
The Department of Pain Management offers a service for adults aged from 18 years old who live in persistent/chronic pain. Ongoing developments and an increased understanding of the importance of pain management and the need for collaborative care has resulted in the Department being amongst the busiest in the East of England.
The Department provides an assessment, advice and treatment service for people with a wide variety of pain conditions.
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:
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:
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
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'
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. The department has psychology as part of their multidisciplinary team and the department has strong links with Cambridgeshire Talking Therapies (CTT) service. So, depending on your presenting difficulties and their severity, will indicate whether you access psychology input within the department or within the Long-Term Conditions part of CTT.
What is psychology?
Psychology is the study of people: how they think, feel, and behave. Clinical Psychologists/therapists are trained in using this knowledge to help people who are facing difficulties in their lives. They 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/Talking Therapist does not mean that your pain is “in your head” or that your pain is part of a mental illness. Chronic/Persistent pain affects the person 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?
Psychology/CTT 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 psychologist/talking therapist 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, they aim to help people engage in useful pain management strategies by:
More specifically they can help you with:
What happens at the initial appointment?
Whether your appointment is with the psychologist or talking therapist, the aim of the initial assessment is to clarify what you know about the bio-psycho-social approach to pain, find out from you the impact of pain on areas of your life, including work, leisure, socialising and relationships with family and friends. They may work with you to form a shared understanding (called a formulation) of the issues you are struggling with. And they may highlight areas which you may want to work on or improve.
At the end of the initial appointment you will agree a plan going forward. This may involve:
Please be aware that there is usually a waiting list to see a Psychologist/talking therapist. Each service is doing its best to make the wait as short as possible.
Psychological therapy
Psychology/Talking Therapy use a variety of psychological approaches to help people. Some include Cognitive Behavioural Therapy (CBT), Acceptance and Commitment Therapy (ACT) and Compassion Focused Therapy (CFT) to name a few.
However, whatever approach the psychologist/talking therapist 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?
Whether you are seen for psychological input within the pain team or at CTT, the sessions are held in a quiet, private room whether they are over video, phone or in person.
Whatever the service, the clinician will make a summary of your appointment which will be added to a NHS record. When the therapist/psychologist writes to you they will copy in your GP and other relevant clinicians where appropriate. If you tell the therapist/psychologist information which you would rather is not passed on, then please discuss this with the therapist/psychologist. Usually there are only a few reasons why such ‘sensitive’ information would be shared:
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.
Prior and/or during your initial assessment your consent will be sought for the service to liaise with your GP and/or other service providers for the benefit of your care. Feel free to ask for clarification about this.
What if English is not my first language?
It is possible to organise interpretation services for you if necessary. Please make sure the service knows that you require an interpreter for your appointment.
Under what circumstances do the sessions come to an end?
There is a limit to the number of sessions the Psychologist/Talking Therapist can offer, and it is important that the sessions are proving useful in helping the person move towards their goals. Sessions will at some point come to an end for a variety of reasons:
The psychologist/talking therapist will review the sessions with you regularly and agree on the best action to take.
What other support is there?
Not everyone who is recommended psychological input needs it 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.
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.
Useful ways to get more active:
People who live with persistent pain are often very hard on themselves. These videos are about psychology and compassion:
The most common way to be referred to our department is through your GP or Dynamic Health (Musculoskeletal (MSK) Service). Both of these use an electronic system to refer to us which is called the NHS e-Referral Service.
Please note that our department no longer accepts referral for people whose GP is registered within Lincolnshire. This is because Lincolnshire has a county wide pain service called Connect Health.
Email: lincs.painservice@nhs.net
Tel: 01522 581777
Consultants
Dr Subhash Kandikattu — Clinical Lead
Dr Andreas Erdmann
Dr Arun Sehgal
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, Ms Laura Hesketh.