Pain Services

The outpatient Pain Management service is available for people who experience long term persistent or chronic pain. Commonly seen conditions include persistent back or neck pain, sciatic pain, joint pain, fibromyalgia, pain following surgery and neuropathic (nerve) pain etc.

In many cases the treatment and management of pain is complex and difficult and there may be no straightforward cure or solution. That's why it's really important that the patient and specialist team work together as partners. The team aims help people to manage their pain, whilst trying to maintain or improve their functioning. This can reduce the distress caused by pain and improve quality of life.

How is the service accessed?

Patients are referred to us from a wide range of health providers, including G.P.s, Hospital Consultants, Nurse Practitioners and Extended scope Physiotherapy practitioners (Musculoskeletal services).

We advise patients to consult with their healthcare provider to assess the suitability of a referral to our service.

What happens following referral?

All referrals are triaged by the Medical Consultants in Pain Medicine. The Consultant reads the referral and the associated notes, makes a decision about what aspect of the service to direct the person towards. This may mean that a person will be offered a range of treatment or assessments including:

• An individualised assessment by a Medical Consultant in Pain Medicine, who is a medically qualified and trained specialist doctor. During this assessment a treatment plan will be agreed and further arrangements for treatment made (if appropriate).
• A recommendation that the person be sent information in the form of a booklet called ‘Nurse Led Practical Pain Management’ which has a medical focus offering practical approaches to pain management.
• A recommendation that the person attend a Pain Science & Your next steps (PMI) session which focuses on understanding the biology of pain and how to take a non-medical approach to pain management).
• The focus of both of these later two options is to offer information, advice and guidance regarding the impact of pain, and the positive ways to implement strategies based on the biopsychosocial approach. For many people they benefit from accessing both of these options (NLPPM and attending the PMI session).

Any of the above options may lead on to the option of a therapy assessment, specialist therapy workshops, medical reviews with one of the nurses, which are all tailored to the person’s needs and preferences.

What treatments are available?

As treatment is delivered by a multi-disciplinary team, there is a wide range of possible treatment options available. These may include:

• General advice and support with the management of the pain condition- including self-help measures.
• Injections for pain relief (only in selected cases and where appropriate). Other interventions may include radiofrequency denervation, pulsed radiofrequency or lidocaine infusions and in rare cases a referral to a spinal implantation centre for dorsal column stimulation.
• Specialist Clinical Nurse support and follow-up, and advice about general pain relief measures, TENS machines, external neuro-modulation treatment and medication.
• Workshops about how to apply self-management techniques.
• Individualised therapy;
  • Physiotherapy - an assessment of physical function and facilitating improvement of fitness and function through exercise and self-management strategies.
  • Occupational Therapy – assessment of an individual’s self-care, leisure and purposeful occupations, with the purpose of minimising the impact pain has on the performance of such tasks. This is achieved through establishing therapy goals, chosen by the person as their priorities for change. Where relevant, advice and support is offered to also help people stay in work, or start the return to work process.
  • Psychological Therapy- assessment of emotional/psychological difficulties and exploring the relationships between pain, understanding and emotions, so that the person can learn new ways to respond to their pain.

What will progress look like?

As everyone is different, progress is difficult to predict and depends on many factors, including each person’s individual response and personal motivation and engagement in the treatment options offered. For some patients, there can be a significant relief from pain following medical treatment, which enables an increase in exercise and activity, and leads to an improved quality of life. In many situations, learning to manage and continue or improve functioning despite the pain can be a positive and helpful way forward. However, expected changes are often gradual and may take many months.

Will a letter be written after each appointment?

It is standard practice for your GP/referrer to be sent a letter following appointments, which the patient is usually copied into. Within the therapy team, letters are mostly written at assessment and discharge. These letters are written to you and the GP copied in. Letters may be done at other times by the therapists if needed/indicated.

Finding us

Our service is based at Stamford Hospital. Most outpatient clinic appointments are held in the outpatient department at Stamford but there are some clinics which run at Peterborough City Hospital and Hinchingbrooke. All procedures/injections take place in the Greenwood Ward procedure suite. Individual therapy appointments are delivered at the department of pain management in the outpatients clinic or if they are remote they can be done over video (NHS Attend Anywhere) or telephone.

