The Bury Integrated Pain Service is a service for people who have long-standing problems with pain. It aims to help patients to manage their pain as well as possible and return to their usual activities. Clinicians from several different professions work together with patients to make sure that they get the most appropriate care and meet their goals.
Following a detailed assessment, patients will be offered the services that are most appropriate to their individual condition. This may include a medication review, specialist pain physiotherapy, pain-focused psychological treatment, mental health support, a pain management programme, acupuncture or interventional procedures, such as radiofrequency denervation. Not all treatment will be appropriate for all patients, so the services you are offered will depend on the type of pain that you are experiencing. In addition, we will liaise with any other services that you are under to try and ensure that your treatment is co-ordinated with other healthcare teams.
The Bury Integrated Pain Service is run by a team of experienced physiotherapists, nurses, psychological therapists and doctors. It aims to get your pain as well controlled as possible, to help you manage your pain independently and let you do your usual activities. It is not always possible to get rid of pain altogether, however your clinician will help you understand why you are getting pain and what you can do about it.
Your first assessment will last approximately one hour. This will help to identify the different factors that may be contributing to your pain. This will allow us to tailor treatment towards your needs. Currently, initial appointment are face-to-face, however, if you would prefer a telephone or video consultation this can also be arranged.
What should I bring to the appointment:
- Reading glasses – you may need to fill out some questionnaires to help us understand your pain and tell us about how it is affecting you. This also helps us to monitor how you are improving.
- A list of any medications, including doses, that you are taking (a current prescription is fine)
- Any letters from other clinicians or hospitals about your painful condition
- Your clinician may need to assess you if you have not been fully examined in the past. Please wear loose fitting clothing around the affected body part. Alternatively, bring shorts or a loose fitting top to change into.
Following your assessment your clinician will agree a treatment plan with you as to which options you want to try. This might include a number of different options such as:
- Advice about how to get back to your usual activities
- Information which explains why you get pain
- Taking part in a pain management programme. This is delivered by physiotherapists and psychological wellbeing practitioners. It involves a combination of exercise, advice, education and planning how to get back to your usual activities. Many people find the group environment very supportive and for many people this is the best option.
- Taking part in an exercise programme which is at the right level for you
- Talking therapies to help you manage your pain by helping to recognise where stress is making pain worse
- Talking therapies to help improve your mood, decrease anxiety or to improve sleep
- Trying some new medications
- Helping you to decrease the amount of medication you take.
What happens after my assessment?
Once you have agreed a plan with your clinician you will have a follow up appointment arranged to start your treatment. Sometimes other treatments are required and your clinician will discuss this further if needed. Sometimes your clinician will discuss your case with other members of the team to make sure that you get the best treatment.
What happens after treatment?
Once you have completed your agreed treatment programme you will be discharged back to your GP. When you are discharged we will agree a plan with you so that you know what you need to do to keep your pain under control and keep active. We will also advise your GP of anything that they can do to help support you.
Who will I see?
The Bury Integrated Pain Service is made up of advanced physiotherapy practitioners and specialist pain physiotherapists who have expertise and specialist knowledge in persistent pain.
Advanced Physiotherapy Practitioner
The advanced physiotherapy practitioners have an advanced level of skill and practical and theoretical knowledge to undertake a thorough holistic assessment. They can determine a clinical diagnosis and formulate individualised management and treatment plans. These may include: advice and discharge, referral to specialist pain physiotherapy or other professions for management, request further investigations and diagnostic procedures (MRI, X-rays, blood tests) and interpret these to lead assessments.
Pain Consultant
The pain consultant is an anesthetist by training with a special interest and knowledge in pain conditions. You may be referred to the consultant if it is deemed appropriate that you require a more medical approach to your pain. This may include complex medication reviews and treatments including low level laser therapy.
Specialist Pain Physiotherapist
The specialist pain physiotherapists are experienced physiotherapists with specialist skills and knowledge in persistent pain. They will carry out specialist assessments to determine the physical, medical and psychological aspects of a person’s pain. They will develop a treatment plan to support people with persistent pain to develop the skills they need to manage their condition and increase their function and movement.
Non-Medical Prescriber
Some of the team also work as non-medical prescribers. These clinicians have completed an additional course to be able to independently prescribe medications relating to pain management. Clinicians will review past and current medications and work together with the patient, and the patient’s GP, to develop a medication plan that works for them.
