiveness and any medication that you are currently taking. A relevant clinical examination will be performed, as appropriate, which may result in you being referred for further investigations. At your first outpatient appointment after the examination, the Consultant will discuss the extent of your pain and the proposed initial plan for your pain management. Your subsequent visits may be with other members eg Advanced Nurse Practitioners.

If your Pain Consultant feels it is necessary you will be sent for investigations, e.g. MRI scan, X-ray or Nerve Conduction study if indicated.

You may not receive feedback about the investigations from the Pain Service unless the scan shows something unexpected. However, you must ensure that you continue to attend all your future appointments that have been booked for you according to the plan agreed between yourself and your Consultant.

What does Injection Treatment involve?
The Consultant may advise you to consider having interventional pain management. This approach could involve injections into joints, muscles around specific nerves in your body or Radio Frequency Treatment. However, new techniques in pain management are continually arising as science progresses. Your Consultant will discuss the available options for treatment that are
suitable for you, so that together you can reach an agreed plan of treatment that is appropriate for your pain. The vast majority of injection treatments are performed in an operating theatre. This means you will have to be admitted to our Day Surgery Unit in the Treatment Centre. You will see a nurse first followed by your Consultant. The Consultant will discuss the proposed procedure with you and then obtain your consent.

Many of the pain procedures are performed under sedation, so you will need to fast for 6 hours prior to your admission. You should continue to take your medications as normal unless instructed otherwise. After your injection treatment you will be taken to Recovery ward and from there you will go to the ward in the Treatment Centre.

The nurses at the Treatment Centre will perform further checks after your injections to assess when it is safe for you to go home. As the process of injection treatment may still affect your body for up to 24 hours later we ask that you do not operate machinery, drive or cook and that you have a responsible adult to take you home and look after you overnight. However, if this is not possible you will need to let the Schedulers know when booking your date so that an overnight stay in hospital can be arranged.

TENS Treatment
TENS is a nerve stimulator which is a battery-operated device. Adhesive pads called electrodes are placed directly on the skin around the area being treated. The low speed setting delivers a tapping sensation over the skin and its effect is to stimulate the production of the body’s own naturally occurring pain killers which are released to overcome pain. The high speed setting delivers a continuous rubbing sensation over the skin and its effect is to block the pain signal being sent from the area that is painful. You need to inform us if you have high blood pressure (which is difficult to control with medication), if you have a pace maker fitted, if you are pregnant or likely to be, or if you suffer from epilepsy.

Full instructions on how to operate the device are given during your clinic appointment by either the Advanced Nurse Practitioner or Pain Nurse Sister. The device is loaned to you for two weeks. You will then have a telephone follow up appointment to discuss whether TENS has been beneficial for you.

Acupuncture Treatment
Acupuncture is an ancient form of Chinese medicine, which has been used for the last 3000 years. It is now practised alongside conventional western medicine. The chronic pain clinic can offer one course of acupuncture treatment which is based on a Westernised Medical model. There is a growing evidence base to support the clinical effectiveness and safety of this treatment for chronic painful conditions.

Reference: Acupuncture for chronic neck pain a cohort study in a chronic pain clinic. Blossfeldt. P. (2004).22(3) 146-151.
Trinh KV, Graham N, Gross AR, Goldsmith CH, Wang E, Cameron ID, Kay T, Cervical Overview Group.
Acupuncture for neck disorders. Cochrane Database of Systematic Reviews 2006, Issue 3.

Treatment you can expect
Very fine sterile needles are inserted through the skin at specific areas known as acupuncture points. The number of needles and location used varies depending on the condition being treated. They are usually left in position for about 10-20 minutes. Once the needles are in place you may experience the following:

• Slight pin prick discomfort
• ‘Pins and Needles’ sensation
• The area being treated may feel warm

These sensations may last a few hours. Some people feel tired afterwards and may have a good night’s sleep. Occasionally the symptoms may get a little worse for several days before an improvement is felt, i.e. pain relief, reduction in muscle spasm, feeling in a more relaxed calmer mood. The usual practice within the Chronic Pain Service is to offer you one set of six weekly treatments that will be carried out by the Advanced Nurse Practitioner. However, if you suffer from lower back or knee pain and your GP is located in Milton Keynes then you will be referred to a community provider for your treatment. This means that you will be given details of providers within Milton Keynes for you to contact to arrange an appointment. After you have received your 6 treatments you will either be referred back to your GP or be reviewed as a follow up at the hospital by your Pain Consultant.