All other service arrangements are subject to change and patients are strongly advised to read their appointments letters carefully.

What if you can’t get to an appointment?

Please call the department on 01733 678332, as soon as possible. If you are unable to make it to more than two sessions or if you miss one session and you don’t get in touch, it is hospital policy that you will be discharged from the service.  

Each referral to our department is looked at by one of our Medical Consultants. Based on the information they have available to them, they determine the most appropriate course of action. 

So your first appointment with our department could be

1. with one of our nurses over the phone to discuss the Nurse Led Practical Pain Management information that the consultant wanted you to have. 
2. an information session called Pain Science & Your Next Steps which the consultant wanted you to attend. This session is run by the therapists in the department and can be either in person or online. It is a lecture style session to help you understand the scientific understanding of pain. It introduces the Biopsychosocial Approach to persistent pain. And it outlines the next steps if you’d like to have some input from the therapy (non-medical) side of the Department of Pain Management.
3. with one of our Medical Consultants which is likely to be an in person appointment. 
4. or it could be a telephone call with a member of our department to find out more information about what may be the most appropriate next step. 

Whoever your first appointment is with it can be really helpful to prepare for your appointment.  Pain Concern has developed a paper-based tool for patients to prepare themselves to bring up their concerns and worries in appointments. Designed to help patients navigate their concerns and bring the most important questions up in their appointments, the Navigator Tool was trialled 2017-2018 with healthcare professionals and their chronic pain patients.

Below is the link to the website for you to download or look at the forms 'My pain concerns form' and 'Questions to ask your health-care professional'

Self-Management Navigator Tool - Pain ConcernPain Concern 

It is possible to organise interpretation services for you if necessary. Please request this by calling the department at least a week in advance of your appointment.

Physiotherapy helps restore movement and function when someone is affected by injury, illness or disability. It uses physical approaches to restore body, mind and social well-being. Pain, and the fear of more pain, often causes people to alter the way they move which can lead to their body becoming stiffer and weaker with poorer balance and co-ordination. As a result they move less; this vicious cycle can lead to reduced ability to get on with life and often leads to more pain.

So the physiotherapist will help individuals become more aware of their body, their posture and how they use their body functionally. They will help individuals to learn how to use their body in more optimal movement patterns. And advice them on exercises to help address muscle imbalance, joint stiffness, proprioception, balance, coordination and gait. Generally helping individuals to become fitter and improve their functioning.

The Occupational Therapist (OT) works with individuals to assess their occupational functioning in self- care, leisure and productivity occupations, and the impact pain is having on these occupations. The OT also provides individual therapy to restore, maintain or improve functioning in key occupations that matter to the individual. A range of standardised assessments are used to assess individuals, depending on the reasons they are referred, and these are aligned with the Model of Human Occupation and the Canadian Model of Occupational Performance. 

Helping people to stay in work or regain/develop the skills to engage in a work/productivity role is a key part of the Occupational Therapist’s remit. The OT can advise on specific aids and equipment that might assist a person to function more safely or without as much difficulty both at home and in the workplace. The OT also supports individuals who are having problems related to their functioning due to poor sleep and other lifestyle related issues promoting occupational balance.

NWAFT’s Pain Service includes an out-patient service for persistent pain (also known as chronic pain), and an in-patient service (for hospital in-patients with pain). Both cater for adults aged from 18 years old.

Many people are surprised that psychology is part of pain management so here’s some information about the role of psychology.

What is clinical psychology?

Psychology is the study of people: how they think, feel, and behave.  A Clinical Psychologist is trained in using this knowledge to help people who are facing difficulties in their lives.

Clinical Psychologists often work with people who have physical health problems, as there is a strong link between the mind and the body. Physical health problems can often lead to mood difficulties, which in turn can make it harder to cope with the given physical health problem.

Being recommended to see a psychologist does not mean that your pain is “in your head” or that your pain is part of a mental illness. Chronic, persistent pain can affect us physically, socially and emotionally so it is important that your treatment takes into account your experience as a whole person.  

How does a clinical psychologist help?

Clinical psychologists work alongside you and other members of the pain management team (such as Medical Consultants, Clinical Specialist Physiotherapy, Clinical Nurse Specialists and Clinical Specialist Occupational Therapy) to help you manage your pain. 

