Chronic pain

What is it?

Chronic pain, sometimes called long-term or persistent pain, is a common condition in which pain persists longer than 3 months, which would normally be enough time for tissues to recover following injury, trauma or illness. It can be attributed to a number of different causes and can be associated with different types of pain with variable severity. Chronic pain can cause significant reduction in function, quality of life and emotional well-being.

The referral pathway

The Leeds Teaching Hospitals Pain Management Service exists to provide advice, care and support to individuals with long-term or chronic pain. The majority of patients seen are residents of Leeds but some come from further afield in order to access specialist care. The service sees around 1600 new referrals per year. We believe it is important that patients follow the correct pathway for managing their pain to achieve the best outcome.

For many patients, self-management of their pain is effective and the most convenient option.

Some patients will need to consult with their general practice who will be able to suggest additional options. If this is unsuccessful, then referral to a specialist pain management service will be needed. In Leeds, this will always be the Leeds Community Pain Service in the first instance. This service offers individualised help and support including with management of medicines. For a small proportion of patients, the Leeds Community Pain Service may decide to refer to the Leeds Teaching Hospitals Pain Management Service.

The hospital-based service has access to specialist interventions which may be offered after an initial assessment. These may include medication management, physiotherapy, clinical psychology and interventions such as injections, radiofrequency lesioning and spinal cord stimulation.

It is not possible to access the hospital based service by self-referral or by direct referral by your general practitioner. The correct pathway must be used. This is also the case for patients from outside Leeds who will need to have seen their local pain service first. The reason for this is to ensure that patients benefit from the resources available from the community service as these are not duplicated within the hospital service. A very small number of patients may be referred for specific interventions by a consultant in another discipline.

Further details can be found on the Leeds Health Pathways Website which demonstrates the agreed model from the clinical commissioning groups.

What we offer

Assessment

Patients who are accepted by our service are seen and assessed. This can take place face-to-face, by telephone or video call.

Patients may be asked to complete a questionnaire to help with the assessment.

The outcome of this will be explained during the consultation. It will be documented in the medical records and a copy of the clinic record will be sent to the GP and patient.

Interventions and/or injections

We offer a range of interventions from simple injections through to complex implantable devices such as spinal cord stimulators and intrathecal pumps. Our choice of intervention will follow national guidance and commissioning pathways and it will be individualised to each patient, based on the nature and cause of their pain, medical comorbidities and potential risks.

This list is not exhaustive and other interventions are available.

Patient information leaflets on many of these procedures are available from the Faculty of Pain Medicine website.

Specialist pain psychology

Psychology is an essential part of the Leeds PAIN and Interventional Neuromodulation Service. Our highly skilled team of psychologists have specialist knowledge in the complex interaction between pain and emotional well-being. Patients sometimes worry that being referred to see a clinical psychologist means that pain is ‘all in their head’. This is far from the truth, as the consensus in modern science is that chronic pain is real. Chronic, also called long-term or persistent pain, is as real as acute pain. The reason why patients get referred to psychology is that the experience of pain is affected by multiple factors including mood, anxiety, memories, past experiences, relationships and coping strategies. Therefore, effective management of long-term pain requires a multidisciplinary approach which might include psychological intervention.

Our psychologists work with patients on an individual or group basis. These sessions utilise a range of techniques and can be delivered in individual or group sessions dependent upon the situation. Additionally the psychology team are involved with our multidisciplinary team for neuromodulation and often assess patients to see whether there are any issues that need to be addressed.

The psychology service can only be accessed following a medical assessment to exclude pathology and confirm suitability. This follows the standard referral pathway.

Medication advice and support

As part of the assessment process we review the patient’s medication and make suggestions on how this can be optimised, considering the type and severity of pain, underlying cause, medical comorbidities and allergies. Any medication advice offered as part of the assessment process will be recorded in the medical records and communicated to the patient’s GP who will write the necessary prescriptions and review as appropriate. The GP will manage the patient in the longer term.

We offer a few specialist medication support sessions with input from our specialist pain pharmacist who works as part of our team. These are often centred on medication reduction, such as reducing high-dose opioids. These are accessed following medical assessment and follow the standard referral pathway.