Oxford Pain Management Centre Information for patients

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1 Oxford University Hospitals NHS Trust Oxford Pain Management Centre Information for patients

2 About us The team at the Oxford Pain Management Centre (OPMC) includes: pain consultants clinical psychologist specialist nurses health care assistant administrative staff As a team, we are involved in working with people who have persistent pain. This information booklet is designed to tell you about the services offered at the OPMC and how we will try to help you to manage your pain. About the OPMC approach Persistent pain is often difficult to explain, difficult to understand and a challenge to treat. The treatment of persistent pain has changed in recent years and the OPMC team continues to develop to include new knowledge and treatments. Our aim is to keep you, the person with pain, at the centre of the management plan. This will help both us and you to work out what may be causing or aggravating your pain, although for some people a cause may not be identified. Whatever the outcome, we can then look into possible treatments which may be able to alter your pain and the negative effect it may be having on your life. Page 2

3 Acceptance and change At the OPMC we accept that your pain is real and as you describe it. You may still be coming to terms with accepting that your pain may be long-term, or even permanent. Without this acceptance it may be difficult for you to progress and for us to be able to help you. OPMC clinical assessment A referral has been made for you to come to the OPMC because you have persistent pain that has lasted for more than 3 months, and it is having a negative effect on your life. You will have an individual clinical assessment with one of our pain consultants. This will take about 45 minutes. You are welcome to bring someone with you if this will make you feel more comfortable. Please bring an up to date list of your current medications with you to this appointment. Before you come to the appointment, please fill in the questionnaires included with this booklet. These are part of your assessment and will be included in your medical notes. Please bring the completed questionnaires with you to your appointment. As part of your assessment you will be asked about your pain, previous investigations and diagnoses, medication and previous treatments and how the pain has affected other parts of your life. You may also have a physical examination as part of your assessment. You may find that your pain temporarily increases after this examination. At the end of the assessment the consultant will discuss possible diagnoses with you and outline a management plan. Page 3

4 The management plan may include suggestions about your medications, your physical and emotional health and your general lifestyle. The consultant may discuss whether you need treatment with an injection to help with your pain. If so, we will give you a leaflet to explain this treatment. We encourage you to take an active role in working through the recommendations in your management plan. This will help you to get the best results possible. Please speak to one of the staff on the Oxford Pain Management Centre team if you are unsure about anything. A copy of the assessment and the management plan will be sent to the doctor who referred you, your general practitioner (GP) and also to you. This should be with your GP within 10 days. Unfortunately the OPMC cannot give you a prescription for medications; this will be provided by your GP when they receive the letter. The management plan: A whole person view of pain The management plan that the OPMC will create for you will focus on you as a whole. This will help us to provide a broader and more holistic approach to treating your persisting pain. This is a different approach from the traditional medical model which usually focuses on medications and medical interventions. Focusing on you as a whole person allows us to address the problem of your persisting pain in three ways: 1. Biology any biological factors that could be causing your pain, such as disease or injury. Page 4

5 2. Psychology how you think and feel about your pain and what could be causing it. 3. Social how your family, work and social pressures may be contributing to the problem. The example below (based on back pain) shows how different aspects of your life can contribute to your pain; creating a circle which causes it to continue or get worse. Back Pain Worry about the cause of pain and the future consequences Further reduction in movement, causing loss of fitness, social withdrawal and depression = more pain Avoidance of movement and activities (work, sport, hobbies) due to fear of making it worse The management plan: What the OPMC has to offer Pain management education We will give you practical advice on managing your pain. Together we will explore strategies and techniques that you can use yourself to give you more control over your pain and your life. You may be helped with this by the Clinical Psychologist and Clinical Nurse Specialists. We may refer you to the Optimise Rehabilitation Pain Programme, which is an outpatient pain management programme. Page 5

6 Medication Your GP may have started you on pain relief medication to help reduce your pain. There may be other, less familiar, medications which can be useful for reducing persisting pain. There are a variety of different medications that can be tried; you may need to try a number of these to find the one that suits you best. Initially, you may need to take these medications for several months but, ultimately, our long term goal is to have you taking as little medication as possible to manage your pain. If we think that you would benefit from a trial of strong opioid medication you may be referred to the Opioid clinic, based within the OPMC. We will advise your GP of any recommendations to changes with your medication. Your GP will continue to oversee the prescription of these drugs. If we do recommend that you try a course of opioid medication, these will be prescribed by your GP only. Transcutaneous electrical nerve stimulation (TENS) This is a small portable battery-operated device that can reduce pain by blocking pain signals. It works by passing a mild electrical current through sticky pads placed on your skin. This feels like a tingling sensation and the effect is similar to rubbing an area after you bump it. If we think that you would benefit from using TENS, we will show you how to use the machine. We will arrange to lend you a machine for one month. If you find it beneficial you may then wish to buy a machine. You can either buy the machine from the OPMC or they are available from many chemists, supermarkets and from the internet. Injections Sometimes an injection may be useful for your pain. Details of specific injections that may be helpful to you will be given to you by your consultant at your initial consultation. It is worth noting, however, that injections are not always appropriate; they do not always relieve pain and generally only give temporary relief. Page 6

