NHS Pain Management Programmes
NHS Pain Management Programmes (PMPs) help people to live with chronic pain by helping them to learn ways of dealing with the disabling effects and distress caused by being in pain.
They involve talks and practical sessions where people learn about pain and ways to try and control and limit pain and how to exercise safely and build up activity levels. They use a number of different techniques on these programmes such as:
- Cognitive Behavioural Therapy (CBT) - a type of talking therapy that combines cognitive therapy (examining the things you think) and behaviour therapy (examining the things you do) and focuses on how thoughts, beliefs and attitudes affect feelings and behaviour and aims to teach coping skills to help deal with problems.
- Mindfulness Based Stress Reduction (MBSR) - combines various meditation practices with modified yoga exercises and mind-body education. The idea behind mindfulness is that by being more aware of the present moment, including feelings and thoughts, your body and the world around you, it can positively change the way people feel about life and how they approach challenges.
- and Acceptance and Commitment Therapy (ACT) - encourages people to re-evaluate their relationship with their experiences, including learning to develop a greater division between themselves and their thoughts. These changes are used to help people become more psychologically flexible changing the agenda away from controlling negative experiences and instead helps to focus on setting value-based goals.
They help people to become more independent about managing pain, including cutting down drugs which don't help and understanding better the links between what people think, how they feel emotionally, what they do, and the pain, so eventually helping improve mood and confidence.
PMPs vary; some are two- to four week residential programmes while others are based in hospital outpatient departments, or community settings, and continue for several weeks. Programmes are run by pain specialists including psychologists, physiotherapists, nurses, doctors and sometimes occupational therapists and pharmacists.
One man explained that a GP or consultant needs to refer you to a PMP and that people often confuse PMPs that help people to live with pain, with pain clinics that offer mainly medical treatments (see also 'Medical treatments and pain clinics').
- Age at interview:
- Senior trainer NHS Expert Patient Programme; single, living with long-term partner; 3 children.
How do you apply to get into a Pain Management Programme?
There's two ways. You can either be referred by your GP or you can be referred by the Consultant at the hospital, that can be an orthopaedic consultant or the pain doctor, the rheumatologist, or neurologist, the people that do the neuro, or the neurosurgeon, but you have to be referred by either one of those and the Pain Management Programmes are up and down the country.
Now, there's two, a lot of GPs they get mixed up, they think a pain clinic and a Pain Management Programme are the same thing. A pain clinic is where they'll give you medication, injections, all sorts of you know interventions I suppose. Whereas a Pain Management Programme won't give you that, any medication. Their main primary purpose is to help you take more control of your pain. They accept the fact, they're not saying they're disbelieving you, but on the Pain Management Programme there'll be a pain doctor, an anaesthetist who specialises in pain management, clinical psychologist and a physiotherapist.
They're the three main criteria for running a pain management... to call your self a Pain Management Programme. And it's not, when you say... when I say to people there's a clinical psychologist they immediately think 'I ain't mad' but it, that's not like that. Because pain has a psychological effect on you as well, like your thoughts and feelings, you need someone like that, with that professionalism to actually take you through that, to say 'Well hang on a minute, perhaps you need to change your thoughts here a bit'. So, but a lot of GPs, I was at a pain meeting the other night and a lot of GPs in the audience didn't understand the word pain management. They all thought a pain management was a pain clinic.
So, yeah even the health', some healthcare professionals get it wrong as well. But to be referred onto a programme, you need to be referred by your GP, the pain consultant, rheumatologist, an orthopaedic consultant or surgeon or the neurosurgeon, a healthcare professional. Physiotherapy can't do it, or occupational therapy, it's got to be someone like a doctor type bod.
Although there are many more Pain Management Programmes available now most people we talked to had been on a long waiting list and some had travelled to attend a programme. Despite this, most people felt that what they had learnt had been very helpful and wished they had found the PMP much sooner. A man who had considered back surgery said that he thought everyone should try a PMP first - he considered himself lucky that it had worked for him.
Often people were assessed before going on a PMP to find out how pain was affecting their lives, what treatments they had tried and to establish whether they would benefit from the programme. Not everyone stayed on the courses - some had noticed there were dropouts, including people who didn't seem to 'fit in' or found it too challenging.
- Age at interview:
- Unemployed; divorced; 2 children.
