WWL Teaching Hospitals NHS Foundation Trust

Treatment Options

Within the chronic pain clinic we can offer a wide range of treatment options to try and manage your pain, however, not all options are suitable for everyone and until we meet you we cannot say which one would be right for you.

Please feel free to look at all our treatment options we offer so that you are aware of them and feel informed but remember some may not be suitable for you. When you come for your consultation we can discuss what options would be appropriate for you.

What we offer

Medications
Within chronic pain we use drugs that will be familiar to you and drugs that may not be. It is unlikely unfortunately, that these medications will offer you 100% pain relief. Some medications are used for pains such as aches, throbbing and joint pains, other types of medications are used for nerve pains, such as shooting, burning and altered sensation type pains. Again until we meet you and discuss your pain we don’t know what medication you would need / require, if any. Please click on the links below to read about the different drugs we use but remember there is the possibility that these may not be suitable for you.

Pain 011 Amitriptyline Patient Leaflet
Pain 012 Capsaicin Cream Patient Leaflet
Pain 015 Gabapentin Patient Leaflet
Pain 020 Trial of Oral Ketamine Patient Leaflet
Pain 034 Pregabalin Patient Leaflet
Pain 040 Tapentadol Patient Leaflet
Pain 041 Duloxetine for Pain Relief Patient Leaflet

Self Acupuncture
This service is where we teach you how to do your own acupuncture. Unlike conventional acupuncture where you will have lots of needles placed around where you have pain, we use 1 needle in each hand and foot. This is thought to be the main points for pain relief and relaxation. Over the course of your sessions we then go onto teach you how to do it safely, competently and effectively. You need to be able to reach your feet with both hands to do this or have a relative who would be able to do this for you but they need to be able to attend every appointment with you. Again this is not suitable for everyone. Please see leaflet for information.

Pain 033 Acupuncture Treatment at Home Patient Leaflet

Psychology
Most people tell us that living with chronic pain can have a major impact upon their everyday lives. Long-lasting pain is very difficult to live with, and can affect many different aspects of people’s lives, e.g. personal relationships, activity levels, work-status etc. This can lead to a reduced quality of life and emotional distress, such as anxiety, low mood and depression.

Alongside medication, and sometimes injections, the Pain Clinic aims to work within a multi-disciplinary approach, to help people learn to cope better with the pain they experience and to increase their quality of life. This often involves referring to services such as an individual exercise programme via Physiotherapy, or relaxation and pacing advice through Occupational Therapy.

Clinical Psychology is also part of the Pain Clinic, and aims to help with the negative emotions associated with chronic pain, such as anxiety, depression, guilt, fear-avoidance. etc, and to assess and work on how these are affecting you within your everyday life. A psychological approach does not aim to cure your pain, but rather to help you cope with the difficult emotions associated with it. We often find that reducing negative emotions can help people feel more positive and more in control of pain. Being referred to Clinical Psychology does not mean that we think your pain is “all in the mind”, rather that we recognise that living with chronic pain has emotional consequences. Talking with someone about how you are thinking and feeling about your pain is often the first step to identifying how your emotions affect you and your overall pain experience.

Useful resources:

Whilst every care has been taken to ensure that these links are relevant and appropriate, please note that WWL are not responsible for managing nor updating the content of these sites.

Occupational Therapy
The Occupational Therapist will work with you to problem solve and explore what difficulties you may be experiencing because of your pain such as:

Personal care - getting dressed/washed
Activities of daily living - cooking/shopping/cleaning
Hobbies or past times - walking/socialising/craft/fishing/exercise (along with the Physiotherapy Team)
Social/job roles - being an employee/son/daughter/parent/grandparent/carer/friend
Or any other activity that has value and meaning to you

We will help you explore alternative ways of doing these tasks such as:

Different techniques/alternative ways
Pacing, prioritising and planning strategies
Small aids or adaptations
Strategies to help you cope and think about living with pain
Help you set targets or goals that are realistic and manageable for you to achieve despite your pain condition
Deep breathing, mindfulness, relaxation, and sleep techniques and ideas

These are some of the many tools you can use to help you manage your chronic pain condition.

we also work closely with the other team members such as the Doctors, Specialist Nurses, Psychologists and Physiotherapists to help you continue the roles in your life that are important to you.

