Information for discharge from pain service

Your pathway through the pain clinic has now been completed and you are being discharged back into the care of your GP.

The aim of pain clinic has been to help you manage your pain more effectively and so reduce the impact it has had on your quality of life. Your on-going pain management plan will include some of the following:

• Self-directed pain management strategies (structured pacing, use of stretch, exercise and active relaxation techniques)
• Trans cutaneous electrical nerve stimulation (TENS)
• Physiotherapy
• Occupational therapy
• Psychological therapies
• Medication

What happens if I have a ‘flare-up’ of my pain?

Should you have a ‘flare-up’ of your pain; that is a sudden sharp increase in your persistent pain (often occurring immediately after a triggering event or within a day or two) you should refer to your ‘flare-up’ management plan and review your self- directed pain management strategies.

Why would this happen?

Some potential causes of pain flare may be:

• Overdoing an activity
• Sitting for too long
• A period of inactivity; such as a recent illness.
• A sudden jolt; such as a trip, slip, cough or sneeze
• A stressful event as this may cause an increase in muscle tension
• A change that may affect your posture
• A reduction in your medicines

How will I manage this?

• Stay calm; you will probably not have damaged yourself and this ‘flare-up’ will settle in a few days by using your management plan and strategies. The pain is due to your nerves and muscles (signalling system) becoming overactive again due to a trigger.
• Try to understand what may have been the trigger (cause) of the ‘flare-up’.
• You may need to review your activities in the context of your management strategies in relation to structured pacing.
• Change your position frequently and continue with your stretches as they will help to reduce muscle tension.
• Don’t forget active relaxation; using breathing techniques and active muscle relaxation.
• Think about reducing some of your engagements for a few days.
• If you have ‘as needed’ medication take it regularly within the permitted prescription and then reduce it back to ‘as needed’ when the current ‘flare-up’ settles.
• Recognise unhelpful thoughts about a flare-up of pain that can leave you feeling worse. Try not to blame yourself for your flare-up or feel guilty. Replace these with accepting thoughts and try to make some adjustments for your day.
• Try to remain positive in your thoughts and feelings.
• Remember communication is important. Other people do not necessarily understand or know what would be effective help when you have a flare-up of your pain.
• Please see also the information at the end of this leaflet, on local facilities available to aid you in continuing with your management strategies.

General information on chronic pain

These are details of websites and contact details for organisations and groups relevant to chronic pain:

The British Pain Society (opens in a new tab)

Third Floor
Churchill House
35 Red Lion Square
London
WC1R 4SG

Telephone: 020726 97840

Fax: 020783 10859

Email the British Pain Society

Pain Concern (opens in a new tab)

A charity providing support and information for people who live with chronic pain.

62-66 Newcraighall Road
Edinburgh
EH15 3HS

Telephone (Office): 0131 669 5951

Email Pain Concern

Helpline telephone: 0300 123 0789 (limited availability) Open Monday from 14:00 to 16:00 and Friday from 10:00 to 12:00 and 14:00 to 16:00.

Email Pain Concern helpline

• Pain relief foundation (opens in a new tab)
• Chronic pain support group (opens in a new tab)
• Pain UK (opens in a new tab)
• Action on pain (opens in a new tab)
• UCLA Health - guided meditations (opens in a new tab)
• NHS - 10 ways to reduce pain (opens in a new tab)

Pain education

These booklets and website give information to help explain chronic pain:

• Know Pain - A practical guide to persistent pain therapy (opens in a new tab)
• The pain toolkit (opens in a new tab)

Videos

• What is Chronic pain? - Blazin' Guns

Information on general pain management

• Pain Concern - A guide to becoming more active and reducing flare-ups (opens in a new tab)
• British Pain Society booklet 2015 - Understanding and managing long term pain: information for people in pain (opens in a new tab)

Information on chronic pain to listen to

• Pain Concern - Airing pain (opens in a new tab) - Includes a series of podcast programmes on chronic pain.
• Living With Chronic Pain (opens in a new tab) - Chronic pain, management strategies and relaxation exercises that can be ordered in the form of a CD or downloaded free.
• HealthTalk - Chronic pain (opens in a new tab) - Includes recordings of people with chronic pain talking about their experience of using strategies to manage their pain.

