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
- 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.
NHS PMPs 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 2–4 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‘).
Described how you get referred to a pain management programme and the difference between pain…
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.
Was assessed before going on a pain management programme to make sure he was going to benefit.
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.
Was filmed walking at the start and the end of the pain management programme and was amazed…
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 thirties and forties. However, most found it good to meet others with pain and some even formed strong bonds and ongoing friendships with people.
Explained that the people on the pain management programme all had chronic pain for different…
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 hadn’t thought of before.
Learnt simple techniques at the pain management programme that weren’t earth shattering but…
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‘).
Learnt, on a pain management programme, how negative thoughts and stress affect her pain and was…
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.
On the pain management programme he was initially reluctant to join in and exercise but when he…
Being taught to exercise safely with a programme of exercises could help people to build up at their own rate.
Was scared to exercise but on the pain management programme learnt how to gradually increase the…
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‘.