The Manchester and Salford Pain Centre is one of the country’s leading clinics for the management of all forms of pain. We are an interdisciplinary clinical team of doctors, physiotherapists, psychologists and nurses who are expert in managing all forms of pain, ably supported by reception and administration staff. This section is for information on the chronic pain outpatient service.
Referrals are received from GPs and from within the Trust. We also encourage referral of patients with complicated pain conditions from other pain clinics for our more advanced treatment options such as intensive pain management programmes and spinal cord stimulation. We would usually expect that you have completed any outstanding investigations or treatments aimed at pain relief prior to being referred to the service.
What is Chronic Pain?
Chronic pain means persistent or long-term pain. It is pain that has lasted for longer than 3-6 months, and in many cases, it can last for most of a lifetime. Chronic pain can be a confusing and frustrating condition to live with, particularly as it is something that cannot be seen from the outside by those around us. Most of us grow up understanding that pain will go away. So how can we make sense of pain that doesn’t go away - pain that becomes persistent?
Firstly, there are important differences between acute pain and chronic pain.
Acute pain
Is an indication that damage has happened as a result of injury (e.g. hitting your thumb with a hammer). It is a helpful alarm signal that enables us to get out of harm’s way and to protect our bodies while we heal.
When you have a new injury (acute pain) it is easy to guess which part of your body is causing the pain - the bruise, the broken bone, or swelling around a sprained ankle. With chronic pain, it is much more difficult.
Chronic pain
Is long lasting or persistent pain, which has no useful purpose and is not an indication of new or further damage. There are 3 processes that contribute to chronic pain:
- There are physical or structural changes within the body
- There are changes in the way pain messages travel to the brain
- Pain changes your level and type of activities
The reasons for your pain will be a combination of these factors.
You may not have had an explanation of your pain that makes sense to you. Often, no obvious physical cause can be found for chronic pain. This can be confusing and frustrating - after all, you know you have pain.
You might think that some of the advanced scans that are available now would help to pinpoint the physical problem. This is often not so. Even the best scanners only give a ‘snapshot’ picture of your body. They only show the physical structures or organs, not how messages are sent to the brain to make you aware of what is happening inside. Even when doctors can pinpoint physical changes on the scans or x-rays (for example, arthritis or a disc problem) it is still impossible to say whether these are the source of your pain or not, as two different patients, one with pain and one without pain, may look the same on the scan. Clearly, pain is very complex, and scans and x-rays don’t always give us the full picture.
In chronic pain, the messaging system is behaving differently to the way it does in acute pain. In acute pain (new injury), pain is very important. It makes us rest and protect the injured area so that no further damage happens and things have a chance to heal. However, even in this situation, it is possible to have an increase in pain - without further injury: think of a new, purple, swollen bruise. What does it feel like if someone gently prods it? Gentle pressure on the bruise does not cause further damage - but it will certainly cause pain!
In chronic pain it is as if the useful changes that happen to the messaging system after an injury don’t ‘switch off’ - even though any healing has completed. It is a bit like having a fire alarm system that has gone off and keeps ringing even when the fire has been put out. Medical science has not yet discovered why the pain messages system stays 'switched on' for some people after injuries have healed.
Just because we may not be able to give you a specific diagnosis or tell you exactly which structure is causing the pain, it does not mean that your pain is not real. Your pain is likely to be a combination of all the factors mentioned. While your pain cannot be seen from the outside it is important to understand that your pain is real, and it is not ‘all in the mind’. It simply means that from your symptoms, from examining you and from the tests you have had we can say there is no further medical or surgical treatment needed to help with your pain.
For more detailed information about chronic pain physiology you can read this booklet ‘explainling pain’ or watch this clever animation ‘tame the beast’.
How can we help?
