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:

Chronic or Persistent musculoskeletal pain
Pain duration >6/12
The person is open to self-management and able to make a commitment to the methods and goals of treatment.
All relevant investigations have been completed
Some acceptance that a cure may not be possible
No planned referral to another specialty for diagnosis or treatment of pain
Patients have an understanding that Persistent Pain is a diagnosis.

Who not to refer:

Age <16yrs
Patients who require prior treatment/assessment of interdependent conditions:
Moderate/high 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, moderate/severe anxiety, anger management issues, obsessive compulsive disorder and bereavement require disorder specific 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 https://apps.nhslothian.scot/refhelp/urgent-care/flow-centre.

How to refer:

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

Edinburgh patients: Not Available (Currently under review as of 09-02-24)

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 currently does not operate a local Chronic Pain Management Service.

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: Chronic Pain (RefHelp Page)

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
Patients have an understanding that Chronic or Persistent Pain is a diagnosis.

For Patients (also useful for individual professional learning)

Lothian Chronic Pain Service: https://services.nhslothian.scot/lcps/

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 for chronic pain.

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

A selection of resources created by people living with persistent 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.

Paintoolkit: 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-pain management. The pain Toolkit 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 guidance provided for exercise. One 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 about self-management and resources about pain. They have an online support network where members share their experiences. Patients feel well supported in this safe environment that allows space for patients to air their views and experiences. They also voice patients concerns about policies that affect them.

They have a self- management navigator tool which is designed to improve communication between patient and HCPs in primary care that guides in self-management and helps patients to make most out of their appointments. (https://painconcern.org.uk/navigator-tool-video-series/)

There is no medical advice available. The phone call however could be charged to the patient.

NHS Inform: https://www.nhsinform.scot/

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.

https://www.nhsinform.scot/translations/languages/british-sign-language-bsl/illnesses-and-conditions/chronic-pain

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

A website that provides online pain recovery coaching delivered by registered health professionals.

The Site offers free online and internet-delivered pain management program which is 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.

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

For those who want to learn mindfulness for well-being and to help performance they provide on line course for free at

https://www.futurelearn.com/courses/mindfulness-wellbeing-performance.

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.

Versus Arthritis: https://www.versusarthritis.org/ . A UK charity supporting people with arthritis.