Chronic MSK Pain (Local Services)

Physiotherapy Led Chronic Pain Management Service

Services

The service provides a biopsychosocial approach to Persistent Pain, delivered by a team of physiotherapists across Lothian who have had training in pain management.

Their aim is to encourage exploration into the different methods of self management to ultimately allow the individual to cope better with their pain.

Each patient will be assessed and offered individualised pain management through a combination of group sessions and / or one to one sessions.

Group sessions provide an opportunity to learn, understand and reflect on all aspects of pain management and how pain personally affects each individual. The classes are delivered over 6 weeks. Patients learn and consolidate their self-management strategies by attending group learning in: Understanding Pain, Pacing, Relaxation, Activity Management, Managing Thoughts and Flare up planning.

Who to refer:

Are aged 16 or over
Chronic musculoskeletal pain > 6 months
Exhibit mild to moderate psychological or emotional distress regarding their pain. Please see “who not to refer” for further information
The person is open to self-management and able to make a commitment to the methods and goals of treatment.
No planned referral to another specialty for diagnosis or treatment of pain.
All relevant investigations have been completed

Who not to refer:

Age <16yrs
Unresolved abuse, post traumatic stress, eating disorders, severe anxiety, anger management issues, obsessive compulsive disorder require disorder specific services. Mental Health (Adult) – RefHelp
Patients who require prior treatment/assessment of interdependent conditions:
- High levels of psychological or emotional distress: If caused by factors not related to pain eg severe depression, severe anxiety, psychosis and high risk of suicide or self-harm are best managed by Mental Health Services.
- Patients with severe psychological distress due to their pain are likely to require Pain Psychology. In this circumstance please consider referral to the Lothian Chronic Pain Service at the Astley Ainslie Hospital: Chronic Pain – RefHelp
- Patients with substance use issues which interfere with their ability to function are most likely to benefit from addressing these issues prior to referral Alcohol and Drug Use – RefHelp
- For support in managing pain and substance use consider referral to the Pain and Dependency Clinic at Leith Community Treatment Centre Pain Clinic – Lothian Chronic Pain Service
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 Musculoskeletal (Physiotherapy) – RefHelp (nhslothian.scot)

How to refer:

Via SCI gateway. Mark the referral for the attention of Physiotherapy Pain Management.

Please include as much relevant information as possible including the patient’s physical limitations and issues affecting progress.

For more complex pain presentations and high levels of psychological and emotional distress, consider referral to the Lothian Chronic Pain Service at the Astley Ainslie Hospital: Pain Clinic – Lothian Chronic Pain Service

Edinburgh patients: Currently under review as of 25-02-25

East Lothian patients

Please make an electronic referral via SCI Gateway by selecting:

AHP – Physiotherapy

> East Lothian – East Lothian Rehabilitation Service

> LI Physiotherapy.

Please specify ‘Physio-led chronic musculoskeletal pain management’ in the drop-down box.

West Lothian patients

Introductory class: patients self-refer by telephoning the physiotherapy department (0131) 536 1060 (Option 3) to book themselves into their preferred class or can “drop in” to their preferred class. All GP practices have the updated class days/times leaflets with the contact number to self-refer.

1:1 MSK physiotherapy pain management: please make an electronic referral via SCI Gateway by selecting AHP – Physiotherapy > West Lothian St Johns Hospital > LI Physiotherapy WL.

Please mark the referral for the attention of Physiotherapy Pain Management.

Midlothian patients

1:1 MSK Physiotherapy management with a level 2 or 3 pain trained Physiotherapist.

Currently under review as of 25-02-25

Pain Discussion

It is important that prior to referral there has been discussion with the patient about their readiness to

Change and move away from the acute medical model
No longer seek a cure and more investigations
Accept new ways of coping and managing their pain

Pain Discussion

It is important that prior to referral there has been discussion with the patient about their readiness to

Change and move away from the acute medical model
No longer seek a cure and more investigations
Accept new ways of coping and managing their pain

For Patients (also useful for individual professional learning)

Understanding Pain

Lothian Chronic Pain Service

https://services.nhslothian.scot/lcps/

Flippinpain

https://www.flippinpain.co.uk

A selection of resources created by people living with chronic pain, healthcare professionals and pain scientists. It aims to help patients understand their pain and give patients the knowledge and skills to manage their pain.