The Team
Dr David Thompson, Advanced Physiotherapy Practitioner and Non-Medical Prescriber
Dr Deborah Antcliff, Advanced Physiotherapy Practitioner
Dr Vinod Gadiyar, Pain Consultant
Rebecca Lock, Specialist Pain Physiotherapist and Non-Medical Prescriber
Matthew Ramshead, Specialist Pain Physiotherapist and Non-Medical Prescriber
Antony Walmsley, Specialist Pain Physiotherapist and Non-Medical Prescriber
Blanca Alhambra Olalla, Specialist Pain Physiotherapist and Non-Medical Prescriber
Jane Hayes, Specialist Pain Physiotherapist and Non-Medical Prescriber
Alex Flaherty, Specialist Pain Physiotherapist
Kara Haslam, Administrator/Secretary
Ginette Jordan, Administrator/Secretary
Persistent pain is any pain that goes on for longer than would be expected after an injury or illness. Pain is initially produced when we have an injury or to let us know something is wrong. When we have an injury our bodies produce chemicals which cause our pain nerves to become more sensitive so that we get pain as a “warning sign” before we injure ourselves further. Normally, once the injury gets better our nerves go back to normal and the pain stops.
Unfortunately, in some people their nerves stay too sensitive. This means that they continue to get pain even though there is no longer any problem with the body’s tissues. This can also mean that they have to reduce the amount of activity that they do. Sometimes people also become concerned about the cause of the pain and worry about damaging things more. Unfortunately, this causes the nerves to become even more sensitive, often meaning that the pain gets worse and starts to affect different parts of the body.
Not everyone develops persistent pain following an injury. Some people find that their symptoms start without any obvious cause. We know that other things can also cause the nervous system to become too sensitive. For example, we know that poor quality sleep, low mood and stressful life events (such as a bereavement or losing a job) can cause the pain nerves to become too sensitive. For other people, long standing health problems (such as breathing problems or arthritis) can cause people to stop exercising as much as previously.
Not only does this mean that the body becomes less fit, the nerves are no longer used to doing activities and can start to send pain messages when doing activities that used to be painless. This is known as the persistent pain cycle as shown below:
Persistent pain can be extremely uncomfortable, particularly when doing activities that are harder than usual or that you are not used to doing. It is important to remember though that even though you may be in a lot of pain, this does not mean that there is a serious underlying problem with the tissues of your body. Similarly, persistent pain is not a sign that you are damaging your body more. There are no tests to diagnose persistent pain.
Sometimes other investigations, such as MRI scans or blood tests can be useful in excluding other causes for the pain. However, these investigations are only helpful if you have certain symptoms and often they do not add any extra information. Most commonly the best way to diagnose painful conditions is through a thorough assessment with a health professional that specialises in working with people with long-term pain.
Although no cure exists for persistent pain, this does not mean that nothing can be done to improve your symptoms. There are many things that contribute to pain and learning how to work on each of these is usually the best way to improve your symptoms.
Regularly exercising, gradually exposing your body to normal movements, improving your sleep and focussing on your mental health and emotional wellbeing can all improve pain and function. Learning how to make changes in how you do your day-to-day activities can also be helpful in managing your symptoms.
Keep moving
Persistent pain is often caused by our nerves becoming too sensitive. Gradually getting things moving helps to de-sensitive the nerves and get them used to doing that activity again. If a movement is painful, do a slightly easier version of it on a regular basis. It will gradually get easier and you can then increase the difficulty of the activity. Try to avoid doing so much of an activity that you can’t do it again for several days. The body responds best to doing activities little and often at first.
Exercise
Exercise can help pain in a number of ways. Firstly, moving the body helps to de-sensitize the nerves which play a part in persistent pain. Exercising also stimulates your body to release chemicals which can help to reduce pain and de-sensitize nerves. Finally, regularly exercising helps to build strength and fitness which will make doing activities easier.
Improve your sleep
We know that a lack of refreshing sleep will make your pain worse and in some cases can actually be the main cause of pain. Likewise, getting too much sleep or sleeping during the day can also make problems worse. Try to establish a routine, avoid daytime naps and cut down on the amount of caffeinated drinks, alcohol and cigarettes you consume, particularly before bedtime.
Download the sleep information sheet to learn more about strategies to help improve your sleep.
Pace your activities
Many people with persistent pain experience good and bad days. People often cram as much activity as possible into days when they have less pain, but find that their pain is much worse the next day. Aim to do similar amounts of activity on all days, even when you may be feeling worse than usual. Making a plan, rather than seeing how you feel at the time, can be helpful in setting sensible activity levels.
Download the pacing activites information sheet.
Set goals
Many people find that their pain limits how much activity that they can do. Although it is not always possible to get straight back to the things you used to do, setting goals can be a helpful way to gradually get back to doing your usual activities. Think about which activities are most important for you to get back to doing. Choose one or two activities to start with and set your goals around this.