Apps to try to get you started:

Headspace - mindfulness
Calm - meditation techniques for sleep and stress reduction
Breathe In - deep breathing
iBreathe - deep breathing

If you are struggling to put these apps into practice; if you have been referred to the Pain Management Therapy Team, they can help you get started and learn more about tension and how this feeds into your pain experiences.

Physiotherapy

The Specialist Chronic Pain Physiotherapist will work with you to help understand why you are in pain and what you can do about it. The physiotherapist will help you to gain control over your pain and be as independent as possible. This will encompass pain education, goal setting, talking therapy strategies and exercises.

Following your assessment, the physiotherapist will guide you through a suitable exercise programme that is personal to you. You will be educated on the benefits of exercise in managing chronic pain and the other benefits it has on your health and wellbeing.

There is a whole team approach to support you in managing your chronic pain. You might see the physiotherapist independently, jointly with Occupational Therapy or as part of the Pain Management Programme. Everybody is different therefore it is important to find the treatment option that suits you best.

Pain Management Programme

Your specialist nurse, doctor or other health professional will have discussed with you a long term plan for managing your chronic pain. This involves you learning more in depth about your pain, how other daily life activities can trigger your pain perceptions and providing you with a ‘tool kit’ of skills to better manage your pain now and in the future.

What can you expect from the Pain Management Therapy Service?

The therapists utilise evidence based practice to provide you with the most up-to-date information and treatment for you to be able to decide which strategies/skills or techniques work for you the best. They communicate regularly as a team to ensure your treatment/input is timely and safe.

Who Are We?

We are a team consisting of an Occupational Therapist, Physiotherapist and Psychologist who are specialised in Chronic Pain, assisted by a Pain Management Therapy Assistant, Assistant Psychologist and Trainee Clinical Psychologist.

We offer group-based education sessions on different aspects of pain management; these may be delivered by one or multiple members of the team. There may also be a need for some individual therapy sessions which will be determined by specific needs.

Occupational Therapy

The Specialist Chronic Pain Occupational Therapist provides diaphragmatic breathing, body awareness, mindfulness and relaxation training; another tool to managing your chronic pain.

The Occupational Therapist will also work with you to problem solve functional difficulties you may have with your personal care, sleep hygiene or activities of daily living that have value and meaning to you. We may advise on adapted techniques or small aids to help you accommodate any restrictions you may have.

Activity analysis, goal setting, pacing, prioritising and planning are other skills the Occupational Therapist can support you in learning to help you gain that sense of control over your pain condition.

They also work closely with the other team members to help you continue the roles in your life that are important to you.

Physiotherapy

The Specialist Chronic Pain Physiotherapist will work with you to help understand why you are in pain and what you can do about it. The Physiotherapist will help you to gain control over your pain and be as independent as possible. This will encompass pain education, goal setting, talking therapy strategies and exercises.

Following your assessment, the Physiotherapist will guide you through a suitable exercise programme that is personal to you. You will be educated on the benefits of exercise in managing chronic pain and the other benefits it has on your health and wellbeing.

There is a whole team approach to support you in managing your chronic pain. You might see the Physiotherapist independently, jointly with Occupational Therapy or as part of the Pain Management Programme. Everybody is different therefore it is important to find the treatment option that suits you best.

Psychology

See psychology section in "Treatment Options"

Pain Management Programme

The Pain Management Programme is an interactive course currently delivered at Leigh Sports Village. It is delivered by the Pain Management Therapy Team for 2 and a half hours per week over 10 weeks. There are usually between 10-15 patients in attendance with a variety of chronic pain conditions. The group environment provides an opportunity to share experiences and learn from other people who have chronic pain.