Well the process to go through the pain clinic is just, you get a referral from your doctor and the doctor would then... the pain clinic would actually get in touch with you and you go for an interview, the initial interview, and with a psychologist, I think it was. And they assess you. If your, think they'd be, get a benefit out of the programme and they get back in touch with you and you go for a second interview, I think I went for a second interview, and they tell you when the programme's going to start and the programme lasts for I think it was 12 weeks and the actual programme itself it's like a group therapy session.
I wouldn't say group therapy but it's a group session, a group discussion and it was always done things in a group and there was psychologists, physiotherapists, medical profession and they've all got something to say and they get feedback from you and you go through various parts of programmes like exercises. How to do the exercises properly, how long to do them for, when to do them, relaxation. I think that was a big factor that didn't really work for me. I've got my own way of relaxing so relaxation tapes just did not work for me.
I had to use music tapes to relax and that went on for 12 weeks. Psychologists talking to you, understanding things, lots of form filling in and that was it. And one interview, well one meeting, about a month after the programme had finished just to see how we were getting on with things, see how we were coping. I'd say my mobility because of the advice I had got from the programme, I'd say it went up by another 20-30% so I'm quite happy about that. I'm actually being able to get on with my life to a certain extent. Well, I'm not as near as what I want it to be but a lot better than what I was before.
One man explained that you needed to be ready to move on in life and not still looking for a medical cure for the pain. Others were told that pain management cannot give a cure but can help people to live with their pain.
Often the first thing that happened on a PMP was a series of tests and questions to measure pain and how it was affecting activities. Some people were filmed performing various tasks at the start and the end of the programme. One man was amazed by the difference pain management had made to him and, like many others we talked to, felt pain management should be available sooner.
- Age at interview:
- Medically retired lorry driver; single.
When I went to pain management, one of the first things they do is video you walking up and down the corridor - front and back views. After the third week, they do another video of you walking up and down the same corridor and they show you the results of the videos, before and after, and the difference is unbelievable, wouldn't believe it, the difference in your walk, there's so much difference.
As I say about the girl with the crutches was the most, was... since she was on crutches the first day and after three weeks she was walking up and down the passageway without them. All right, she could only walk up once and back and then she had to put on the crutches, but she actually walked up and down that passageway with no crutches and it was great, it was a great thing... Should have more of them.
What else did they do? Did they ask you any other questions about your pain?
Mostly about tablets, what sort of medication we was on. They're quite hard on that, they try to get you to cut down on your tablets and they succeeded in I'd say 99% of the cases. Everyone that I knew cut down on their tablets and I think this is the sort of thing that it should, you'd come when you first had the accident, before anything else, if someone has an accident at work or at home and they've injured their self and get in this sort of position, this should be one of the first things they go to, a Pain Management Clinic. Not leave it ten years before you go. They should have these up and running, straight in. It'd make life a lot easier.
Most PMPs are run as groups and include people with different types of chronic pain. Some were sceptical about the approach or initially found it difficult to fit in. Some assumed that it would be dominated by elderly people and were surprised that so many were in their 30s and 40s. However, most found it good to meet others with pain and some even formed strong bonds and ongoing friendships with people.
- Age at interview:
- Age at diagnosis:
- Writer/driver; married; 2 children.
Anyhow there were a group of us. I think there were about eight people and one was a lady who'd had a leg amputated and had phantom pain. There was a nurse who had a... she had something similar to me. There was a postie who'd broken his neck and had pain all down his body and we were just a random group of people from all over England and we' One was a policeman who'd had a hernia operation go wrong, left him in chronic pain.
And we just sort of... because of the common element of sort of hopelessness and pain we just gelled. There was one lady who didn't fit in. There was a girl who quit, couldn't cope with it. She was a victim of a motorcycle accident. But the rest of us sort of stuck together and we went gradually through this programme. And first of all they educated us.
They told us how the pain systems in the body worked. They told us what happens to the body when people get chronic pain and stop moving, all the tendons, ligaments and that seize up, you get muscle guarding and all these things and so that gradually movement becomes more and more painful, not because of the original illness or disease but because you're seizing up. And so through a very gradual, a very careful process of exercise they taught us to limber up.
While some people were immediately drawn to the psychology of pain, others were sceptical or found the exercise part more appealing. Others were initially terrified of exercising. On the whole people were agreeably surprised at how the emotional and physical aspects fitted together in the programme. One woman remarked that the things she learnt were not “earth shattering” but had changed her life because they were things that she had't thought of before.
