Chronic Pain

Services

New eAdvice Service via SCI Gateway.
You can access advice from the Lothian Chronic Pain Service Consultants by choosing the Advice Only option in the SCI Gateway. We shall endeavour to reply promptly.

Lothian Chronic Pain Service provides out-patient multi-disciplinary management of adults with chronic pain.

The team consists of consultants in pain medicine and in rehabilitation, specialist nurses, physiotherapists and psychologists.

The service is split into a Pain-Management-Programme at AAH and Pain Medicine at WGH, RIE and Leith CTC.

Pain Management Programme offers:
Rehabilitative & psychological approach to pain self-management.
Individual and group-based programme.

Pain Medicine offers:
Assessment and further investigation.
Medication review and drug management.
Injection therapy and complementary therapy.
The two are not mutually exclusive. Patients will transfer between pain disciplines where there is clinical need. Referrers can request that the patient be seen by a particular discipline but this request may not be fulfilled. Patients should be aware of this when being referred.

cCBT for Chronic Pain and emotional difficulties.

There is a high prevalence of mental health difficulties in people suffering from chronic pain. In turn those can worsen pain experiences.

There is a computerised CBT programme available for people in Lothian who have chronic pain and mild to moderate anxiety and depression (including panic attacks).

Who to refer:

Pain causing significant distress or disability
Duration > 6 months
Age 16yrs and over
No planned referral to another specialty for diagnosis or treatment of pain

Pain Management Programme is effective if:
- Patient accepts the need to learn new ways of coping but not reducing pain
- Patient understands these new skills are taught by specialist physiotherapists and psychologists
- Patient accepts the search for diagnosis and cure has ended
- Patient has sufficient cognitive function and motivation to engage

Who not to refer:

Age <16yr
Patients who require prior treatment/assessment of interdependent conditions:
Major depression, psychosis and high risk of suicide or self-harm are best managed by Mental Health Services
Patients with drug and alcohol dependency benefit from assessment by substance misuse services
Unresolved abuse, post traumatic stress, eating disorders, severe anxiety, anger management issues, obsessive compulsive disorder and bereavement require disorder specific service
Please do not expect hospital admission as we are outpatient only
Spinal Red Flags: if you suspect fracture, cord compression, cauda equina, infection or malignancy please investigate and/or refer to appropriate specialty with appropriate degree of urgency- please see here.

How to refer:

SCI Gateway is the best pathway for referral

Your referral will be triaged to either Pain Management Programme or Pain Medicine based on the information you provide. Referrers may request that a patient be seen by a particular discipline but this request may not be fulfilled. Patients should be made aware of this when being referred.

Pain Discussion

It is important that there has been discussion with the patient about their readiness to change, to move away from the acute medical model, away from seeking a cure and more investigations, towards a search for, or a willingness to accept, new ways of coping and management of the pain as a long term problem.

Pain Management helps pain sufferers come to terms with what has happened to their lives and to accept that they may not find a magic answer to cure their pain. Pain Management skills help people to think and plan for their own future in a positive and constructive way.

Email Advice: You can pose clinical questions directly to pain medicine consultants by email: lothianchronicpainservice@nhslothian.scot.nhs.uk

Pain Management Programme

Dept of Clinical Psychology
Astley Ainslie Hospital
133 Grange Loan
Edinburgh, EH9 2HL
Tel: 0131 537 9128
Fax: 0131 537 9120

The Pain Clinic
Leith Community Treatment Centre (LCTC)

12, Junction Place
Edinburgh, EH6 5JQ
Tel: 0131 5366225
Fax: 0131
lothianchronicpainservice@nhslothian.scot.nhs.uk

ALL PAIN OUTPATIENT CLINICS MOVED TO LEITH CTC IN 2014. PAIN CLINIC INTERVENTIONS (INJECTION THERAPY) STILL CONTINUE TO BE AT DCN AT WESTERN GENERAL HOSPITAL

Chronic Pain Management Principles

NHS Scotland’s Quality Prescribing for Chronic Pain: a Guide for Improvement 2018-21 promotes a focus on the prescribing of analgesics for chronic pain, with patient–centred structured review of appropriateness, efficacy and tolerability of treatment and promotion of optimal care.

Often key is establishing understanding round medications used for acute pain, and ensuring that those are reviewed to avoid long-term inappoprioate prescribing. The ideal is to reassess if pain continues for 12 weeks, when chronic pain approaches are indicated, including deprescribing where appropriate.

There is a high level of risk associated with consumption of opioids due to the associated risks and adverse effects. Lothian has produced a Vision Guideline for chronic pain to help support good practice, including round prescribing, coding and signposting to other resources.

Please note useful Patient Information Leaflets and further information on the Resources and Links Page.

Note: this approach should not be used for palliative patients and patients with cancer-related pain.

Good Practice in Chronic Pain Assessment – resources:

Chronic pain recording
Read code for chronic pain:
1. 1M52 (Chronic pain) or 66n (Pain review)
Character/type of pain – pain assessment tools provided in the Vision guideline
Site(s) of pain
Pain score (patient score/10)
1. ‘Rate your pain on a score of 0 to 10 where 0 is no pain and 10 is pain as bad as you can imagine’

Holistic, patient-centered consultation – education and expectation:
‘What matters to me’ approach
Not Just Painkillers – NHS Lothian leaflet – describes acute and chronic pain, gives information on the different types of pain medicine, includes information and links to advice on self-management
Live Well with Pain Goal Setting resource – patient-identified goals
Lothian Chronic Pain Management website: videos and resources e.g. Pain Toolkit, Reconnect 2 Life.

Patient management plan resources:
Self-management options, supportive resources available locally; green prescribing; Link Worker where available
Provide patient information on pain medicines
- Opioid Painkillers – keep then short, stay safe
- Opioids Aware patient leaflets
- Gabapentinoid reduction
Dose titration to therapeutic level, with explanation
Realistic expectation of analgesia, including that medicines prescribed for pain are reviewed for efficacy and tolerability and may be stopped if the risk benefit balance is not favourable.