It is your responsibility to make sure that you attend all the appointments that you have been given, if you do not attend you will be automatically discharged from the acupuncture waiting list. If it is deemed that the treatment is not working after the first few weeks, the treatment will be terminated as unsuccessful and you will be discharged from the acupuncture waiting list, and you will continue on your chronic pain pathway that was agreed by your Consultant at your first outpatient appointment.

Psychology Service

Introducing the Health Psychology Service
Living with chronic pain can be difficult and at times you may find it hard to cope with your pain. During these times you might find it helpful to speak to a health professional such as a Health Psychologist. A Health Psychologist is specially trained to help people cope with the emotional effects of physical health problems such as chronic pain. Our Health Psychology Service is available to patients and also their partners and family members. We are aware of the emotional strains that partners and family members experience and we hope our service can help them and also help them to support you.

You may want to consider seeing a Health Psychologist if:
• You are having difficulties coming to terms with, or accepting, aspects of your chronic pain
• Changes to your everyday life caused by chronic pain make it more difficult to cope.

What sort of issues can a Health Psychologist help with?
• Low mood, anxiety or stress associated with chronic pain
• Coping with uncertainty in relation to chronic pain
• Keeping control and independence over daily activities
• Adjusting to everyday life with chronic pain
• Coping with medication and making decisions about treatment
• Worries about family problems
• Problems with memory and concentration.

Coping with chronic pain
A common reason why patients or their family members want to see a Health Psychologist is to help them cope with the feelings associated with having chronic pain. Although it is normal to experience feeling down, disbelief and frustration when you first hear the information about your chronic pain, these feelings do not usually last long. If these feelings continue, get worse or b become overwhelming, then this is a useful time to think about asking for psychological support. It is not good for you to feel low, depressed or distressed over a long period of time.

What can you expect from the Health Psychology Service?
All appointments are held in quiet confidential rooms. The first appointment is an opportunity to discuss the reasons why you wanted to speak to a Health Psychologist and describe any worries and concerns you may have. It is also a chance for you to give some background information about yourself. Following this appointment, the Health Psychologist will agree with you a plan to address your concerns.

This may involve:
• Returning for a review session
• Returning for further sessions to work on specific issues
• Being referred to the Pain Management Seminar or the Pain Management Programme

During and in between appointments the Health
Psychologist may suggest that you complete a questionnaire or a diary to help with understanding your feelings and thoughts. These activities will help to keep track of any changes in your feelings and lifestyle over time and are only for use by you and the Health Psychologist.

Confidentiality
The Health Psychologist will normally write to the Pain Consultant who referred you to the Health Psychology Service and your GP after the first appointment and then again when you have finished your appointments. This is to give them a summary of your progress, and to let them know of any issues that they may be able to help with.

Pain Management Seminars
The Chronic Pain Service runs educational group seminars, giving practical advice on coping with pain. The first seminar (which lasts for 1 hour) teaches practical skills to help you manage and cope with your pain. You then attend a follow-up seminar approximately two weeks later, when you’ve had a chance to try out the techniques. The second seminar (which also lasts for 1 hour) is to
review how you are getting on and to discuss any specific problems, and also includes advice on what to do if a flareup of your pain occurs. Pain management techniques are not a ‘cure’ for your pain, but a way of learning to cope with it. You may feel sceptical about whether anything can help. We understand this and only ask that you keep an open mind and try out some of the
techniques, which are tried and tested. Even if there is no complete cure for your pain, it is possible to learn to cope with and manage your pain, and improve your quality of life.

These seminars aim to give you an opportunity to explore self-management and see what the Pain Management Programme has to offer. Please note it is important to attend both Pain
Management Seminars. If you missed the first seminar your place in the second seminar will be cancelled. Please allow plenty of time for parking and finding the meeting room, as once a seminar has started we will not admit latecomers.

Introduction to Pain Management Programmes
Chronic pain affects approximately one in five adults in Europe (Fricker, 2003). Often there is no cure, and people have to learn to live with their pain. Long term pain can have a huge effect on people’s lives. It can cause disability, sadness and frustration.