- Age at interview:
- Medically retired project manager; married; 4 children.
However, I read a magazine, and this guy had been on the Pain Management Programme and I just sort of read this story and I thought 'Yeah, that's going to be me. I'm going, I'm going to do that' and it wasn't as easy as I thought, it was in '92 and it, when I got on the programme it was '94, it took me quite a long time to actually even locate a Pain Management Programme.
It was National Health. But the one that I wanted to do wasn't in my area and it involved, you know, Department of Health. My doctor, actually... it was fantastic because she'd had a back operation herself and she knew that I really, really wanted to get my life back and she believed me because that was the biggest problem I had was that, you know, even though I'd had these operations some people still didn't really believe me.
But anyway she, she was absolutely brilliant. I wrote to my MP, I did this, I did that. Anyway to cut a long story short, I did get onto the programme and at that time in '94, I went into a hospital over three weeks and I cried for three weeks. I didn't really think that I was that emotional but I obviously must be but I didn't cry emotionally. I cried because I was in pain because I'd never, apart from after that last operation I'd never exercised in my life and I was now 54 and to go into a sort of exercise routine from never, you know, doing exercise. It had never been part of my life. I found it excruciatingly painful.
But because I'd been so screened by physiotherapy, psychologists and everything like that, they knew that in spite of the surgery I'd had and in spite of the pain that I was getting, it was safe for me to do this. And I, even to this day I don't know why, but I just felt safe in their company and I don't, I don't know whether it was because I'd just read this story of this guy, you know, got his life back. I thought 'Yes. This is going to happen to me'. Even as much as I believed them and I felt safe in their company, I still went in there thinking I was going to be cured.
And the turning, that's why it was a turning point in my life, because after 3 weeks you come out. You get a programme to practice exercises. I mean there were lots of psychology and stuff like that. It wasn't just simple. It was quite hard actually. You talked about drugs and things like that but you just learned to live by different rules and they're really simple rules and then that, there's nothing earth shattering about it.
When anyone ever goes on a Pain Management Programme, they always say the same thing, you know, 'Why didn't I think about that?' You know instead of sort of standing there doing ironing for like 3 hours. Why don't you just do it for 10 minutes and take a break and it's all silly things like that, you know, simple things that one pushes themselves to the limit thinking that if I just do that and then I can sit down and I'll be okay instead of making your pain worse by stopping it probably helps it.
And it's all silly things like that and also exercising which for me was the biggest revelation because now I can't live without exercising. You know, it's simple but that's part of my life.
Sessions included talks about what happens in the body when people experience chronic pain and how pain levels can be increased by negative thoughts, stress and anxiety. People learnt how to challenge negative thoughts and reduce stress and anxiety using relaxation and breathing.
A woman said she found it helpful to get a logical explanation for her symptoms of stress and whilst she was dubious about relaxation she was pleasantly surprised when it worked (see also 'Pain management: relaxation and distraction').
- Age at interview:
- Pensions administrator; married; 2 children.
The Pain Management Programme also sort of covered, sort of physical fitness and I hadn't realised how unfit I had become and how shortened many of my muscles were. You know, my hamstrings had shortened dreadfully and I still have problems with that.
But it certainly put me on the right track, and I also hadn't realised the affect that my thoughts had on my pain, you know the sort of negative thoughts and the tensing and, you know, it was explained to us about the, the build up adrenaline when you're almost in panic mode about this pain and the symptoms of the build up of adrenaline, you know the sort of almost breaking into a sweat and being quite shaky etc...
I mean, I had experienced that, but not quite worked out what it was. And it was actually just comforting to find the reasoning behind some of the sort of symptoms that I had and some of the things that had happened me. It was actually just quite nice to find out, well there's a logical explanation as to why that's happening, and I can actually do something about that.
I know that a lot of the Pain Management Programme as well was based around relaxation techniques and, again, I was sort of very sceptical about whether that would have any affect on my pain at all and was quite amazed the first time that I came home clutching my relaxation tape and I said to my husband 'Now this takes 20 minutes, so I don't want to be disturbed for 20 minutes' and sort of rushed through to my front room and lay down on the floor and lit candles, I had a nice cosy fire going and I slept for about two and a half hours on the floor.