7 If we feel that you could benefit from injections, you can have them as a day case procedure in the treatment room at the OPMC. The treatments can be carried out by a consultant or a supervised anaesthetic advanced pain management trainee. The initial injections should be thought of as being diagnostic. This means that they can give us more information to help pinpoint where your pain may be coming from. You will be contacted by a Clinical Nurse Specialist by telephone after your injection. They will collect information about the effect it has had on your pain. This will help us to decide whether to offer you further injection treatments. You can expect your total stay for an injection appointment to be between 1 and 4 hours. The time you will be in the treatment room will be around 30 minutes and you will then need between 1 to 3 hours to recover afterwards, depending on the type of injection you are having. It is not necessary to fast (stop eating and drinking) before an injection. You should continue to take your regular medication unless you have been advised not to by the pain clinic. If you are diabetic you must make sure you have stable blood sugars (below 10) when you come for your injections. This is because steroid medication, which is often used for injections, can increase your blood sugar. If you have an infection or are on antibiotics we will not be able to do your injection. Please let the clinic know so we can reschedule your treatment. You must have someone to take you home after the injection, as you may still have pain or your pain may be worse after the injection. Please make sure you have arranged this before you come, otherwise the injection will not be done. You do not need to be supervised when you are back at home, but need to be able to call a nearby friend or relative if you feel you need help or are unsteady. Page 7

8 Psychological support Persisting pain can affect every aspect of your life. It can change how you perform your normal daily activities, how you think and feel and it can even change your relationships. Often, if you recognise and address each of these areas, you may find you can cope better with living with persisting pain. You may find that meeting with the clinical psychologist and Clinical Nurse Specialists can help to: increase your understanding of persistent pain improve your physical ability reduce low mood and depression related to pain lessen your anxiety about pain improve stress management improve your confidence to manage your pain. It can also help you to lead as normal a life as possible, despite your pain, through a gradual return to activities that you value or find enjoyable. The clinical psychologist and Clinical Nurse Specialists can work with you to make sure that you can use your pain medication effectively, including helping you to gradually reduce the dose if you need to take pain medication on a long-term basis. Optimise Pain Rehabilitation Unit The Optimise Pain Rehabilitation Unit (OPRU) at the Nuffield Orthopaedic Centre offers expert advice and treatment for musculoskeletal pain which has not responded to other, less intensive therapies. This rehabilitation aims to help people to increase or return to activities that they want or need to do in daily life. Page 8

9 The OPRU offers programmes of varied intensities to suit different abilities and requirements. Facilities include a modern purpose-built gym and hydrotherapy pool. The aim is to help you understand your persisting pain, introduce you to a manageable exercise programme and improve your quality of life. Helpful information Some of your appointments at the OPMC will be for a consultation, some for a treatment procedure and others may be over the telephone. Please check that we have up to date contact details for you, including a telephone number to call you for the telephone appointments. Telephone appointments are as important as a clinic appointment. The assessment and outcome of these can help us to plan your further treatments and appointments. Please note that hospital policy means that we are unable to say who we are if we are not able to speak with you. This is to protect your privacy. If you are not able to come to your appointment, or will not be available for a telephone appointment, please contact us as soon as possible. This will allow us to use the appointment time for someone else and reschedule your appointment for another time. You will have received a set of questionnaires that ask you about your experience of pain and how it affects your life. Throughout your treatment we will ask you to complete these questionnaires; this is so we can assess the continuing effect of your pain on your life and review how we are treating you. We do our best to keep appointments to time but hope you will understand if there are any delays. If there is a delay we will try to let you know as soon as possible. Page 9

10 After each visit or telephone appointment we will write to your GP to tell them about your pain clinic care. We do this as they will also work with us to provide your care, and would be your first point of contact for any advice. When you come for your appointment Bring your glasses, if you need them for reading. Always bring a list of all your current medication. Please tell the doctor or nurse if you are taking or start taking anticoagulants (medication to thin your blood). If you do not do this we may have to delay your treatment. If there is any possibility you may be pregnant please tell the doctor or nurse. The OPMC is a teaching hospital and we are committed to the training of medical and nursing staff. Anaesthetic trainees and medical students regularly spend time in the clinic as part of their training programme. Please let us know if you would rather not be seen by a trainee or medical student. How do I get advice? If you have any general questions, please feel free to leave a message on the OPMC voic or send us an . A Clinical Nurse Specialist will get back to you within 7 days. Advice line for the Pain Relief Unit: Tel: If you have any urgent problems, please contact your GP. Page 10

11 Other resources Understanding pain: what to do about it in less than 5 minutes Website: The pain toolkit Website: Health Talk Online Website: long-term-conditions/chronic-pain/topics Backcare Website: Mindfullness Website: British Pain Society Website: Fibromyalgia Website: Chronic Fatigue Syndrome (ME) Website: Migraines Website: Pain UK Website: Pelvis Pain Website: Shingles Website: Trigeminal Neuralgia Website: Exercise Works Website: Page 11

12 If you have a specific requirement, need an interpreter, a document in Easy Read, another language, large print, Braille or audio version, please call or Dr Frampton, Pain Consultant March 2015 Review: March 2018 Oxford University Hospitals NHS Trust Oxford OX3 9DU OMI 11617P

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