{"id":3793,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/chronicpain\/"},"modified":"2024-02-29T14:08:26","modified_gmt":"2024-02-29T14:08:26","slug":"chronicpain","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/chronicpain\/","title":{"rendered":"Chronic Pain"},"content":{"rendered":"\nChronic Pain <\/title>\n\n\n\n<h4 class=\"wp-block-heading\">Services<\/h4>\n\n\n\n<p>New eAdvice Service via SCI Gateway.<br> 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.<br> <br><strong>Lothian Chronic Pain Service<\/strong> provides out-patient multi-disciplinary management of adults with chronic pain.<br> <br>The team consists of consultants in pain medicine and in rehabilitation, specialist nurses, physiotherapists and psychologists.<\/p>\n\n\n\n<p>The service is split into a<strong><em> <a rel=\"noreferrer noopener\" href=\"https:\/\/services.nhslothian.scot\/lcps\/pain-management-aah\/\" data-type=\"URL\" data-id=\"https:\/\/services.nhslothian.scot\/lcps\/pain-management-aah\/\" target=\"_blank\">Pain-Management-Programme<\/a><\/em><\/strong> at AAH and <strong><em><a href=\"https:\/\/services.nhslothian.scot\/lcps\/pain-clinic\/\" data-type=\"URL\" data-id=\"https:\/\/services.nhslothian.scot\/lcps\/pain-clinic\/\" target=\"_blank\" rel=\"noreferrer noopener\">Pain Medicine<\/a><\/em> <\/strong>at WGH, RIE and Leith CTC.<\/p>\n\n\n\n<p><strong>Pain Management Programme offers:<\/strong><br> Rehabilitative & psychological approach to pain self-management.<br> Individual and group-based programme.<br> <br><strong>Pain Medicine offers:<\/strong><br> Assessment and further investigation.<br> Medication review and drug management.<br> Injection therapy and complementary therapy.<br> 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.<\/p>\n\n\n\n<p><span style=\"text-decoration:underline\"><strong>cCBT for Chronic Pain and emotional difficulties<\/strong><\/span>.<\/p>\n\n\n\n<p>There is a high prevalence of mental health difficulties in people suffering from chronic pain. In turn those can worsen pain experiences.<\/p>\n\n\n\n<p>There is a <a rel=\"noreferrer noopener\" href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/ccbtchronicpainwithdepressionanxiety\/\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/ccbtchronicpainwithdepressionanxiety\/\" target=\"_blank\">computerised CBT programme available for people in Lothian who have chronic pain and mild to moderate anxiety and depression<\/a> (including panic attacks).<\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who to refer:<\/h4>\n\n\n\n<p>Pain causing significant distress or disability<br>Duration > 6 months<br>Age 16yrs and over<br>No planned referral to another specialty for diagnosis or treatment of pain<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Pain Management Programme is effective if:\n<ul class=\"wp-block-list\">\n<li>Patient accepts the need to learn new ways of coping but not reducing pain<\/li>\n\n\n\n<li>Patient understands these new skills are taught by specialist physiotherapists and psychologists<\/li>\n\n\n\n<li>Patient accepts the search for diagnosis and cure has ended<\/li>\n\n\n\n<li>Patient has sufficient cognitive function and motivation to engage<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Who not to refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Age <16yr<\/li>\n\n\n\n<li>Patients who require prior treatment\/assessment of