Try and set realistic targets and try to stick to these. Think about how long it is since you last did the activity. If it has been a long time you will probably need to do a smaller amount at first than you used to do. Also think about what happened last time you tried the activity. If it made you feel lots worse afterwards, make the goal easier to start with. If you were just a little worse, remind yourself that this is normal until your body gets used to doing it again. Often, good goals to start with are activities that you miss doing or things that make you feel down because you can’t do them (e.g. hobbies or socialising). Once you have done the activity think how this has affected your mood. Does it feel good to be doing it again? Has it given you a sense of achievement? Once you achieve one goal, make a new, slightly more difficult one. By doing this you should find that you can gradually build up your activity levels over time.
Download the goal setting information sheet.
Take care of your mental health
Your mood can have a big effect on your physical health, and vice versa. Scientists who study the brain have shown us that if you’re stressed or feeling low you experience much more pain than when you’re feeling happy. Many people with symptoms of pain become very frustrated that they cannot do things as they would like. This can lead to anger, anxiety, low mood and loss of confidence. For some people simple steps, such as making sure you do an enjoyable activity each day, can be enough to improve their mood. For others, talking therapies can be extremely helpful in managing stress, anxiety or low mood. Occasionally peoples’ mood can be so low that they need medication to help to return the chemical imbalance in the brain to normal and allow them to engage with other treatments. Getting some support with from a psychological therapist who understands pain can be really useful in beginning to reduce the pain you feel.
If your pain clinician has not already done so, you can refer yourself for talking therapies here.
Reflect and accept
Recognise that symptoms will be worse at some times than others. Sometimes there will be a physical reason for this (such as over-doing an activity), however, there may not always be. Reflect on what you have and haven’t been doing recently. Have you been exercising? Are you under more stress or feeling low? Have you been using the strategies that have helped you in the past? It is often what you haven’t done, rather than what you have done that causes symptoms to worsen.
Have a flare up plan
Unfortunately, people with persistent pain can experience times when their pain is much worse than at others. This is known as a flare up. This does not usually mean that you have done anything wrong and flare ups can happen even if you manage your symptoms as well as you can. However, if you do experience a flare up, there are certain steps that you can take to make sure that your symptoms settle and you get back to your normal activities as quickly as possible. Although short periods of rest can be helpful, prolonged bed-rest is likely to mean that your flare up lasts longer. It will also mean that getting back into activities will be harder. Try to do some simple exercises to get the painful body part moving and gradually build your activities up over time.
Download the managing setbacks information sheet.
Very occasionally an increase in symptoms can be due to a different problem. If an increase in symptoms is associated with weight loss, feeling generally unwell or other new symptoms speak to your GP. If you have problems with back pain and you develop any of the following problems you should attend A&E immediately:
- Numbness or loss of feeling around the genitals or back passage
- Losing control of your bladder or bowels
- Not being able to pass urine
- Not knowing when you need to pass urine
- Loss of the ability to achieve an erection
- Loss of feeling during sexual intercourse
Patients frequently tell us that medical terms and jargon can be confusing and often makes them worry more about what is going on with their body. This section gives a brief outline about what many of these terms and conditions mean and how they are treated.
Exercise circuit - Level 1
Exercise circuit - Level 2
Week 1 - Physical Activity and Persistent Pain
Week 2 - Goal setting
Week 2 - Pacing Part I
Week 3 - Pacing Part II
Week 4 - Medications
Week 5 - Sleep
Week 6 - Managing setbacks
After your assessment you may be referred to the Pain Psychological Medicine team. This team is made up of clinicians with expertise and specialist knowledge in the complex interaction between pain and emotional distress.
People sometimes worry that being referred to the Pain Psychological Medicine team means we think the pain is ‘all in their head’. This is incorrect and we understand that the pain you experience is very real. What pain science has shown is that for all of us our experience of pain is affected by many different factors including our memories, relationships, sleep, mood and anxiety. In fact pain itself is defined as an ‘unpleasant sensory and emotional experience’ so it very common that some fear or distress will be present if we are in pain. Due to this, effective management of persistent pain requires a ‘multi-disciplinary’ approach which incorporates psychological interventions. The Pain Psychological Medicine team work with people who may be experiencing significant distress as a result of their pain, or who have pre-existing mental health difficulties which interact with the pain.
What will happen if I am referred to this service?
If you are referred to this team you may be invited in for a further assessment. We appreciate that it may be frustrating to have to attend multiple assessments; however the Pain Psychological Medicine team may need to gather different kinds of information and wish to understand more fully the impact of your pain on your day-to-day life. The assessment process usually takes between 1-4 sessions. Following an assessment, you may be offered a time-limited intervention which will be based upon your needs and agreed with you and the clinician you will be working with.
