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Treatments to relieve long term pain and improve self management

We can’t offer you a cure for long lasting pain.

But we can in many cases relieve pain to help you manage better, improve mobility and sleep, be more active, have a more enjoyable social life, return to or stay in a job or be able to explore a new career.

In cases where attempts to relieve pain are inappropriate, fail or result in short term improvement only we focus on improving your situation accepting that pain to one extent or other will continue.

The treatments we offer include those listed below. To view further information simply click on the title:

We work together with other services, including:

 

Medicines

Most patients with long term pain will need a combination of standard pain killers and more specific medicines to help control pain in the long term. This is a bit like treatment of high blood pressure with tablets taken regularly.

A good combination of medicines can and should achieve around 50% of pain relief – it will not stop pain altogether. As individuals respond differently a tailored combination needs to be found for each person, and this usually requires trying several different drugs to find the most effective.

Some medicines are useful for limited periods of time  - such as a few months  - to manage flare-ups or to help until other forms of treatment begin to work. These medicines should not be used constantly for longer because of risks of side effects (most anti-inflammatories) or because a useful effect is lost over time (Codeine, Dihydrocodeine, Tramadol, Morphine, Oxycodone, Fentanyl, Buprenorphine, Diazepam etc).

Other medicines are more effective for long term control but take a little while to work initially (Amitriptyline, Nortriptyline, Gabapentin, Pregabalin, Duloxetine and others). These need to be taken regularly to keep pain under control.

 

Prescriptions

The Pain Clinic specialists usually advise the referring General Practitioner about medicines for pain relief to prescribe. We rarely prescribe medicines ourselves in clinic. This can be considered in some exceptionally urgent situations; we cannot prescribe for longer than four weeks in any event.

Patients need to see their GP to get the recommended medicines prescribed after the clinic letter arrives. Please make sure that you continue to take your medicines as agreed with the Pain Clinic clinician or GP, unless you have intolerable side effects. When you run out of your tablets/capsules/patches please see your GP in time for a repeat prescription.

 

Targeted injections

If pain is limited to a body region and is there are structural changes indentified that may contribute or cause this pain, then targeted injections can help to relieve pain. These work by numbing a specific structure – such as a nerve, a joint, a muscle etc  - with local anaesthetic and reduce inflammation and irritation with cortisone. Sometimes impairing nerves with targeted heat (or RF) treatment can prolong the effect of targeted injections. However, none of these treatments will lastingly relieve or cure pain. While relief from an injection can be profound, then effect is time limited, lasting from a few weeks only to – rarely – a year or a bit longer.

Injections therefore need to be part of a wider treatment package. Another good purpose of injection treatment is to relieve pain during most intense flare-up episodes.

We perform injections such as…

  • Epidural injections at all spinal levels (with X-Ray or ultrasound guidance)
  • Joint injections, e.g spinal facet,  sacro-iliac and some other joints
  • Spinal nerve blocks (root or dorsal root ganglion blocks)
  • Peripheral nerve blocks such as intercostals, suprascapular, ilioinguinal, genitofemoral and other nerves
  • Muscular trigger point injections, sometimes with Botox.
  • Scar infiltrations
  • Drug infusions e.g. Lidocaine (local anaesthetic)
  • Sympathetic nerve blocks, e.g. stellate ganglion, lumbar sympathetic nerves
  • Thermal (RF lesioning) or chemical nerve ablations

We do not offer…

  • Implanting or reviewing implantable drug pump systems
  • Spinal Cord Stimulator, but can sometimes refer to the Wessex Neurosciences Centre in Southampton for this)
  • Continuous nerve blocks via catheter treatment
  • Racz catheter treatment
  • Cordotomies
  • Epiduroscopies or epidurolysis

 

TENS

TENS means transcutaneous electrical nerve stimulation. This is a form of external pain relief treatment for painful body regions, using mild electricity applied through the skin. It works by counter stimulation based on the established Gate control theory.

While we cannot provide TENS machines and necessary skin patches, these can be obtained personally for ca. £20-30 in local Pharmacies or ordered via online purchase. We can help you how to make best use of your TENS machine, such as where to put the patches, how to operate the machine settings and when to apply it.

 

Acupuncture

Acupuncture is widely regarded as a “mild” form of pain relief treatment for a variety of conditions. While it does not help everyone,  some patients receiving it find it very useful to control pain, with low risks of side effects and discomfort during treatment.

The effect of acupuncture is mostly short term. Due to decision by Island Health Commissioners we can only provide one course of six sessions of acupuncture. Even if effective, there is no further access to this treatment in the Pain Clinic.

 

Specialist Physiotherapy

Exceeding general physiotherapy, the Pain Clinic offers specific forms of physical treatments tailored for long term pain patients. The main target is to improve strength, mobility and confidence in the longer term. To be successful, a consistent and longer engagement is necessary, resulting in regular exercises or other physical activities in the longer term. After initial assessment, advice and supervision you will increasingly come to pursue this in your daily environment. Individual or group based comprehensive sessions are available.

 

Psychological services in the Pain Clinic

Often people might question why they would need to see a psychologist when they clearly have a physical pain problem.  There are two reasons why psychological support is an essential part of treating long term pain. 

First, having pain has an effect on most aspects of life; it changes what you can and cannot do, it changes your mood, influences your work opportunities, it can affect relationships and self confidence.  In themselves these changes are distressing, but we know they in turn make managing pain more difficult.  The psychologist will work with you on how best to tackle these changes.

Second, the psychologists in the team have a special interest in the neuroscience of pain and how sustained pain brings about alternations in the central nervous system. Anxiety, frustration, depression and feeling low can have a significant effect on the levels of your pain and our interest is in the mechanisms the underpin this.  The psychologist will work with you both to reduce these problems and to help you understand the importance of approaching your pain in this way.  These are often practical methods and are not psychological therapy in the traditional sense.

 

Group–based treatments
(including Functional Restoration and Pain Management Programmes)

We offer Functional Restoration Programmes (FRP) outside St. Mary’s Hospital to improve physical functions such as mobility for patients with predominantly lower back problem.

The Isle of Wight Pain Management programme has been established since 2006 and aims to combine an opportunity to learn both the science of chronic pain with the best possible ways of managing its effects.  It is run be a Consultant Clinical Psychologist and a Senior Special Physiotherapist both of whom have considerable experience in the management of long term pain.

Long term pain has a profound effect on people’s lives not only changing what you can and cannot do, but also affecting your mood. Additionally, as we are increasingly understanding, sustained pain also brings about subtle and important changes in your central nervous system.

The programme is class-based (usually with 10 people max) and provides an opportunity to consolidate knowledge of your condition, to ask question, talk with others, and learn practical techniques for good long term management of your condition.  Specifically:

  • It will run for six weeks, two days per week (usually a Tuesday and Thursday).
  • It uses a combination of psychological, physical and practical methods to work on your problems of pain, physical difficulties, distress and poor quality of life.
  • It will show you ways to understand and potentially ‘desensitise’ your pain system – we call this Brain Training

After you have been to a pain management programme, you should find your pain easier to manage and be able to do more of the things you want to do. Also, you should feel more optimistic and confident about the future despite continuing pain.  It will also be possible to tap into post-programme support networks on the Island.

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