The group aims to help patients understand more about their pain condition and the factors which influence it. It is an opportunity to learn new skills to be able to manage pain more effectively, gain a sense of control over the pain, enhance mood and improve productivity and activity levels through self-management strategies.

Key themes of the programme are:

Understanding pain
The psychological impact of chronic pain
Introduction to relaxation & mindfulness techniques
Sleep hygiene
Pacing techniques
SMART goal setting
Activity management & adaptation of daily living tasks
Exercise and keeping active

Patients are encouraged to bring a drink of water, pillows, move around, stretch, change position and bring anything required to make the group experience as comfortable as possible. Loose fitting clothing and supportive footwear or trainers are essential for the exercise component of the group. The exercise element is graded and will be tailored to your needs.

What does the group expect from you?

You must commit to all sessions of the group. You will be encouraged to practice the skills learnt each week during the time between sessions.

Patients who have accepted there are no further medical or surgical options to manage their pain will respond well to the Pain Management Programme.

Resources:

Week 1 –

Week 2 –

Week 3 –

Week 4 –

Week 5 –

Week 6 –

Week 7 -

Week 8-

Meet the Team

Consultants

Dr Goeke Glatzel - clinical lead
Dr Jaitly
Dr Murugesan
Dr Krishnamoorthy
Dr Ghaly
Dr Swayamprakasam

Associate Specialist

Dr Poonamallee

Clinical Nurse Specialists

Susan Downs
Louise Barnes

Pain Management Specialist - Occupational Therapist

Sarah Reeve

Pain Management Specialist - Physiotherapist

Jemma Leigh

Pain Management Therapy Team Assistant

Dionne Carroll

Clinical Psychologist

Deborah Anderson

Psychology Assistant

Astrid Nelson

Internet Resources for Self Management

www.nice.org.uk/guidance/ng59

www.nice.org.uk/guidance/ng193

https://www.youtube.com/watch?v=C_3phB93rvI

https://www.tamethebeast.org/

https://www.pathways.health/how-occupational-therapists-support-patients-with-chronic-pain/

https://www.retrainpain.org/

https://www.flippinpain.co.uk/

https://www.csp.org.uk/conditions/chronic-pain

https://www.csp.org.uk/conditions/managing-pain-home/managing-your-pain

https://www.nhs.uk/live-well/exercise/walking-for-health/

https://www.nhs.uk/conditions/nhs-fitness-studio/

https://www.nhs.uk/conditions/back-pain/

https://livewellwithpain.co.uk/

Apps:

Headspace—mindfulness

Calm—meditation techniques for sleep and stress reduction

Catch it—University of Liverpool CBT app Useful telephone numbers:

Samaritans—116 123—nationwide helpline number

Local NHS mental health crisis line health team for urgent

Mental health support: 0800 051 3253

Further reading:

‘Pain is Really Strange’ - Steve Haines

COMMON QUESTIONS

Do I need to go to accident and emergency if my pain increases?

No, it is probably a flare up. With Chronic Pain it is important to remember that Flare ups are normal. They will happen to everyone. What varies is how often (Frequency) and how much they affect the person (Severity and Duration). They can last a few hours, few days or even a few weeks. They can be worrisome initially but it is not an indication that the underlying condition has worsened and definitely not a cause for panic. The goal is to continue as normally as possible and over time work to shorten the duration and reduce the frequency and severity.

Flare ups can be caused by many reasons; sometimes being a little overzealous with day to day activities, a change to work or home situations, a change to or missing a dose of your medication. So, some self reflection is important to try and identify potential “triggers” of your flare ups. Once you have an idea of what is causing them, then you can make changes to avoid these in the future. Please note there may not always be a trigger to a flare up.