I just dropped off to sleep half way through this relaxation tape but it was bliss, it was bliss just to get that, that release, that escape from the pain.
Exercise is an important part of PMPs. Pain can make people become less active and reluctant to exercise, leading to muscle weakness and stiff joints (see also 'Exercise and activity'). As this gets worse people worry that they might hurt themselves.
- Age at interview:
- Retired university teacher and author; married; 3 children.
And so it was arranged that I went into the pain management course and I was very reluctant to do the things that I was being asked to do. Like exercise. When I... every movement produced cramps and spasms, to suggest that I did exercise was completely beyond the pale.
And I was very angry and the first week, I think I just was sitting there, well sitting there for a few minutes at a time then wandering round and then coming back and sitting down again and reluctantly doing perhaps one attempt at each of the exercises that we were given, physiotherapy exercises.
I enjoyed the relaxation that we had, that was good. And I enjoyed the sessions with the psychologist. And at the end of the first week I was beginning to feel well I might have got something out of it but I wasn't quite so sure whether it was for me. But I was enjoying the whole process of people together sharing their experiences. What was good was seeing that there were other people like myself who had got pain and were struggling and were going through, were in various stages of coping.
What was good, I found, was that they were people who'd started their four week session and were now in their third and fourth weeks when I was in my first. And hearing from them, that they had been like myself when they started, and I could see these people doing tremendous physical exercise, being very positive, that was, I think the biggest thing that convinced me that there was something about the pain management approach that was for me.
I was living in digs in [city]. I went over to [city]. Lived in digs just about 100 yards from the hospital to make getting there a bit easy. And so I went home on the Friday, after the first week, and it was quite interesting that I got the idea into my head that, by then that, well perhaps things should change.
I'd been in this situation of not being able to sit through a meal, and so I went home and decided I would sit in a different chair for a meal, family meal. This happened to by my youngest son's chair. I think I chose him because he was least likely to object, or he was the least powerful member of the family!
But I sat in his chair and sat through the meal and this became a family joke, that change does something. And I felt as though I'd achieved something absolutely miraculous and major, that I'd actually sat through a meal, simply by changing my chair. So I went back full of enthusiasm for the course on the Monday and I started to make a lot of progress.
Being taught to exercise safely with a programme of exercises could help people to build up at their own rate.
- Age at interview:
- Care home manager; single.
Back to the Pain Management Clinic... Their programme of exercises I think again I pretty well knew what to do but I think I got myself into a cycle of progressively doing less and less, getting stiffer and stiffer and it was difficult to say which was, what was pain caused by an injury or whatever or what was stiffness, that any use was going to cause me pain.
So I managed to get myself moving a bit more and I think an awful lot was caused by stiffness. And also that however much I rationalise to myself that exercise wouldn't hurt me, there was the belief there that it's going to hurt me. I think finding out in a safe environment that it didn't hurt me and it was actually beneficial was very good as well.
They also spent quite a lot of time with me trying to persuade me to pace myself because if I take something on that I like to finish it, come what may, and I come from the sort of old school 'Oh anyway if it's a bit sore never mind get on with it' kind of thing. Which was all very well because I was getting on with it and then days on end I was paying for it, so he taught me to sort of do things in little bits and build up to things so again I think that was a very helpful discipline and to have people there. The group there and also the psychologist and the physiotherapists to sort of, if you like, chivvy me on was, was good and to sort of check things out, try things out and get back to them and they would adjust things so'
People also learnt to pace everyday tasks to avoid increasing pain. This involved working out how long you could perform a task before the pain made you stop, setting a baseline below that level, setting realistic goals, and building up steadily by small amounts.
One woman described how she had learnt about combining the skills that she had learnt on the PMP to deal with a flare-up of pain (see also 'Coping with flare-up'). Some had been given advice about getting back to work. One man who described his PMP as 'miraculous' had been helped to resume his career as a managing director by taking things in monitored stages.
After the PMP some people attended a follow up meeting, others had been given written information or tapes, which they still referred to and some found it helpful to join a support group (see also 'Support groups').
The British Pain Society’s publication on ‘Participant Information for Pain Management Programmes (2013)’ has more information on this topic. See also 'Pain management: pacing and goal setting' and 'Pain management: relaxation and distraction'.
Last reviewed May 2015.
Last updated May 2015.