A Clinical Psychologist cannot cure your persistent pain. However, they will work with you to build on some of your existing ‘self-management skills’ and help you develop new ones to enable you better manage your pain. Usually, Clinical Psychologists aim to help people engage in useful pain management strategies by:

• Helping them make useful changes in the way they feel, think or do things.
• Helping them understand and manage their difficulties more effectively.

More specifically they can help you with: 

• Coming to terms with having persistent pain.
• Improving your use of skills for self-management of persistent pain.
• Reducing the distress related to pain and ill health (commonly anxiety, low mood, anger, low self-esteem and stress related problems).
• Improving your communication in relation to your persistent pain.
• Decision making about treatment to support your discussions with health professionals.
• Lifestyle changes towards improving quality of life and preventing deterioration of physical functioning.

What happens at the initial appointment?

The Clinical Psychologist will ask you what you have read or found out about the bio-psycho-social approach to pain and will go through the questionnaire which you may have filled in, before your appointment.

Using this paperwork and by talking to you about the impact of pain on areas of your life, including work, leisure, socialising and relationships with family and friends, they will work with you to form a shared understanding (called a formulation) of the issues you are struggling with. This may highlight areas which you may want to work on or improve.  

At the end of this session the aim is that you will agree a plan with the psychologist. This may involve: 

• Providing you with recommended self-help information and discharging you if this is all you require.
• Recommending that you attend further sessions offered by the department.
• Returning for a further session to decide on the best course of action (if it doesn’t seem clear at the initial appointment).
• Returning for further sessions to work on your goals (these sessions are time-limited and goal-orientated, i.e., the Psychologist will regularly review how the sessions are going in order that progress is being made).
• Being referred to a local service (perhaps via your GP) for further support that is closer to your home or more appropriate.

Please be aware that there is usually a waiting list to see a Psychologist. The department is doing its best to make the wait as short as possible.

Psychological therapy

Clinical Psychology use a variety of psychological approaches to help people, including Cognitive Behavioural Therapy (CBT), Acceptance and Commitment Therapy (ACT) and Compassion Focused Therapy (CFT), to name a few.

Whatever approach the psychologist and you agree on, there is an expectation that you take an active role and do agreed activities in-between sessions to enable learning (research suggests that those who do “home practice” have much better outcomes than people who don’t).

What about confidentiality?

Sessions are held in a quiet, private room.  The psychologist works as part of a multi-disciplinary team and will make notes in your medical file which includes a summary of our discussion. When the psychologist writes to you they will copy in your GP and other relevant clinicians where appropriate.  

If you tell the psychologist information which you would rather is not passed on then please discuss this with the psychologist. Usually there are only a few reasons why such ‘sensitive’ information would be shared:  

• Sharing knowledge will enable you to receive better medical, nursing and/or social care.
• It is necessary to refer you to another specialist. 
• The circumstances are special, for example, if there is a concern for your safety or the safety of others.

The psychologist will do their best to discuss the reasons with you, before sharing such sensitive information. If you have any concerns about confidentiality then please raise them in the discussion with the psychologist.

As part of your assessment the psychologist may wish to contact your GP for any relevant information which may be helpful e.g., whether you have seen a counsellor in the past or any previous or current mental health issues. If you would rather this did not happen then please raise it with the psychologist at the first appointment.  

Under what circumstances do the sessions come to an end?

There is a limit to the number of sessions the Psychologists offer and it is important that the sessions are proving useful in helping the person move towards their goals. Sessions could come to an end for a variety of reasons:

• The person has achieved their goals of therapy.
• The person has made some progress and has learned strategies by which they can continue to work towards reaching their goals.
• The person has made enough progress in order to move on to another therapeutic approach e.g. physiotherapy, occupational therapy.
• The person has been unable to engage enough in the therapy to justify further sessions i.e. the person has been unable to regularly attend appointments, doesn’t or isn’t able to do the agreed ‘in-between’ session tasks etc.
• The person has made progress towards their goals but isn’t able to progress much further.

The psychologist will review the sessions with you regularly and agree on the best action to take.  

What other support is there?