interdependent conditions:<\/li>\n\n\n\n<li>Major depression, psychosis and high risk of suicide or self-harm are best managed by Mental Health Services<\/li>\n\n\n\n<li>Patients with drug and alcohol dependency benefit from assessment by substance misuse services<\/li>\n\n\n\n<li>Unresolved abuse, post traumatic stress, eating disorders, severe anxiety, anger management issues, obsessive compulsive disorder and bereavement require disorder specific service<\/li>\n\n\n\n<li>Please do not expect hospital admission as we are outpatient only<\/li>\n\n\n\n<li><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Spinal-Red-Flags-Page-from-Old-RefHelp-Pain-Mgt.pdf\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Spinal-Red-Flags-Page-from-Old-RefHelp-Pain-Mgt.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Spinal Red Flags<\/a>: 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 <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/FlowCentre\/UrgentReferralPathwayByPresentingComplaintFlowCentre\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/FlowCentre\/UrgentReferralPathwayByPresentingComplaintFlowCentre\" target=\"_blank\" rel=\"noreferrer noopener\">here<\/a>. <\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">How to refer:<\/h4>\n\n\n\n<p>SCI Gateway is the best pathway for referral<\/p>\n\n\n\n<p><strong>Your referral will be triaged to <\/strong><strong><em>either<\/em><\/strong><strong> Pain Management Programme <\/strong><strong><em>or<\/em><\/strong><strong> Pain Medicine based on the information you provide.<\/strong> 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.<\/p>\n\n\n\n<p><strong>Pain Discussion<\/strong><\/p>\n\n\n\n<p>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.<br><br>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.<\/p>\n\n\n\n<p><strong>Email Advice: <\/strong>You can pose clinical questions directly to pain medicine consultants by email: <a href=\"mailto:lothianchronicpainservice@nhslothian.scot.nhs.uk\" data-type=\"mailto\" data-id=\"mailto:lothianchronicpainservice@nhslothian.scot.nhs.uk\" target=\"_blank\" rel=\"noreferrer noopener\">lothianchronicpainservice@nhslothian.scot.nhs.uk<\/a><\/p>\n\n\n\n<p><strong>Pain Management Programme<\/strong><\/p>\n\n\n\n<p>Dept of Clinical Psychology<br>Astley Ainslie Hospital<br>133 Grange Loan<br>Edinburgh, EH9 2HL<br>Tel: 0131 537 9128<br>Fax: 0131 537 9120<\/p>\n\n\n\n<p><strong>The Pain Clinic<\/strong><br><strong> <\/strong>Leith Community Treatment Centre (LCTC)<\/p>\n\n\n\n<p>12, Junction Place<br>Edinburgh, EH6 5JQ<br>Tel: 0131 5366225<br>Fax: 0131 <br><a href=\"mailto:lothianchronicpainservice@nhslothian.scot.nhs.uk\" data-type=\"mailto\" data-id=\"mailto:lothianchronicpainservice@nhslothian.scot.nhs.uk\" target=\"_blank\" rel=\"noreferrer noopener\">lothianchronicpainservice@nhslothian.scot.nhs.uk<\/a><\/p>\n\n\n\n<p>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<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><strong>Chronic Pain Management Principles<\/strong><\/p>\n\n\n\n<p>NHS Scotland\u2019s <a href=\"https:\/\/www.therapeutics.scot.nhs.uk\/wp-content\/uploads\/2018\/03\/Strategy-Chronic-Pain-Quality-Prescribing-for-Chronic-Pain-2018.