Unfortunately, we rarely have a cure for chronic pain. Medicines are often unhelpful, and most people have had unsuccessful treatments and interventions. However, thinking differently about your pain, and developing skills to better manage pain can be very beneficial. It can help people to improve their quality of life, despite the ongoing pain. Even reading this information can be helpful, as it can reduce the ‘threat’ of pain. Looking at how you plan and pace your activity, and developing manageable exercise programmes can help improve your overall activity levels. We know that worry, low mood and frustration can ‘wind-up’ pain, so developing skills to manage these common negative emotions can be useful. Have a look at the other sections on this web page to find out a bit more.
Pain Specialist Physiotherapy
The physiotherapy team consists of six physiotherapists who specialise in the field of pain management. We are involved in both new patient assessment clinics, and in the subsequent rehabilitation appointments.
The physiotherapy team utilise a combination of exercise therapy, education and advice on strategies such as pacing and goal setting to help people with chronic pain work towards their personal rehabilitation goals. The physiotherapists work within a cognitive behavioural approach and work closely with the clinical psychology team providing multidisciplinary joint treatment sessions and pain management programmes. Overall, the pain centre physiotherapists aim to enable people with chronic pain to develop self-management strategies to improve their physical function and quality of life despite their pain.
The physiotherapy team also provide training and educational sessions for other healthcare professionals and local universities.
Pain Specialist Clinical Psychology
Clinical Psychologists are highly specialised practitioners in the assessment and treatment of psychological distress. In addition to this, a Clinical Psychologist in a Pain Centre has specialised knowledge about the impact of being diagnosed with a chronic pain condition, and the bearing that this can have upon an individual’s quality of life.
The psychologists assess the impact of chronic pain on people’s lives, particularly the effects on family life, work, social activities and mood and help people learn new coping strategies to reduce the impact of pain in these areas.
People often tell us that pain makes it much more difficult to cope with other problems so we may start off by looking at stress management techniques such as breathing and relaxation exercises. This helps people to remain calm and think clearly in stressful situations. This also works well when combined with the stretching exercises given by the physiotherapists.
We also help people to rebuild their confidence by learning to recognise and challenge any negative thoughts or unhelpful thinking styles. This helps people to feel less frustrated and more realistic about dealing with problems, more in control of their lives again.
How can clinical psychologists help with chronic pain information guide
Medical Consultants
Manchester and Salford Pain Centre has a team of five medical consultants. Pain clinics originally developed through procedures being performed by anaesthetists for cancer pain. This role has expanded to include management of chronic non-malignant pain leading to interdisciplinary team working. The consultants in the Pain Centre therefore have anaesthesia as their base speciality. We also have some GPs with a special interest in pain management working within the service.
The consultants are involved in assessing patients at point of first contact clinics independently and also alongside other members of the team. The purpose of the medical review is to exclude disease processes which may be more appropriately managed by other specialists as well as optimising medication management for pain. In addition, patients may be listed for interventional pain procedures if appropriate. We offer medical support to the pain management programmes and also conduct acute pain ward rounds.
Pain Management Programmes
Manchester and Salford Pain Centre is a national centre in the delivery of interdisciplinary Pain Management Programmes (PMPs). PMPs have been running in Salford since 1983 and are currently provided on a residential and outpatient basis as part of our comprehensive pain management service.
What is a Pain Management Programme (PMP)?
A PMP, is a group rehabilitation programme for patients who are suffering chronic pain and is led by a Clinical Psychologist, Physiotherapist and Medical Consultant, all of whom specialise in the management of chronic pain. Around 12 patients attend each programme.
Chronic pain is pain that has lasted more than six months and remains unresolved despite many different treatments and investigations and it can often affect many areas of life including work, social life, home life, mood and sleep.
Prior to attending a PMP, a patient will undergo detailed assessment from all members of the team. On the basis of assessment, the programme team will determine which programme the patient is likely to gain most benefit from. If a PMP is not thought to be suitable, the reasons for this will be fully explained and other recommendations will be made, if possible.
