Treatment services for persistent pain

As well as having our own Specialist Pain Doctor, we work closely with our patients’ other practitioners and specialists including GP, neurologists and consultants in pain medicine and rheumatology.

Our clinical philosophy embraces the ‘bio-psycho-social’ model of care and so medical and structural considerations for pain are important. Using drugs as an early adjunct to the more active approaches to treatment is often quite useful. It can provide patients with a window of reduced symptoms allowing them to engage more effectively in their physical rehabilitation and other therapy. Once patients are making progress, medication can then usually tapered and eventually ceased altogether in most cases. This is of course dependent on success in the more active rehabilitation strategies.

We know that, particularly as pain becomes more persistent, it is only loosely linked to structural changes in the body. As such, we encourage patients not to become too focused on scans and other tests to try and work out what is physically ‘wrong’ with them.

That said, we do work with patients who have ongoing active systemic disease such as ‘Ehlers-Danlos Syndrome’, lupus and rheumatoid arthritis where the structural integrity of tissues can make progress harder and the ‘bio’ part of the bio-psycho-social model takes on more significance.

This is where most patients start their treatment journey. After ruling out any urgent medical reasons for your symptoms we complete a really thorough analysis of all underlying clinical and lifestyle variables involved in your case. You will have lots of time to let us know exactly what has happened, how you are feeling, your worries, how the problems are affecting you and the impact it may be having on your life, your work and your relationships. This will be married up with relevant physical tests along with results of any investigations you may have had which can then be put into context accurately. A working diagnosis, based on all of these factors, is given in simple terms that you understand. We give you plenty of time to ask all the questions you need so that you are really clear about the causes of the symptoms you are experiencing. We will agree some goals around what you want to achieve and a formulate a clear treatment plan around these. You will always be ultimately in control of what we do; our job is to provide you with all the relevant information so that you can make the best informed decisions about your care. We can then work together to help you feel like the real you again. Referral to other specialist disciplines, including help with the emotional side of chronic pain, are often recommended; research tells us that it is this team approach to treatment that get the best results.

Don’t worry, if you are unable to come to the clinic in person for face to face sessions, we can still help you just the same. Patients reading this will inevitably have had symptoms for quite some time and tried various attempts at basic physio, osteopathy and chiropractic treatment or other similar options. Some will also have had medical interventions like injections or even surgery. Sadly around 40% of patients with persistent back pain give up at this point with many more being ambivalent.

Having ruled out serious medical or structural reasons for pain, much of how we are able to help patients is by providing education and reassurance; getting a more accurate and more helpful understanding of pain actually goes a long way to reducing symptoms and there is really good scientific evidence to back this up. This is sometimes called ‘Pain Reprocessing Therapy’. For some patients this is taken further with cognitive behavioural therapy for pain (CBT for pain) and this is also effective, in most instances, with online sessions.

As well as education about the real causes of pain, guidance in how to regulate your pain systems again alongside effective physical rehabilitation and treatment for deeper mental well-being issues can also be easily delivered online.

So pain coaching is pretty much the same as being seen in person just without the face to face reassurance and direct physical encouragement that can often help to facilitate optimal movement again.

We have two psychotherapists working in the team who, as well as being able to help with general emotional well-being, have a specialist interest in how emotional wellbeing can affect pain. We know that there is a two-way relationship between many mental health problems and persistent pain; for example patients who have depression are more likely to develop chronic pain and patients with chronic pain for whatever reason are also more likely that the general population to then develop depression.

Many patients are slightly nervous about this as a part of their overall treatment. There may be the perception that, if you are seeing a psychotherapist, your pain is somehow not real or genuine. Someone’s pain is their unique personal experience and often quite hard to put into words, but it is always real.

Some patients also admit feeling a weakness of character in some way if they are seeing a therapist. This is certainly not our view and something we would encourage you to rethink. If we get you to challenge your thoughts or beliefs, it is always done with respect and empathy and only ever with the intention of helping you.

We also know that this area of treatment is not for everyone. You have to be ready for it and we fully understand that. The key to successful therapy is good communication and trust between therapist and patient.