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Quality Prescribing for Chronic Pain: a Guide for Improvement 2018-21<\/a> promotes a focus on the prescribing of analgesics for chronic pain, with patient\u2013centred structured review of appropriateness, efficacy and tolerability of treatment and promotion of optimal care. <\/p>\n\n\n\n<p>Often key is establishing understanding round medications used for <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/acute-pain\/\" target=\"_blank\" rel=\"noreferrer noopener\">acute pain<\/a>, 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.<\/p>\n\n\n\n<p>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.<\/p>\n\n\n\n<p>Please note useful Patient Information Leaflets and further information on the Resources and Links Page.<\/p>\n\n\n\n<p><strong>Note: this approach should not be used for palliative patients and patients with cancer-related pain.<\/strong><\/p>\n\n\n\n<p><strong>Good Practice in Chronic Pain Assessment – resources:<\/strong><\/p>\n\n\n\n<ol class=\"wp-block-list\" style=\"list-style-type:1\">\n<li><strong>Chronic pain recording<\/strong><\/li>\n\n\n\n<li>Read code for chronic pain:\n<ol class=\"wp-block-list\">\n<li>1M52 (Chronic pain) or 66n (Pain review)<\/li>\n<\/ol>\n<\/li>\n\n\n\n<li>Character\/type of pain – pain assessment tools provided in the Vision guideline<\/li>\n\n\n\n<li>Site(s) of pain<\/li>\n\n\n\n<li>Pain score (patient score\/10)\n<ol class=\"wp-block-list\">\n<li> \u2018Rate your pain on a score of 0 to 10 where 0 is <em>no pain<\/em> and 10 is  <em>pain as bad as you can imagine\u2019<\/em><\/li>\n<\/ol>\n<\/li>\n<\/ol>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Holistic, patient-centered consultation \u2013 education and expectation:<\/strong><\/li>\n\n\n\n<li>\u2018<a href=\"https:\/\/www.whatmatterstoyou.scot\/\" target=\"_blank\" rel=\"noreferrer noopener\">What matters to me<\/a>\u2019 approach<\/li>\n\n\n\n<li><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Not-just-painkillers-V3.0.pdf\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Not-Just-Painkillers-PIL-002.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Not Just Painkillers<\/a> \u2013 NHS Lothian leaflet – describes acute and chronic pain, gives information on the different types of pain medicine,\u00a0 includes information and links to advice on self-management<\/li>\n\n\n\n<li><a href=\"https:\/\/my.livewellwithpain.co.uk\/resources\/self-management\/goal-setting\/\" data-type=\"URL\" data-id=\"https:\/\/my.livewellwithpain.co.uk\/resources\/self-management\/goal-setting\/\" target=\"_blank\" rel=\"noreferrer noopener\">Live Well with Pain Goal Setting resource<\/a> – patient-identified goals<\/li>\n\n\n\n<li><a href=\"https:\/\/services.nhslothian.scot\/lcps\/\" target=\"_blank\" rel=\"noreferrer noopener\">Lothian Chronic Pain Management website<\/a>: videos and resources e.g. <a href=\"https:\/\/www.nhs.uk\/Planners\/yourhealth\/Documents\/The%20pain%20toolkit%20-%20Oct%2010%20-%20READ.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Pain Toolkit<\/a>, <a href=\"https:\/\/www.torbayandsouthdevon.nhs.uk\/services\/pain-service\/reconnect2life\/\" target=\"_blank\" rel=\"noreferrer noopener\">Reconnect 2 Life<\/a>.<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Patient management plan resources:<\/strong><\/li>\n\n\n\n<li>Self-management options, supportive resources available locally; green prescribing; Link Worker where available  <\/li>\n\n\n\n<li>Provide patient information on pain medicines<ul><li><a href=\"https:\/\/policyonline.nhslothian.scot\/Policies\/PatientInformation\/Opioid_painkillers-keep_them_short_stay_safe.