What can we do for you?

Your initial pain clinic appointment

The obvious aim of the pain clinic is to reduce - and ideally to cure - your pain. There are a number of ways the team will try and help you to reduce your pain. At the initial appointment your consultant will review your current medication and suggest any changes that may lead to better pain relief.

The drugs used for pain relief include:

Non-opioid medication

• Paracetamol
• Non-steroidal anti-inflammatory drugs (NSAIDs)

Opioid medication

• Weak opioids eg codeine and dihydrocodeine
• Srtong opioids eg buprenorphine, tramadol, morphine etc. Strong opioids are often not very useful for persistent pain but occasionally can be helpful. Your consultant will discuss the options with you.

Adjuvant medication

• An "adjuvant" drug is a drug that is prescribed for a reason other than the one it was origionally licenced for. In pain there are two main groups of drugs that are sometimes helpful:
• • Anti-convulsants (anti-epilepsy drugs) e.g. gabapentin and pregabalin
  • Anti-depressants e.g. amitriptyline and duloxetine

Topical medication

• If your pain is very localised ocassionally "pain patches" or creams can be helpful. These include:
• • Topical lignocaine plasters
  • Topical capsaicin patches (Qutenza) or ointments

Injections are sometimes helpful in reducing or even curing pain. However it must be remembered that injections are usually only of short term benefit and are not appropriate for a large number of pain problems. The injections offered at the Pain Clinic include:

• Epidurals
• Nerve blocks
• Facet joint injections
• Trigger point injections

Where injections are offfered they will usually be combined with other strategies designed to help you improve your level of physical fitness and function e.g. visiting the physiotherapist.

Other techniques that are sometimes helpful in reducing the intensity of pain are TENS, acupuncture and physiotherapy. They are discussed below.

It is not always possible to cure or even reduce the intensity of pain. However, there are many ways in which the impact the pain is having on your life can be reduced. Education about why you are suffering with chronic pain and an understanding that pain itself is a disease can be reassuring. Having persistent pain does not necessarily mean you are damaging your body and learning how to use your body more normally again can help in terms of both achieving your goals in life and improving your physical fitness.

The pain team is multidisciplinary and you may well be referred onto one or more of the other team members after your initial consultant appointment.

Physiotherapy

You may be referred to physiotherapy by a member of the pain team because your pain is causing you physical difficulties. Although you may have had physiotherapy before, you will be seen by a senior physiotherapist who has a special interest in pain as a member if the pain management team. Consequently they may have a different approach to what you have already tried.

You will have a thorough physiotherapy assessment which will include pain education and information about intervention options. Your physiotherapist will discuss with you the clinically indicated opportunities available to support your rehabilitation. These may include individual physiotherapy, TENS, acupuncture and/or referral to one of our groups in the hydrotherapy pool or the gym at the Bristol Royal Infirmary (BRI). An assessment for our Pain Management Programme may also be appropriate. The overall aim of physiotherapy is to enable you to work towards your personal goals. The physiotherapist will support you to increase your confidence, activity levels and overall function.   

TENS (Transcutaneous Electrical Nerve Stimulation)

A TENS machine can be helpful for some people to reduce their pain or distract them from it. TENS seems to work by stimulating nerves in your skin to partially block the danger signals (in the same way rubbing or holding the thumb you have hit with a hammer seems to ease the pain) and it may increase the body's own pain killing chemicals (endorphins). We can loan you a TENS machine for a couple of months to see if it is helpful for you. At your appointment a nurse or physiotherapist would explain how to use the machine, which programmes to try and then review you to see how you are getting on with managing your pain and how you got on with the TENS. 

Acupuncture

Acupuncture is the insertion of fine, sterile needles into the skin to relieve pain. The acupuncture approach is Western or Trigger point acupuncture (not Traditional Chinese Medicine). We normally book you in for three treatments then review how you got on. We are unable to offer more than 6 treatments. Some people find acupuncture helpful in managing their pain; some find it helpful when their muscles are in spasm, to move more easily (hence do their exercises); and some people report it helps their sleep and sense of wellbeing too.

See the British Medical Acupuncture Society website for more information about a Western acupuncture approach:

www.medical-acupunture.co.uk

Psychology

We understand that persistent pain can have a significant impact upon your life. You may have reduced meaningful activity because of your pain, for example you may no longer be working, socialising, exercising or doing other enjoyable activity. Often being in persistent pain can affect the way you think, for example you may have thoughts like "I'm useless now I can't do...." These thoughts, together with the change in lifestyle, can cause you to feel frustrated, hopeless, anxious and depressed. We know that how you are feeling can impact upon your pain mechanisms. So, if you are low or stressed, it is likely that you will find it more difficult to manage your pain. All of these reactions are entirely normal, and they affect a significant number of people we see in the clinic with persistent pain problems.

Your consultant may suggest you meet with the team clinical psychologist to explore how your pain impacts upon your life, and to support you in developing strategies to reduce this impact, so that you can begin to live well alongside your pain. You may find just one meeting with the clinical psychologist helpful or alternatively you and the clinical psychologist may decide that you would benefit from further meetings.

Pain Management Programme

The Pain Management Programme is a course which runs one morning a week for 8 weeks. A specialist physiotherapist, clinical psychologist and specialist nurse lead the programme for between 10 and 14 people with persistent pain. During the programme group members are supported to make changes in order to improve their lives alongside their pain. The programme does not aim to reduce pain but can help people to become more confident so that they can improve their quality of life by managing their pain better and lessening the impact it has on their lives.

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