Who will I see?
The Pain Psychological Medicine service is made up of an advanced clinical practitioner, two clinical psychologists, and a consultant liaison psychiatrist. The service also offers placements to trainee clinical psychologists and occasionally other students.
Advanced Clinical Practitioner
The advanced clinical practitioner is a nurse by background and works at the interface between physical and psychological care. They will look to assess your psychological needs and aim to provide holistic guidance in relation to pain, provide short term interventions on mood, sleep, diet and exercise and signpost to relevant services which could help manage your mood alongside your pain experience. You may spend some time with the advanced clinical practitioner to prepare you for therapy interventions with a clinical psychologist, prior to engaging with the consultant liaison psychiatrist or before being referred to another service.
Clinical Psychologists
A clinical psychologist is a doctor of clinical psychology, whose role is to help people in distress. Clinical psychologists draw upon psychological theory and evidence-based approaches to work with you to make sense of the problem and will think with you about how your pain impacts upon your emotional wellbeing and vice versa. The beauty of clinical psychology is that psychologists are trained to work from a number of therapy models which means your treatment plan will be tailored to your individual needs. The treatment offered may include group or 1-1 psychological therapy and the length of time it lasts will be agreed between you and your psychologist.
Consultant Liaison Psychiatrist
A consultant liaison psychiatrist is a medical doctor who has qualified in medicine and then undertaken training in the medical speciality of psychiatry before being recognised as a specialist. Liaison psychiatry is the branch of psychiatry that works at the interface between physical and psychological care. The liaison psychiatrist will approach your care holistically, drawing upon knowledge of medicines, physical health conditions, mental health conditions and psychological approaches to advise on your treatment. They will work closely with all other members of the Bury Pain Psychological Medicine team, and the wider Integrated Pain Service. They may also work closely with your GP or other healthcare providers.
The Team
Denise Journo, Medical Secretary
Dr Sophie Broere, Clinical Psychologist
Dr Louise Sell, Consultant Liaison Psychiatrist
Matthew Hall, Advanced Clinical Practitioner
Bury Pain Psychological Medicine Service Office: 0161 253 6675
If you feel you might benefit from seeing someone from the Pain Psychological Medicine team speak to your pain practitioner or your GP
Lifestyle service
The Bury lifestyle service can advise you how to improve your health in a number of ways, such as exercising more, losing weight or giving up smoking.
Tel: 0161 253 7554
Email: lifestyleservice@bury.gov.uk
BEATS (Bury Exercise and Therapy Scheme)
If you would like to continue to exercise in the longer term, but feel that you need further support, your pain clinician can refer you onto the BEATS team. Patients who are referred to BEATS will receive on-going supervision with exercise and improving their health and subsidised access to Bury leisure facilities.
I Will If You Will
I Will If You Will is all about helping the women and girls of Bury to get more active, more often and have fun while they do it. Funded by Sport England and delivered by Bury Council, this initiative is about women getting together and trying something new.
For more info go to www.Iwillifyouwill.co.uk
Tel: 0161 253 7575
The Bury Directory
The Bury directory contains information about various services across Bury. The directory can be found at https://www.theburydirectory.co.uk
Further information about pain you can have a look at:
- Pain Toolkit
- Arthritis Care
- Arthritis Research UK
- Pain concern
- British Pain Society
- Opioids Aware
- Live well with pain
- What is arthritis?
- Osteoarthritis
- Osteoarthritis of the hip
- Osteoarthritis of the knee
- Osteoarthritis of the spine
- Back pain
- Neck pain
- Shoulder pain
- Fibromyalgia
- Ankylosing Spondylitis and related conditions
- Joint hypermobility syndromes
- Rheumatoid Arthritis
- Carpal Tunnel Syndrome
Further information about conditions and treatment options:
Further information about healthy eating:
Further information about mental health issues:
Samaritans
If you need to talk to someone, in your own way, about anything that is bothering you, the Samaritans can offer you free support. Call 116 123 from any telephone to receive free, confidential support, visit online (link to www.samaritans.org) or email jo@samaritans.org
The Sanctuary
The sanctuary is a 24 hour mental health crisis line. The service is available 24 hours a day, 7 days a week (for clients over 18 years old only). Call 0300 003 7029
CALM (Campaign Against Living Miserably)
Calm is a charity dedicated to reducing male suicide. Call 0800 58 58 58 or web chat at www.thecalmzone.net
PAPYRUS
For children, teenagers and young people up to 35 who are feeling suicidal and need support. Visit online www.papyrus-uk.org, call 0800 068 41 41 or text 07786 209697. (Mon-Fri: 10am-10pm, Weekend: 2pm-10pm, bank holidays: 2pm-5pm).