The Pain Management Programme service at Manchester & Salford Pain Centre complies with the current guidelines for PMPs by the British Pain Society. PMPs are advocated by the British Pain Society for the management of chronic pain.
Types of Pain Management Programme
There are currently two types of pain management programme at Manchester and Salford Pain Centre, plus other forms of group based input:
- Intensive Pain Management Programme (Monday to Friday, full days, for 3 consecutive weeks)
- Standard Programme (2 full days per week, for 4 consecutive weeks)
- Facing Forwards - An online pain management programme specifically for people with persistent facial pain.
We also run some less intensive options including the Accessing Pain Management Online (APMO) course and the Introduction to Managing Pain (IMP) course, which is available both online and face to face.
Who is suitable?
Patients attending pain management programmes can expect:
- Improvements in interpersonal relationships
- Reduced depression and anxiety
- Increased physical fitness
- Increased likelihood of work retention or readiness to return to work
- Optimised medication use
- Reduction in health care use
A patient may be suitable for a PMP if the following criteria are fulfilled:
- Chronic pain causing significant disability and / or distress.
- Over 18 years old.
- All appropriate investigations and treatments for pain have been completed.
- No planned referrals to other specialities regarding the pain problem.
- Other health problems should not be risk factors for active rehabilitation (e.g. uncontrolled angina or asthma).
- Can manage basic activities of daily living and is self-caring.
- No major substance misuse (including alcohol).
- No major psychiatric disorders of current significance.
- The patient is willing to participate in a group programme involving psychological and activity-based interventions.
Due to the nature of the programme the PMP may not be suitable for all patients. An offer of a place on the programme will be made on a case by case basis, after discussion with the patient and consideration of any reasonable adjustments. In some cases the patient may be offered individual input to work towards attending a future programme or they may be offered an individualised programme of care rather than a PMP.
Hear from our patients/videos
Hear from some of our patients who have completed the Pain Management Programme (PMP).
Before PMP - What was life like before the Pain Management Programme?
During PMP - What happened on the Pain Management Programme?
After PMP - How have things changed after the Pain Management Programme?
There is strong research evidence for the effectiveness of both outpatient and residential cognitive-behavioural PMPs as a package, compared with either no treatment or standard treatments.
Spinal Cord Stimulation
Spinal cord stimulation for chronic neuropathic nerve pain information guide
- Live well with pain - Information for patients and health care professionals, including the ‘Ten Footsteps to Living Well with Pain’ - a step-by-step online guide to living well despite persistent pain and information on opioid reduction
- Pain concern - charity for people with pain including podcast
- Flippin’ Pain™ - a public health campaign with a clear goal: To change the way we think about, talk about and treat persistent pain. Flippin’ your understanding of pain could change the lives of you and your loved ones forever.
- Rethinking Pain - Developed by a West Yorkshire pain service with translated resources including Arabic, Bengali, Hindi, Pashto, Polish, Punjabi, Ukrainian and Urdu
- Retrain Pain – website with a scienced based approach to help people overcoem chronic pain. Information available in a variety of languages
- Pain Toolkit - pain self-management advice
- Tame the Beast - Useful 5 minute video to help understand pain
- Understanding pain in under 5 minutes
- painHEALTH - Australian website for people living with musculoskeletal pain to access practical evidence-based information and skills
Patients can be referred to the centre either by their GP or any hospital specialist. A formal letter of referral should be sent to AdminCentreReferralsSCO@nca.nhs.uk outlining the patient’s history and current position. Other useful information to include would be a list of current medications and results of any investigations such as a summary of scan results and any pertinent psychosocial history.
Once we receive a referral the patient will be asked to complete and return a questionnaire about their pain. The information they provide will help us understand more about the pain they are experiencing and how it is affecting them, both physically and emotionally. These questionnaires are an important part of the assessment and are reviewed by an MDT. They help us to allocate to the most appropriate clinic and allow more time during the appointment for discussion and explanation. Please emphasise the importance of these questionnaires when you discuss the referral with your patient