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Opioid Painkillers \u2013 keep then short, stay safe<\/a><\/li><\/ul><\/li>\n\n\n\n<li><ul><li><a href=\"https:\/\/fpm.ac.uk\/opioids-aware\/information-patients\" target=\"_blank\" rel=\"noreferrer noopener\">Opioids Aware patient leaflets<\/a><\/li><\/ul>\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Gabapentinoid-Reduction-PIL.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Gabapentinoid reduction<\/a><\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Dose titration to therapeutic level, with explanation<\/li>\n\n\n\n<li>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.<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><strong>Resources for Professionals<\/strong><\/p>\n\n\n\n<p><a href=\"https:\/\/www.sign.ac.uk\/our-guidelines\/management-of-chronic-pain\/\">Management of chronic pain (sign.ac.uk)<\/a><\/p>\n\n\n\n<p><a rel=\"noreferrer noopener\" href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Vision-Guideline-for-Chronic-Pain-March-2023.pdf\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Vision-Guideline-for-Chronic-Pain-March-2023.pdf\" target=\"_blank\">Vision-Guideline-for-Chronic-Pain-March-2023.pdf<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/www.britishpainsociety.org\/about\/\" target=\"_blank\" rel=\"noreferrer noopener\">The British Pain Society<\/a><\/p>\n\n\n\n<p>Using opioids in chronic pain (Initiation & further management)<\/p>\n\n\n\n<p><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Not-Just-Painkillers-PIL-002.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Not-Just-Painkillers-PIL-002.pdf<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Opioid-Painkillers-Keep-them-short-stay-safe-PIL.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Opioid-Painkillers-Keep-them-short-stay-safe-PIL.pdf<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Gabapentinoid-Reduction-PIL.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Gabapentinoid-Reduction-PIL.pdf<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/eur01.safelinks.protection.outlook.com\/?url=https%3A%2F%2Fwww.therapeutics.scot.nhs.uk%2Fwp-content%2Fuploads%2F2018%2F03%2FStrategy-Chronic-Pain-Quality-Prescribing-for-Chronic-Pain-2018.pdf&data=05%7C01%7CCatriona.Morton%40nhslothian.scot.nhs.uk%7C08dbee1279114b6a7e1a08db221b916f%7C10efe0bda0304bca809cb5e6745e499a%7C0%7C0%7C638141274168405676%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=q4TnlPi54dw%2Bp87%2BjZI1qxF2Rh%2B7ivir5KLTMbDbrdQ%3D&reserved=0\" target=\"_blank\" rel=\"noreferrer noopener\">Quality Prescribing for Chronic Pain: a Guide for Improvement<\/a><\/p>\n\n\n\n<p><strong>Pain related Lothian Prescribing Bulletin Articles: <\/strong><\/p>\n\n\n\n<ol class=\"wp-block-list\" start=\"1\" style=\"list-style-type:1\">\n<li><a href=\"https:\/\/eur01.safelinks.protection.outlook.com\/?url=https%3A%2F%2Fformulary.nhs.scot%2Fmedia%2F1467%2Flpb-107-may-2021.pdf&data=05%7C01%7CCatriona.Morton%40nhslothian.scot.nhs.uk%7C00105c7d578741dad99a08db221e7579%7C10efe0bda0304bca809cb5e6745e499a%7C0%7C0%7C638141286558039635%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=DrEOBuxoqqhK3eKZHddfr7Mzsq%2FurqUfd6hHRjqTXY4%3D&reserved=0\" target=\"_blank\" rel=\"noreferrer noopener\"><em>Understanding treatment options in chronic pain<\/em> NHS Lothian Prescribing