Clinical psychology in the pain service

This leaflet is for patients who have been offered a consultation with a clinical psychologist in the pain service, and aims to explains to you and your family the purpose of the clinic and what you might expect as the outcome.

What does a clinical psychologist do?

Clinical psychologists help you to consider chronic pain in the context of your life. They work with you to understand and enhance the helpful ways you have of managing pain. The fact that you have been referred means that we do take your pain seriously.

We believe your pain is real. There is no known cure for chronic pain, but the way you think about pain and how you cope with it can help or hinder recovery.

The paradox of chronic pain is that the normal responses to pain, like pushing through or withdrawing socially, can help keep problems going. These may be areas to overcome as part of managing chronic pain.

This view of chronic pain takes into account your experience as a whole person. The focus is on what you do already that are helpful skills to improve your wellbeing and quality of life for the long term and considering alternative responses to your pain.

How does a clinical psychologist help you?

The clinical psychologist in the pain service focuses on your priorities and your abilities. They typically offer help with:

• coming to terms with and adjustment to chronic pain and ill-health
• improving your use of skills for self-management of chronic pain
• understanding emotional, physical and practical coping strategies
• reducing distress related to pain and ill-health
• improving your communication in relation to your chronic pain
• Improving quality of life despite persistent pain
• help with decision-making about treatment to support your discussion with other healthcare professionals
• increasing access to ongoing support
• lifestyle changes towards preventing deterioration of physical function and improving quality of life

Patients experiencing chronic pain commonly suffer a range of difficulties. Sessions with the pain clinic may cover your goals relating to:

• health anxiety and other forms of anxiety
• low mood
• anger and frustration
• low self-esteem
• stress-related problems

You will consider with the clinical psychologist your current ways of coping. It can be useful to look at how your pain can be affected by things that you have experienced in the past. However, the emphasis tends to be on putting your skills for self-management of chronic pain into action, consistently, in situations in the present. It may be that, for some problems, support can be accessed from your general practitioner (GP) or by referral to another specialist service.

What happens next?

The psychologist will discuss your referral at a triage meeting. You will be offered the best treatment and service for your needs. You will be contacted with the outcome. The clinician with the pain clinic who referred you will have asked your consent to a discussion at the triage meeting with NHS services in the community. If you would like further information about this, please contact the pain clinic (see contact details at the end of this leaflet).

What will happen at my initial appointment?

The psychologist will work with you to form a shared understanding of the challenges you are facing and your hopes for change. You will be contacted for an initial appointment. At the end of your initial appointment you will be recommended one of the following:

• A follow-up assessment appointment to further understand your situation. The assessment will ask about your pain, your mood, what is important to you, the challenges you are facing, and your hopes for change.
• Self-help information.
• A care plan to support you with your goals. This may include a series of treatment sessions following the National Institute for Health and Care Excellence (NICE) guidelines for chronic pain (NICE, 2021). A cognitive behavioural approach is usually offered. This is a brief time-limited approach and typically starts with three to six sessions.
• Referral to NHS Talking Therapies in the community or other services that are better placed to meet your needs and hopes for change.

What is the training for a clinical psychologist?

The team is made up of qualified clinical psychologists, trainee clinical psychologists and assistant psychologists. They have the appropriate level and skills to work in the service. Each of the team members is supervised by qualified clinical psychologists. As their minimum training, clinical psychologists complete a three year honours degree in psychology and an accredited postgraduate training course in clinical psychology. These courses have been at doctoral level since 1996. They have experience, knowledge and skills of working with a range of patient groups. They abide by the British Psychological Society Code of Ethics and Conduct and are registered with the Health Professions Council (the UK regulatory body for health professionals).

Benefits

Chronic pain can be viewed as a problem involving interactions of biological factors, behaviours, thoughts, feelings, social relationships and cultural factors. The clinic takes this perspective on a patient’s chronic pain to help them understand and self-manage the problem to the best of their ability. The aim is not to cure pain, but to help patients resume everyday activities, feel better and make gains in what they can do. There is substantial research literature to support this understanding of the problem, and to suggest the benefits of a cognitive behavioural approach where appropriate, and multidisciplinary treatments for pain management.

Risks

There are no known frequently occurring risks associated with self-management skills and cognitive behavioural approaches for chronic pain. The clinic aims to meet the recommended benchmarks and be up to date on sufficient quality practice-based evidence. The clinic follows a standard assessment schedule to identify problems and as an aid to decisions on suitability. There is the potential to feel worse due to the challenging nature of topics discussed at stages during therapeutic interventions. This might not happen, but it is normal, and you will be supported.

The patient and therapist prepare for this in advance by reviewing the patient’s ways of coping. Some patients decide to postpone sessions until they feel they can commit, in which case brief input can be discussed with the patient that is individually tailored to their needs.

Alternatives

Should you require discussion on this or other options you can contact one of the clinic nurses, the clinical psychologist, or your GP. You may wish to consider another option for accessing clinical psychology or counselling input via your GP.

Contacts / further information

Pain Concern Charity

Information and support is available from the charity ‘Pain Concern (opens in a new tab)’:
Pain Concern, 1 Civic Square, Tranent, EH33 1LH, United Kingdom
Helpline telephone number: 0844 499 4676

British Pain Society

Information on understanding chronic pain, how it can be treated and helpful strategies is available in the leaflet ‘Understanding and managing pain: information for patients’ (British Pain Society 2010), available for patients via the British Pain Society website (opens in a new tab).

Mind Charity

The leading mental health charity in the UK is Mind (opens in a new tab).
Mind, 15-19 Broadway, London, E15 4BO, United Kingdom
Information line telephone number: 0845 766 0163

The British Association for Behavioural and Cognitive Psychotherapies

Information on cognitive behavioural therapy (CBT) is available from the BABCP website (opens in a new tab).

British Psychological Society

The professional body for psychologists in the UK is the British Psychological Society (opens in a new tab) (BPS).
BPS, St Andrews House, 48 Princess Road East, Leicester, LE1 7DR, United Kingdom
General enquiries telephone number: 0116 254 9568

Privacy and dignity

If you have any concerns at any stage, please speak to the sister or clinical nurse specialist at the pain clinic.

The department of pain medicine is compliant with Cambridge University Hospitals NHS Foundation Trust policies for patient confidentiality. Sessions are confidential unless it is thought by the therapist that your own or another person’s safety is at risk or if you wish members of the pain team to share your information. Clinical notes from sessions are kept separate from your medical notes. Your assessment letter is discussed with you before it is sent to your GP.

All therapists receive supervision of their work with clients to ensure patient safety, this is completely anonymously and is strictly confidential.

We continue to work on ways to improve the pain service. We would welcome your comments on your experience of clinical psychology as part of the pain service. We would also welcome your feedback on this leaflet.

Should you like to comment please write to:

Pain clinic psychology administrator, Department of Pain Medicine, Box 215, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 0QQ