Silverline
The Silver Line is a free, confidential helpline providing information, friendship and advice to older people, open 24 hours a day, every day of the year. Visit online at (link to www.thesilverline.org.uk) or call 0800 470 8090.
NHS Talking Therapies
NHS Talking Therapies is open to anyone with a Bury GP. They provide treatment for anyone who is experiencing symptoms such as difficulty sleeping, low mood, stress, worry or anxiety, feelings of hopelessness or panic attacks. You can refer yourself to NHS Talking Therapies at:
https://www.penninecare.nhs.uk/burytalk or by telephoning 0161 253 525
Greater Manchester Pain Management Resources Hub
This resources hub has been designed and developed by Greater Manchester healthcare professionals to help tackle this disconnect by providing guidance on how to change the focus from pain reduction to improved function with self- management strategies, effective use of medications and with de-prescribing strategies where they are unhelpful. The Greater Manchester Pain Management Resources Hub is endorsed by NHS Greater Manchester and maintained by the Greater Manchester Medicines Management Group.
Will my pain ever go away?
Unfortunately, there is no cure for persistent pain. However, this does not mean that nothing can be done to improve the situation. Pain can be controlled and it is possible to lead a full and normal life despite having pain.
What causes pain?
We would all like a straightforward answer as to why we have pain. Unfortunately, persistent pain is much more complicated and is rarely due to just one cause. Usually a number of different factors contribute to long-standing pain and it is important to tackle each of these to make sure your pain is as well controlled as possible.
Why can’t I just take stronger painkillers?
Strong painkillers were not designed for long-term use and often have side-effects that can be as limiting as the pain itself. These can include drowsiness, confusion, memory problems and excessive sleeping. These side effects are usually not a problem if the medications are only taken for a short period, for example after an operation, but can be very limiting if present every day. In addition, once you have taken a painkiller for a while your body gets used to it and it becomes less effective. This means that greater does are required to get the same benefits. Unfortunately this tends to mean greater side effects. Research studies have actually suggested that strong painkillers do not work particularly well for persistent pain anyway. This is as persistent pain is caused by different factors to acute pain.
I’m worried that I have something seriously wrong with me. Do I need a scan?
Persistent pain is very rarely caused by a serious underlying illness. Most people referred to the Bury Integrated Pain Service will already have had their pain fully investigated. However, if you are concerned that something may have been missed discuss this with your pain clinician at your appointment. If they feel that further investigations are required they will arrange these as appropriate and fully explain the findings to you.
I feel really low and depressed. Is this normal?
Pain can affect all aspects of your life and make it difficult to carry out your usual activities. It is completely normal for this to affect your mood and most people with persistent pain will experience low mood at some point. Talking therapies can be very helpful in improving your mood, and most people find that their mood starts to improve once they start treatment and begin to return their usual activities.
My pain can suddenly increase, particularly if I move the “wrong way”. Are there some activities I should avoid?
Many people experience sudden, sharp or severe pain on certain movements, particularly if it is a movement or activity that they do not usually do. Although such movements can be extremely painful, they are very rarely due to tissue damage and different people will find different movements difficult. These types of pain are usually caused by a combination of muscles and joints not being flexible enough and over-sensitivity of the nervous system. There are therefore no movements or activities that you should avoid. In fact, avoiding certain movements can actually make the problem worse, as the body gets stiffer and more sensitive. If a particular movement is painful, it will usually get easier if you gently get it moving and build up how much you do over time. Your pain clinician will advise on how to best do this.
I’m worried about the future. Am I going to get worse and worse?
Most people with persistent pain worry about things getting worse over time. For the majority of people however, if they do the right things, their symptoms and function will get better rather than worse. Some people get stuck in a vicious cycle and can become more limited by their symptoms. However, even then, if given the correct support and guidance most people can start and get back on track.
The Bury Integrated Pain Service is an evidenced based pain service with a strong physical and psychological multi-disciplinary focus. Patients are initially assessed by a team of experienced specialist pain physiotherapists and specialist pain nurses. They undergo a full bio-psychosocial assessment and physical examination (where appropriate). If investigations are required these can be arranged directly via the integrated MSK service without the need for further appointments. A treatment plan will then be agreed with the patient, based around their personal goals and evidence-based treatments. This may include referral on for multi-professional assessment from psychological therapists or medical practitioners. See further details on the treatments offered here.
If you require advice regarding a patient please ring 0161 724 2168 to speak to pain clinician.