Reference: Fricker, J. Pain in Europe: a report. [Online] 2003. Available from: http://www.paineurope.com/files/PainInEuropeSurvey_2.pdf

Pain Management Programmes (PMPs) help people cope with their pain. They learn to understand their pain and increase their activities. They feel happier and their quality of life improves. The Pain Management Programme at Milton Keynes Hospital has been successfully helping people to cope with their pain since 1998. Most people who attend the Pain Management Programme become happier, fitter and more active and have a better quality of life. Prior to attending the Pain Management Programme you will have attended a pain management seminar (see further on in this leaflet).

Pain Management Programme
The programme takes place in a friendly group setting offsite from the hospital. The programme sessions are twice a week for a six week period. We expect people to attend every Pain Management Programme session and hope that people will come with an open mind and be willing to join in all the sessions.

The Pain Management Programme timetable includes:

Goal setting and pacing
We know that people with pain often do less and less. Sometimes people do too much on a good day and then pay for it afterwards. This leads to frustration. We help you set good goals such as hobbies or jobs round the house. Then we show you how to pace goals, which means doing jobs bit by bit and taking proper breaks. Regular goal setting and pacing after the Pain Management Programme will help you build up your activities and confidence.

Relaxation
We know that people with pain often get very tense. This tension can increase pain and make concentration difficult. You will learn how to relax your mind and body. Doing relaxation after the Pain Management Programme will help you cope with your stress.

Gentle exercise
We know that people with pain are often nervous about movement and exercise. Exercises need to start gently and build up slowly. Gentle exercise will help you increase your fitness and help you gain confidence. Doing daily exercises after the Pain Management Programme will keep you fit and active.

Discussion groups
We know that people with pain want to understand their pain and how it can affect them. The discussions include coping with pain, the effect of pain on your mind and body, medicines for pain, and the effect of your pain on your family and friends. There will be the opportunity to talk to someone from the Citizen’s Advice Bureau and the Disability Employment Advisor. In the discussions you will be encouraged to ask questions.

What happens after the Pain Management Programme?
After the programme it will really help if you continue doing daily exercise and relaxation. It will also help if you set daily targets and pace activity. People with chronic pain enjoy life more if they keep active. You could build up your social life and take up new hobbies. You will then be discharged from the Pain Clinic back to the care of your GP (even if you do not complete the Pain
Management Programme). We run a monthly Support Group, so if you are experiencing any setbacks (as some people do) we are there to help you through these. It is very important that you do not give up. Keep doing the exercises and relaxation, set goals, pace activity and attend the Support Group.

Support Group
The Support Group has been running for several years and has proved to be a successful venture. The Pain Psychology Service facilitates the support group, but the day to day running is organised by previous pain patients. The group helps you to continue using the skills that you have been taught within the Pain Management Programme and has proved to be beneficial for all patients concerned. This forum is run on a monthly basis off site from the hospital. The Health Psychologist is in attendance and will help with any queries or problems you may have. The main objective of the group is to help you maintain and develop pain self management techniques learnt on the Pain Management Programme and to make your life more pleasurable again. It also gives you the opportunity to forge friendships with other people that are experiencing the same feelings/pain as you and who can understand your situation.

The group also helps to alleviate feelings of isolation and loneliness. Meetings are light-hearted and informative, and help to keep you focused on enjoying life. If you wish to access the support group, please ask your Health Psychologist for further information.

Pain Drop-in Clinics
On the first Friday afternoon of the month between 13:00 and 16:00 there is a Pain Drop-in Clinic for existing patients or those who have been discharged from the service in the last 12 months. It is held in the Treatment Centre at the Hospital and is run by our Advanced Nurse Practitioner. No appointment is needed; please telephone Pain Clinic in advance to check Drop-in Pain Clinic is running. The Clinic is for patients who are experiencing a crisis situation. If you have any queries about the drop-in clinic please contact us on 01908 243184.

Useful Information
Main Hospital Number 01908 660033 (If there is only an extension number listed below please dial the main number and ask for the relevant extension number).
Patient Pathway Schedulers 01908 997007
Outpatient Numbers:
Maple Unit Reception ext 86595
Luing Cowley Reception ext 85218
Treatment Centre Reception ext 85453

If you need to email us to cancel or reschedule appointment this can be done by using the following address: [email protected]