Other tips that can help:

Balance between exercise and rest – It’s important not to undo all the hard work you had previously put in in terms of exercise, but obviously the increased pain levels mean that you won’t manage quite as much as previous. The temptation is the stop altogether, but this can often prolong the duration of the flare up. Instead, continue with gentle exercise where possible and balance it with regular rest breaks as well as pacing activities so you don’t “over-do it”.
Medication use – Although managing medication should be applied all the time, its important during a flare up that you keep up with regular dosages as it may help to reduce the severity and duration of the flare ups, while also helping to allow you to continue the exercise.
Positive Thinking – Remember that a flare up is temporary and not an indication that anything has worsened.
Socializing – Make arrangements and see friends/family, go on a walk etc. Social interactions act as a distraction from our pain but can also help release endorphins which make us feel better and may reduce pain.
Relaxation – This can have positive effects both physically but also psychologically. Practicing Yoga and Meditation is something that’s advised to help manage chronic pain in general but again can be especially important during a flare up.

If you should experience any of the following symptoms then you should go to accident and emergency.

Urinary Retention / Incontinence - Unable to pass urine when you feel the need to go or uncontrolled incontinence
Unable to stop a bowel movement or leaking
Numbness in or around your back passage, buttocks or between your inner thighs
A change in ability to get an erection
Pain / loss of power in both legs and/or worsening weakness in the legs

Can I get addicted to my medication?

Many chronic pain patients take some form of opioid medication to help manage their pain, if this helps reduce your pain, enables you to increase your activities and participate in day to day living then this is an acceptable use of your medication but will still need reviewing regularly.

Opioids are most addictive when you take them using methods different from what was prescribed for you, taking more than your prescribed dose of opioid medication, or more often than prescribed, can also increase your risk of addiction. A number of additional factors — genetic, psychological and environmental — play a role in addiction, which can happen quickly or after many years of opioid use.

According to the faculty of medicine published data do not allow firm conclusions to be drawn regarding the prevalence of addiction in the UK in people given opioids for the treatment of pain. Data from randomised clinical trials are unhelpful as trial duration is usually less than 12 weeks. Data from longer-term, open-label extensions of clinical trials are of limited use as there is little agreement on definitions in relation to problematic drug use. It is highly likely that if you take opioid medication regular then you will more than likely become dependant on that medication but that does not mean you are addicted, however if you tried to stop this medication without reducing it you will encounter withdrawal symptoms. If you feel you have become addicted then there is support available, speak to your GP or the pain clinic clinicians.

Will increasing exercise make me worse?

Initially it may do but it shouldn’t make you become bedbound and you should try to continue with the exercises. This is a long term treatment and will take time before you notice any significant benefit. It is all about pacing yourself so your end goal is increasing your exercise tolerance and strengthening your muscles.

Can you fix it?

It is unlikely that we will be able to fix your pain or even give you 100% pain relief. You have been referred for pain management, that entails trying to help you accept that this pain is potentially long term and learning to get on with your day to day activities and life despite the pain.

Patient Questionnaire

Information to follow

Locations

Clinics are held at:

Leigh Infirmary
Thomas Linacre Centre, Wigan
Wrightington Hospital Outpatient Department

All injections are done at Leigh Infirmary only.

Acupuncture clinics are at Leigh Infirmary and Thomas Linacre Centre.

Pain Management Programme is at Leigh Leisure Centre (Studio 3) 1st Floor, Sale Way WN7 4JY - Leigh Sports Village

Our Services

Chronic Pain Service

Patient Journey

What we offer

What can you expect from the Pain Management Therapy Service?

Who Are We?

Occupational Therapy

Physiotherapy

Psychology

Pain Management Programme

What does the group expect from you?

Consultants

Associate Specialist

Clinical Nurse Specialists

Pain Management Specialist - Occupational Therapist

Pain Management Specialist - Physiotherapist

Pain Management Therapy Team Assistant

Clinical Psychologist

Psychology Assistant

Do I need to go to accident and emergency if my pain increases?

Can I get addicted to my medication?

Will increasing exercise make me worse?

Can you fix it?