Retrain Pain

https://www.retrainpain.org/

Reconnect2Life

https://www.torbayandsouthdevon.nhs.uk/services/pain-service/reconnect2life

An interactive programme to help you look at your pain and how it affects you. It consists of a number of different modules which can be completed. It provides helpful resources on self-management strategies.

Pain Toolkit

www.paintoolkit.org

Website includes videos on understanding pain and takes a ‘twelve tools’ approach. These tools are a series of twelve videos designed to help you learn and understand self-management. It aims to help patients understand chronic pain, accept it and find ways in which they can self-manage their pain. Video links provide help to set goals/relax and exercise guidance is provided. Patients can track their progress and plan when they have a setback in their daily plans due to pain. There are regular webinars that patients can book online. This is an interactive way to link up for professional advice and have their questions answered. There is an extensive resource section that includes podcasts and free courses.

Live well with pain

https://my.livewellwithpain.co.uk/

Provides resources, videos and guides on how to live well with pain.

Understanding pain in 5 minutes

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

Pain Concern

https://painconcern.org.uk

This is a UK wide charity organisation with empathic volunteers available on a helpline who provide a safe space to talk about pain, provide with information about pain and self-management. They can guide patients in self-management and resources about pain. They have an online support network where members share their experiences. They have a self- management navigator tool which is designed to improve communication between patient and healthcare professionals which guides in self-management and helps patients to make most out of their appointments. There is no medical advice available. Using the telephone service is chargeable.

NHS Inform

Chronic pain | NHS inform

This website offers simple advice about pain and self-management. It provides links for buying TENS machines/relaxation techniques/managing mental health. There is a very useful guide that uses CBT technique to help patient live with chronic pain. On this website there is a video link using British Sign Language explaining about chronic pain, how it’s treated and self-management.

Pain Association Scotland

www.painassociation.com

A charity organisation that has pioneered the development and delivery of self- management training to patients and carers. There are some good inspirational stories and videos to help stress management/sleep/relaxation/flare ups/diet/acceptance/social interaction/self-image and pacing advice.

Living Life to the full

https://llttf.com

This website is a mix of free and ‘to buy’ courses for mental well-being in patients with chronic pain. Patients need to register on this website to gain access to some free resources. It provides CBT online.

“Free online courses covering low mood, stress and resilience. Work out why you feel as you do, how to tackle problems, build confidence, get going again, feel happier, stay calm, tackle upsetting thinking and more. Our courses are free for individuals using them in their own lives.”

Tame the Beast Website and Resources

https://www.tamethebeast.org/#questions

A website that provides online pain recovery coaching delivered by registered health professionals. The site offers free online and internet-delivered pain management programs which are designed to provide information about chronic pain and to teach practical skills for managing the impact of pain on day-to-day activities and emotional well-being. The courses run 4-5 times a year.

Condition specific resources

Fibromyalgia Association: https://fibromyalgia-associationuk.org/

University of Mitchigan Fibromyalgia Self Help Guide: https://fibroguide.med.umich.edu/pain-care/self-care/ An online symptom management program for people with fibromyalgia.

Reconnect2life Fibromyalgia

What is Fibromyalgia?

University of Mitchigan Fibromyalgia Self Help Guide:

https://fibroguide.med.umich.edu/pain-care/self-care

An online symptom management program for people with fibromyalgia.

Versus Arthritis

https://www.versusarthritis.org

A UK charity supporting people with arthritis.

Audio Resources:

What is Persistent Pain? – Pain Toolkit -tools : Look at the “What Pete says” section

Tame The Beast — It’s time to rethink persistent pain

Understanding Pain in less than five minutes