Bulletin issue 107, May 2021<\/a> <\/li>\n\n\n\n<li><a href=\"https:\/\/eur01.safelinks.protection.outlook.com\/?url=https%3A%2F%2Fformulary.nhs.scot%2Fmedia%2F1490%2Flpb-issue-109-sept-final.pdf&data=05%7C01%7CCatriona.Morton%40nhslothian.scot.nhs.uk%7C00105c7d578741dad99a08db221e7579%7C10efe0bda0304bca809cb5e6745e499a%7C0%7C0%7C638141286558039635%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=Lhv2hIxVMxPNgk7oiQa1ffr3UQQncNbmDwoEd8JWKsQ%3D&reserved=0\" target=\"_blank\" rel=\"noreferrer noopener\"><em>Stepping away from painkillers<\/em> NHS Lothian Prescribing Bulletin issue 109, September 2021<\/a> <\/li>\n\n\n\n<li><a href=\"https:\/\/eur01.safelinks.protection.outlook.com\/?url=https%3A%2F%2Fformulary.nhs.scot%2Fmedia%2Fk5vhd2vk%2Flpb-issue-110-final.pdf&data=05%7C01%7CCatriona.Morton%40nhslothian.scot.nhs.uk%7C00105c7d578741dad99a08db221e7579%7C10efe0bda0304bca809cb5e6745e499a%7C0%7C0%7C638141286558039635%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=cEtZDyEQ1dqzOGExlSNXvltD3%2F2wb2YjgFxiQFWKJTs%3D&reserved=0\" target=\"_blank\" rel=\"noreferrer noopener\"><em>Good practice in chronic pain assessment <\/em>\u2013 for NHS Lothian Prescribing Bulletin issue 110, November 2021<\/a> <\/li>\n<\/ol>\n\n\n\n<p>Arachnoiditis<\/p>\n\n\n\n<p><strong> Arachnoiditis.co.uk  <\/strong><a href=\"http:\/\/www.arachnoiditis.co.uk\/\" target=\"_blank\" rel=\"noreferrer noopener\">www.arachnoiditis.co.uk\/<\/a><\/p>\n\n\n\n<p>Arthritis<\/p>\n\n\n\n<p><strong> The Arthritis Action  <\/strong><a rel=\"noreferrer noopener\" href=\"https:\/\/www.arthritisaction.org.uk\/\" data-type=\"URL\" data-id=\"https:\/\/www.arthritisaction.org.uk\/\" target=\"_blank\">www.arthritisaction.org.uk\/<\/a><strong> <\/strong><\/p>\n\n\n\n<p><strong> Arthritis Care  <\/strong><a href=\"http:\/\/www.arthritiscare.org.uk\/\" target=\"_blank\" rel=\"noreferrer noopener\">www.arthritiscare.org.uk\/<\/a><\/p>\n\n\n\n<p>Chronic Fatigue\/ME<\/p>\n\n\n\n<p><strong>Action for ME  <\/strong><a href=\"http:\/\/www.afme.org.uk\/\" target=\"_blank\" rel=\"noreferrer noopener\">www.afme.org.uk\/<\/a><\/p>\n\n\n\n<p><strong>CFIDS & Fibromyalgia Self Help  <\/strong><a href=\"http:\/\/www.cfidsselfhelp.org\/\" target=\"_blank\" rel=\"noreferrer noopener\">www.cfidsselfhelp.org\/<\/a><\/p>\n\n\n\n<p><strong>Edinburgh ME Self-Help Group  <\/strong><a href=\"http:\/\/www.edmesh.org.uk\/\" target=\"_blank\" rel=\"noreferrer noopener\">www.edmesh.org.uk\/<\/a><\/p>\n\n\n\n<p><strong>ME Association\/ME Connect  <\/strong><a rel=\"noreferrer noopener\" href=\"http:\/\/www.meassociation.org.uk\/\" target=\"_blank\">www.meassociation.org.uk\/<\/a><\/p>\n\n\n\n<p><strong>Fibromyalgia Association UK  <\/strong><a href=\"http:\/\/www.fibromyalgia-associationuk.org\/\" target=\"_blank\" rel=\"noreferrer noopener\">www.fibromyalgia-associationuk.org\/<\/a><\/p>\n\n\n\n<p><strong>Irritable Bowel Syndrome (IBS) Network  <\/strong><a href=\"http:\/\/www.theibsnetwork.org\/\" target=\"_blank\" rel=\"noreferrer noopener\">www.theibsnetwork.org\/<\/a><\/p>\n\n\n\n<p><strong>Lupus UK  <\/strong><a href=\"http:\/\/www.lupusuk.org.uk\/\" target=\"_blank\" rel=\"noreferrer noopener\">www.lupusuk.org.uk\/<\/a><\/p>\n\n\n\n<p>Migraine<\/p>\n\n\n\n<p><strong>   Migraine Action Association  <\/strong><a rel=\"noreferrer noopener\" href=\"http:\/\/www.migraine.org.uk\/\" target=\"_blank\">www.migraine.org.uk\/<\/a><\/p>\n\n\n\n<p><strong>   