You have been referred to Pain Management Service because your pain is interfering with your daily activities and quality of life. Persistent pain is complex and can be very troublesome and disabling and can affect every aspect of your life.  We are aware that you may have had to wait sometime for this appointment.

You will usually have been sent a letter to attend the Outpatient Clinic at New Cross Hospital. You are welcome to bring a partner, family member or friend with you to the appointment. To prepare for this appointment please bring with you copies of any relevant letters (if available) and a list of current medicines prescribed by your GP.

The Pain Consultant will assess the pain that you have been referred with and any related symptoms. You may be asked about how the pain affects your daily activities, general wellbeing and lifestyle. It may include a physical assessment. There may be other members of the team present during your assessment.

After the assessment, your Pain Consultant will discuss your options and make a treatment plan for you. This may include referrals for assessments with other members of the team, such as Pain Physiotherapist, Pain Nurse Specialist or Psychologist.  If further appointments are required with the Pain Consultant, this may be in person or a telephone consultation.

Our service works to support you and your GP to manage your pain and we will write to your GP to advise on your pain treatment plan.

Additional Needs

If you have any additional needs such as partial sight or an interpreter, please contact the Pain Management office.

Cancellations and non-attendance

We understand that in exceptional circumstances patients may need to cancel their appointment on the day. Please try to inform us at the earliest opportunity if you need to cancel your appointment as we may be able to offer the appointment to another patient who is waiting to be treated. To cancel an appointment please contact us between the hours of 8am and 4pm, Monday to Friday

Please note that if you fail to attend an appointment you may not be offered further appointment.

It’s common to expect that medication will completely take your pain away, but with long-term pain, it’s a bit different. While medications can be really helpful in reducing your symptoms, they rarely get rid of the pain entirely.

We’ll always review your medication with you to make sure it’s providing some benefit. Sometimes we might change your medication, or we’ll give you advice on how to use it more effectively.

You might find that some medications commonly used for new, sudden pain (known as ‘acute pain’) aren’t as helpful for pain that’s been around for a while. It’s also important to know that certain medications, like opioids, can sometimes actually make long-term pain worse over time.

We might explore different types of medication with you, or even a combination of medications, as this can often be more effective for managing the different ways pain can feel.

If a medication isn’t giving you any pain relief, we’ll have an honest chat about reducing the dose or coming off it completely. If this is the case, we’ll always advise you to do this with the support of your GP.

You may have some discussion on reducing and coming off pain medication if it does not provide any pain relief. This would be advised to be done with the support of your GP.

Patient information leaflets from the British Pain Society are available below on medications are available on the following medications from Faculty of Pain Management:

• Amitriptyline
• Duloxetine
• Gabapentin
• Non-steroidal anti-inflammatory drugs (NSAID’s)
• Nortriptyline
• Pregabalin

Individuals experiencing pain often struggle with day to day activities, therefore making it difficult to engage in functional activities, hobbies and work.

You may be referred to see the pain physiotherapist within the Pain Management team or referred externally to local physiotherapy services as part of your treatment plan.

Physiotherapy aims to improve confidence in movement and functional abilities which may have suffered as the result of living with persisting pain.

Working with the pain physiotherapist isn’t just about creating a tick list of exercise to perform daily. As pain isn’t just a mechanical issue, it is also influenced by fear of making pain worse, past experiences, and beliefs about movement and exercise. If movement has been painful in the past, it’s natural to associate it with making things worse, danger and avoid it or certain activities.

The pain physiotherapist will talk though the difficulties, concerns and fears you have around your daily activities and pain. They may examine the problematic area or the way you move or carry out daily functions. Together you will explore what is important to you and what activities, hobbies they you would like to work to returning to.

Treatment then may take many different forms include gaining an understanding of your pain, reviewing and discuss any x rays and scans. Exploring how to pace physical activities and defining tolerance levels so you gain confidence to carry out activities without flaring your symptoms. Movements/ exercises designed to enable you to engage in valued activities and hobbies that you enjoy. This may include gentle mobilising or stretching and strengthening exercises.

Injections of drugs called local anesthetic (and sometimes steroids) can be helpful in reducing inflammation, and the benefits often last a few days to a few months. In this time patients are encouraged to explore exercise and return to activities that they may have avoided.  Many people with persistent pain hope these injections will cure their pain, but this is rarely true and for many, they may not be appropriate.

Sometimes patients are referred to the Pain Management Team for a specific injection, and suitability for procedures will be assessed by the Pain team when you see them. There are different types of injections, and the benefits and drawbacks will be discussed in much greater detail if this is one of their treatment options.

Living with a long-term health problem like persistent pain can be really tough, not just physically, but emotionally and mentally too. That’s where our Applied Psychologists come in. They’re here to help you navigate the emotional and mental challenges you might be facing.

We understand that your thoughts, feelings, and actions play a big part in how you experience your pain, how you cope, and ultimately, how well you recover. Sometimes, if you’re feeling really distressed or using ways of coping that aren’t helpful, it can actually make things harder. This can lead to more health complications, a lower quality of life, and difficulties in your relationships, at work, and in your daily life. It might even mean you need more appointments or hospital visits, and it can be challenging for your family and carers too.

Our Goal: Supporting Your Well-being

Our main aim is to reduce any psychological distress you might be feeling, improve your quality of life, and boost your overall well-being. We want to help you live as full a life as possible, even with your pain.

Working Together Through Psychological Therapy

Through psychological therapy, we’ll work directly with you to manage the distress that often comes with living with persistent pain. We can also help with other psychological difficulties that might arise because of your pain, such as anxiety or depression.