Not everyone who is referred to the Psychologist needs, or is ready to commit to, a number of sessions at regular intervals. In these cases, postponing sessions until you are ready may be the most sensible option. Perhaps spending some time reading/looking at the resources contained on this website (e.g. books/videos about understanding persistent pain, connecting with other people who live with pain via the pain toolkit website), may be a good start.

There are lots of useful resources that you can access online to further support putting your pain management into practice:

You can watch a recording of the Departments Pain Science & Your Next Steps session. This session helps you understand the scientific understanding of pain. It introduces the Biopsychosocial Approach to persistent pain. And it outlines the next steps if you’d like to have some input from the therapy (non-medical) side of the Department of Pain Management.   

Please note that NWAngliaFT cannot recommend or be accountable for services provided by any of the organisations below.

• Pain concern; is a charity providing advice and support to people with chronic pain. There are publications, access to the Airing Pain Radio programmes, videos etc. https://painconcern.org.uk/ or put ‘pain concern’ into your search engine. 
• Pain Toolkit;   is great self-management resource, developed by Pete who lives with chronic pain. Pete also does a regular online café – look at the news section of the website for more details. https://www.paintoolkit.org/ or put ‘pain toolkit’ into your search engine.

Useful ways to get more active:

• Stay active at home – strength and balance exercise: https://www.youtube.com/watch?v=n8s-8KtfgFM&feature=youtube  or put ‘stay active at home strength and balance’ into search engine
• Low Back Pain - Simple stretches https://www.nhs.uk/live-well/exercise/lower-back-pain-exercises/  or put 'nhs live well back exercises' into search engine
• https://www.csp.org.uk/public-patient/rehabilitation-exercises/back-pain  or put 'csp rehab exercises back pain' into search engine
• Pilates for lower back: https://www.nhs.uk/conditions/nhs-fitness-studio/chronic-back-pain-pilates-exercise-video/  or put 'nhs fitness studio back pain pilates exercise video' into search engine
• Neck pain - Simple stretches: https://www.csp.org.uk/public-patient/rehabilitation-exercises/neck-pain  or put 'csp rehab exercises neck pain' into search engine
• Yoga for neck, shoulders, upper back:   https://www.youtube.com/watch?v=X3-gKPNyrTA  or put 'adrienne yoga for neck shoulders upper back' into search engine
• Physical Activity Ideas 10-15 minutes yoga;   
• https://www.youtube.com/watch?v=VpW33Celubg  or put 'adriene 10 min yoga for self care'
• https://www.youtube.com/watch?v=XeXz8fIZDCE  or put 'adriene yoga for lower back pain'

People who live with persistent pain are often very hard on themselves. These videos are about psychology and compassion:

• https://www.youtube.com/watch?v=jpuDyGgIeh0  or put ‘Rick Hanson on Hardwiring Happiness’ into your search engine– a 14 minute TED talk from October 2013
• https://www.youtube.com/channel/UCZIsjEy04ghoBpyIXyH42uA   or put ‘Paul Gilbert talk nicely to yourself’ into your search engine– there are 4 x 10 minute videos of Paul being interviewed where he talks about self-criticism
• https://www.youtube.com/watch?v=QS13jRcaufs  or put ‘Dr Russ Harris introduces ACT…’ into your search engine– a 10 minute interview with Russ Harris
• Practice ‘Kirsten Neff’s self compassion break’ which is on Insight timer App/website or on her website; https://self-compassion.org/
• https://youtu.be/uT_R2k2Qnz8for a short video on CBT for chronic pain or put ‘cbt for chronic pain beck institute’ into your search engine.

Information on Depression and Anxiety for our patients.

 To Access Urgent help and Talking Therapies

 

Consultants

Dr Andreas Erdmann – Clinical Lead

Dr Arun Sehgal

Dr Subhash Kandikattu

Dr Namita Arora

 

Clinical Nurse Specialists

Sr Paula Kiddie

Sr Sarah Woolfitt

 

Therapists

Dr Sarah Ronaghan – Consultant Clinical Psychologist

Mr Oliver Richardson – Highly Specialist Physiotherapist

Ms Rebecca Peake - Highly Specialist Physiotherapist

Mrs Susan Codd — Highly Specialist Occupational Therapist

 

Administrative support

Mrs Wendy Seymour, Ms Abby Coles, Mrs Sophie Newton, Ms Laura Hesketh.