Migraine Trust   <\/strong><a href=\"http:\/\/www.migrainetrust.org\/\" target=\"_blank\" rel=\"noreferrer noopener\">www.migrainetrust.org\/<\/a><\/p>\n\n\n\n<p><strong>MS Society of GB & NI  <\/strong><a href=\"http:\/\/www.mssociety.org.uk\/\" target=\"_blank\" rel=\"noreferrer noopener\">www.mssociety.org.uk\/<\/a><\/p>\n\n\n\n<p><strong>National Osteoporosis Society  <\/strong><a href=\"http:\/\/www.nos.org.uk\/\" target=\"_blank\" rel=\"noreferrer noopener\">www.nos.org.uk\/<\/a><\/p>\n\n\n\n<p><strong>Pain<\/strong><\/p>\n\n\n\n<p><strong>   Action on Pain  <\/strong><a href=\"http:\/\/www.action-on-pain.co.uk\/\" target=\"_blank\" rel=\"noreferrer noopener\">www.action-on-pain.co.uk\/<\/a><\/p>\n\n\n\n<p><strong>   Pain Concern  <\/strong><a href=\"http:\/\/www.painconcern.org.uk\/\" target=\"_blank\" rel=\"noreferrer noopener\">www.painconcern.org.uk<\/a><strong>\/<\/strong><\/p>\n\n\n\n<p><strong>   Pain Association of Scotland  <\/strong><a href=\"http:\/\/www.painassociation.com\/\" target=\"_blank\" rel=\"noreferrer noopener\">www.painassociation.com\/<\/a><\/p>\n\n\n\n<p><strong>   Pain Toolkit  <\/strong><a href=\"http:\/\/www.paintoolkit.org\/\" target=\"_blank\" rel=\"noreferrer noopener\">www.paintoolkit.org\/<\/a><\/p>\n\n\n\n<p><strong>Shingles Support Society  <\/strong><a href=\"http:\/\/www.shinglessupport.org\/\" target=\"_blank\" rel=\"noreferrer noopener\">www.shinglessupport.org\/<\/a><\/p>\n\n\n\n<p><strong>Sickle Cell Society       <\/strong><a href=\"http:\/\/www.sicklecellsociety.org\/\" target=\"_blank\" rel=\"noreferrer noopener\">www.sicklecellsociety.org\/<\/a><\/p>\n\n\n\n<p><strong>Stroke <\/strong><a href=\"http:\/\/www.stroke.org.uk\/\" target=\"_blank\" rel=\"noreferrer noopener\">www.stroke.org.uk\/<\/a><\/p>\n\n\n\n<p><strong>Trigeminal Neuralgia Association UK   <\/strong><a rel=\"noreferrer noopener\" href=\"http:\/\/www.tna.org.uk\/\" target=\"_blank\">www.tna.org.uk\/<\/a><\/p>\n\n\n\n<p><a href=\"\/files\/sites\/2\/Pain-Mgt-Flare-ups-Dos-and-Donts.pdf\">https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/ResourcesLinks\/Pain%20Mgt%20Flare%20ups%20-%20Dos%20and%<\/a><a rel=\"noreferrer noopener\" href=\"\/files\/sites\/2\/Pain-Mgt-Flare-ups-Dos-and-Donts.pdf\" target=\"_blank\">20Donts.pdf<\/a><\/p>\n\n\n<\/div><\/div>\n<\/div>\n\n\n\n<p><br><\/p>\n","protected":false},"excerpt":{"rendered":"<p>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<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":3664,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[63],"class_list":["post-3793","page","type-page","status-publish","hentry","category-chronic-pain-management"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/chronic-pain-management\/\" rel=\"tag\">Chronic Pain<\/a>","rttpg_excerpt":"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","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3793","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=3793"}],"version-history":[{"count":20,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3793\/revisions"}],"predecessor-version":[{"id":18366,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3793\/revisions\/18366"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3664"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=3793"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=3793"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}