Ultimately, our goal is to help you achieve your personal goals and live a life that truly aligns with what’s important to you, despite the pain. We’ll also support you in learning and using evidence-based psychological strategies to manage your pain and lessen the impact that pain and related distress have on your life. These approaches are well-researched and have been shown to be very effective in helping people like you who live with persistent pain.

What is the Pain Management Programme (PMP)?

Pain Management Programme is a group based, supported self-management programme for patients with persistent pain. The group sessions explore skills, tools and strategies in a supportive environment intending to improve confidence in managing everyday activities and enhancing quality of life despite pain. The group sessions are run by experienced health care professionals from the PMP Team including Pain Physiotherapist, Psychologist, Pain Nurse and supported by a PMP Clinical Coordinator

Who is PMP for?

The PMP is suitable for those who have experienced pain for more than 6 months which is termed persistent or chronic pain.

All investigations such as x-rays and scans have already been completed and all treatments including surgery and injections have been explored but pain still persists. Common conditions are arthritis causing joint pains, back pain, muscle pain including fibromyalgia, and widespread pain affecting more than one body part.

You will have discussed your individual experience of pain with your Pain Consultant who has referred you to PMP. A member of the PMP team will discuss with you if this approach is suitable and the right time for you.  The programme is unsuitable for patients looking for a medical cure for their pain.  You can also decide that PMP is not for you.

What to expect from PMP

The sessions aim to explore and cover:

• Understanding of why pain can continue long after injury/illness has occurred.
• Increase your understanding of the mind and body connection.
• Connecting with your values and committing to valued actions.
• Explore ways to maintain or increase physical activity and exercise while reducing flaring symptoms.
• Introduction to mindfulness.
• Explore strategies and tools that can help improve sleep.
• Understand more about the pain medication you may take.
• Learn and practice relaxation and breathing skills.
• Create an individualised toolbox of skills, tools and strategies for improving quality of life despite pain.

See further details in the attached PDF

Qutenza is a skin patch for use on your skin. It contains a synthetic form of capsaicin, which is the compound that gives chilli peppers their heat sensation. The capsaicin acts on pain sensing nerves in the skin, making them less sensitive to pain.

It is designed to provide pain relief in people who have nerve pain due to damaged nerves in the skin. Qutenza can be used either alone or in combination with other medicines that you may take to treat your pain.

Who is it used for?

Qutenza is used for neuropathic pain. This type of pain can have several different causes including:

• Shingles
• Nerve damage from an accident or injury
• Following chemotherapy treatment

What does the treatment involve?

• Qutenza is for use on your skin. The patch will be applied by a Nurse who has been specially trained in the Qutenza patch application. The patch will need to stay in place for between 30 to 60 minutes depending on the area being treated. Patients are monitored by the Nurse during the application.
• How soon will I feel pain relief after treatment?
• Most patients will start to feel some pain relief on the day the patch is applied. However, it may take up to 14 days before you feel the full effect at the treatment site.
• How often will I need Qutenza treatment?
• You can have treatment again, if your pain comes back, after about 90 days. However, recent studies have shown that the average time to needing treatment again is about 20 to 22 weeks.

See the patient leaflet here

TENS Transcutaneous Electrical Nerve Stimulation

What is TENS?

TENS stands for Transcutaneous Electrical Nerve Stimulation it is a small battery-operated machine that can be applied to the intact skin over or around a painful area. It can sometimes help to reduce the amount of pain experienced by patients.

How does a TENS machine work?

The TENS machine is a small portable device that is attached to the painful area by self-adhesive pads called electrodes. Once switched on it produces electrical impulses which stimulate the nerves under the skin. The TENS machine can work in two separate ways: by blocking pain messages to the spinal cord and by encouraging the body to produce its own pain killing substances called endorphins.

How do I get a TENS machine?

The pain management service offers a 4 week trial period if you are suitable to use a TENS machine. An appointment will be arranged with advice on how and where to place the electrodes to give you the best possible result. Appointments are either face to face or virtually. We have a video demonstrating how to use the TENS to also refer to.

[Coming soon]

Does TENS have any side effects?

Side effects are rare that is why TENS is considered as a safe form of treatment. Although the electrodes are latex free very occasionally there have been reports of skin irritation therefore we encourage patients to regularly monitor their skin. Very occasionally patients may report that the TENS has aggravated their pain.

Does TENS work for everyone?

The 4 week trial allows patient to experiment using the TENS with the different setting and placement of the pads. Patients report varying benefit of using TENS

For further information see our patient information leaflet

Persistent pain is pain that has lasted for longer than 3 months.  Persistent pain can vary in severity and can affect many aspects of a person’s life.

We understand that living with persistent pain can be difficult and can cause mood problems for some patients, affecting their quality of life. With this information, we can then formulate the best treatment plan for you taking into account biological, psychological and social factors.

This is not always necessary depending on who has referred you to the pain clinic and what your problem is. It may be necessary to see the painful area or observe the way that you move.  It is advisable to wear comfortable clothes that allow you to do this.

Attending a pain clinic does not mean you will be sent for further scans or tests. Often a clinical decision can be formed without the need for further scans or investigations.

Pain interventions and medications can be helpful for some people to help manage their pain but are not a cure. Interventions are offered depending on your assessments. There are many ways that people can learn to manage the effects and impact of pain on their lives with a combination of interventions.

Pain may have started from an illness or injury, from which you may have long since recovered from, but pain remains.  Sometimes there is no one definitive cause of why pain continues. Pain is complex. Many suffer persistent pain in the absence of any past injury, tissue damage or evidence of illness.