Physiotherapy Chronic Pain Service
Introduction
Pain is defined as “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” (IASP, 2011). Persistent pain also referred to as chronic pain follows a different process to acute pain. Persistent pain has been identified as a “long-term pain of more than 12 weeks or after the time that healing would have been thought to have occurred in pain after trauma or surgery” (BPS, 2010). As a result of this persistent pain has been highlighted as a disease in its own right (BPS, 2012). Within the UK it is reported that 7.8 million people have persistent pain (Chief medical officer report, 2008). Therefore within the NHS we need to ensure that treatment for this patient group is adequately provided for.
Our Service
At Whittington Health we offer an outpatient service to help patients who suffer from persistent pain conditions. This is achieved through a multidisciplinary approach to cover the different dimensions that are associated with persistent pain. Treatment sessions can be individual or in a group/workshop setting.
Pain is defined as “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” (IASP, 2011). Persistent pain also referred to as chronic pain follows a different process to acute pain. Persistent pain has been identified as a “long-term pain of more than 12 weeks or after the time that healing would have been thought to have occurred in pain after trauma or surgery” (BPS, 2010). As a result of this persistent pain has been highlighted as a disease in its own right (BPS, 2012). Within the UK it is reported that 7.8 million people have persistent pain (Chief medical officer report, 2008). Therefore within the NHS we need to ensure that treatment for this patient group is adequately provided for.
Our Service
At Whittington Health we offer an outpatient service to help patients who suffer from persistent pain conditions. This is achieved through a multidisciplinary approach to cover the different dimensions that are associated with persistent pain. Treatment sessions can be individual or in a group/workshop setting.
Our Aims and Objectives
The aim of the service is to enable clients with persistent pain to learn management strategies to increase their functional ability.
Our objectives are to:
• Maintain and improve patients’ functional ability through setting SMART goals.
• Educate patients on pain mechanisms to reduce anxiety and have a greater understanding of ongoing pain.
• Offer advice on management strategies such as pacing, problem solving, the effects of stress, sleep, communication, thoughts and feeling, medication and why pain continues.
• Advice on exercise and the importance of movement.
• Offering support through a difficult condition.
• Manage your condition through one specialist service.
Our Locations
The Team
We offer a multidisciplinary team approach to the treatment of chronic pain utilising each professions different skill sets to meet the needs of our patient group. These include Physiotherapy, Psychology and Pharmacy. We also have strong links with Rheumatology and Orthopaedics within secondary care.
How can Physiotherapy Help?
You may have already seen a physiotherapist in the past which may not have helped. Physiotherapy within the chronic pain service is different. The physiotherapists there look at developing different ways to help you get moving again by using SMART goals to ensure the focus of treatment is directed to the your individual needs.
How can a Psychologist Help?
Pain is a multifactorial subjective and individual experience. Our emotions, thoughts and beliefs all impact on the way we process and are able to modulate pain. Persistent pain can be frustrating, depressing and causes anxiety. A Psychologist can help you with these associated problems. Seeing a psychologist does not mean that the pain is all in your mind but recognising that the above component impact on pain will help manage your persistent pain.
How can a Pharmacist Help?
Medication plays a large role with the management of pain. However there are vast numbers of medications that interact and treat different conditions. The role of the pharmacist at present is to review medications, to ensure that you are taking the correct medications, in the correct doses (and in the correct way). They will also advise you and your GP if they feel that your medication can be altered to have a better effect.
Patient Information:
Your First Appointment
At your first appointment you will have a full assessment with one of our physiotherapists that specialise in chronic pain. The appointment will take between 30-45 minutes and will look at the development of your pain, how the pain is affecting your daily activities, the origin of your pain, previous investigations and treatments so far. From this an individual and agreed treatment plan can be developed. The initial assessment may require you to have a physical examination so please ensure you wear appropriate clothing so that the area/areas can be assessed fully.
Outcome measures/Questionnaires
Within the service we use a set of outcome measures to monitor patient’s progress and monitor any change since the start of treatment within the service. Patients will be expected to complete these on their initial assessment with the assistance of one of the team.
Medication
You may already be taking a few medications to help with pain. To ensure that we have the correct information please bring in all of your current medications or a list of the medications that you are currently taking. If your medication needs a review then we can liaise with our pharmacist to best advise you on what medication may be helpful or advise on the best way to use your current medications.
Following the Initial Appointment
Following your initial appointment you will have an agreed treatment plan to best manage your condition. There are a range of treatment options that can be utilised depending on your condition. These include:
• Move and Stretch exercise class (with relaxation component)
• Workshop programme (co-delivered Physiotherapy & Psychology)
• Pharmacy medication review clinics
• Joint Physiotherapy/Psychology Assessment/Follow up clinics
• TENS Trials
• Acupuncture
• Manual therapy
Referral Process
Referral the Physiotherapy Chronic Pain service can occur via 3 different roots. A regular MSK Physiotherapy referral would need to be completed. If specified that you require the chronic pain team then your referral will be triaged and sent to the appropriate team.
1. Referral to Physiotherapy from the local GP or from a local consultant (see below).
2. By completing the self referral form (See below)
3. If already attending physiotherapy within the service and your physiotherapist believes you would benefit from an assessment or intervention by the chronic pain team they have the ability to directly transfer your treatment to our team.
Information For referrers
Please ensure that the referral form is completed correctly to allow us to process it as swiftly as possible. Please note that referral requests should be for one main condition only.
Please send your referral to the Administrative referral team (ARTI)
Please send referrals by email on arti.centralbooking@nhs.net to ensure referrals are received swiftly. Their phone number is 0203 3161111 and fax number is 0844 7746419
When you make your referral into the Musculoskeletal service it will be triaged by a senior clinician to ensure the patient is seen by the most appropriate service. A referral can be triaged into MSK Physiotherapy, Chronic Pain team, the MSK Interface service, Secondary care (Orthopaedics, Rheumatology, Pain consultants or Neurosurgery). The more accurate information we receive on the referral, with relevant investigation reports, the more likely the patient can be triaged to the most appropriate service.
If the patient is seen within MSK physiotherapy the physiotherapist if deemed appropriate can transfer the patient directly across to the Physiotherapy Chronic Pain Service without any delay of treatment.
Useful Links
• http://www.britishpainsociety.org/
• http://www.iasp-pain.org//AM/Template.cfm?Section=Home
• http://www.paintoolkit.org/
Lordship Lane Primary Care Health Centre
Musculoskeletal Physiotherapy Department
239 Lordship Lane
Tottenham
London
N17 6AA
Tel: 02032244111
Hornsey Central Neighbourhood Health Centre
151 Park Road
Hornsey
London
N8 8JD
Tel: 020 3074 2720
Holloway Community Health Centre
11 Hornsey Street
London
N7 8GG
Tel: 020 3316 8840
Last updated11 Jul 2012