Books on self-management and psychotherapy approaches to managing chronic pain

• Overcoming chronic pain: a self-help guide using cognitive behavioural techniques.

Authors: Francis Cole, Helen Macdonald, Catherine Carus and Hazel Howden-Leach. 2005.

• Manage your pain: practical and positive ways of adapting to chronic pain.

Authors: Michael Nicholas, Allan Molloy, Lee Beeston, Lois Tonkin. 2011.

• Living beyond your pain: using acceptance and commitment therapy to ease chronic pain.

Author: Joanne Dahl. 2006.

• Mindfulness for Health: a practical guide to relieving pain, reducing stress and restoring wellbeing

Authors: Vidyamala Burch and Danny Penman. 2013.

Psychology websites

These are some psychology websites for self-help approaches to managing problems. They have information on evidence-based techniques dealing with common problems that accompany chronic pain, such as anxiety and depression:

• Get Self Help (opens in a new tab)- A range of information and resources for self-help using cognitive behavioural strategies.
• Living Life to the Full (opens in a new tab) - Online courses for life skills, using cognitive behavioural therapy techniques covering mood, stress and resilience. This service is available for free. It is one of the most recommended courses in the NHS and one of the most widely used CBT life skills programmes in the world.
• The Big White Wall (opens in a new tab) - A mental health online anonymous community. It does not offer an emergency service. Online guides monitor the site to ensure safety and anonymity. The site offers support, advice and useful information as well as courses. This service is the only online support service registered with the Care Quality Commission (CQC) the quality monitoring body for the NHS.

Mental health information and support

It is normal to experience distress as part of living with chronic pain. However, for some people their mental health becomes a problem to address in itself.

If you experience a deterioration in your mental health you should make an appointment to see your GP to discuss your needs for your health and well-being.

General advice and information on mental health is available on the below websites:

Mind (opens in a new tab)

UK mental health charity. Information, advice and support is available on their website and advice line for people experiencing a mental health problem and their friends and families.

Address:

15-19 Broadway
Stratford
London
E15 4BQ

Telephone: 020 8519 2122

Email Mind

British Association for Counselling and Psychotherapy (BACP) (opens in a new tab)

Gives information on counselling and a list of registered counsellors and psychotherapists. Should you wish to access psychotherapy privately you may consider finding a local therapist on the register.

The Royal College of Psychiatrists’ (opens in a new tab)

Provides useful information and advice on mental health issues to the public.

NHS services

Talking therapies and psychology support are accessible via NHS services in the community. Ask your GP about your local Psychological Well-being Service. In this area, you can refer yourself to the local Psychological Well-being Service (opens in a new tab) online or by calling 03003 000055 or make an appointment to speak to your GP to consider a referral.

Mental health crisis management plan: If you need immediate support for your mental health you are asked to call the mental health crisis telephone line number: 111 option 2.

Other options are to contact your GP or visit your local A&E department. Other helpful telephone numbers are Samaritans: 01223 364455 and Saneline: 0300 3047000.

Information on local facilities available to aid you in continuing with your management strategies

Fitness

• Back Care Group at Addenbrooke's:

Send your postal address via text to 07787990214 or email (Tuesday from 17:00 - 20:00 and Thursday from 17:00 - 19:00)

• Walking for health (opens in a new tab)
• Exercise Referral Services: Ask at your GP practise, or check at your local leisure centre whether they are involved and for more information on how to be referred.

Swimming pools

Various swimming sessions or aqua fitness classes available. Contact your local pool for more information and times:

• Sawston sports centre
  Telephone: 01223 712555
• Abbey swimming pool, Cambridge (teaching pool with steps)
  Telephone: 01223 213352
• Parkside swimming pool, Cambridge (hoist available)
  Telephone: 01223 446100
• Impington sports centre
  Telephone: 01223 200404

Hydrotherapy pools in area

• The Windmill Pool (Eddies), Fulbourn
  Telephone: 01223 882289
• St George’s community hydrotherapy pool, Peterborough
  Telephone: 01733 453583

Privacy and dignity

We are committed to treating all patients with privacy and dignity in a safe, clean and comfortable environment.