Pain management services

We offer the following treatment for pain management:

• Medication
• Western medical acupuncture and TENS
• Psychological assessment and treatment
• Pain specialist physiotherapist assessment
• Procedures including precision intraspinal injections and radiofrequency nerve treatment
• Cognitive and behavioural Pain Management Programme (PMP) – please see other tabs below for this information.
• Advanced neuromodulation
• Implanted spinal cord stimulation
• Drug administration via implanted programmable pump for severe pain and spasm
• Refractory angina service
• Advanced Neuromodulation - a specialist service offered to people living anywhere in the country. It is suitable for people with mainly neuropathic pain that has not been improved by other treatments. Prior approval is sought by the consultant from the local Clinical Commissioning Group.

Pain itself can present as a simple acute episode with known cause, which is usually easily treated with simple painkillers. Circumstances which indicate the need for the pain team to be involved in inpatient care may be: 

• uncontrolled pain, despite painkillers
• chronic or complex history of pain
• adverse effects of painkillers, limiting choice of treatment
• abnormal pain symptoms or behaviour 
• co-existing conditions requiring special consideration.

Basildon

We provide state of the art pain relief for post operative pain.

We also treat patients with more complex pain management needs whilst they are in Basildon Hospital.

Broomfield

The team takes acute or chronic pain referrals from anywhere in the hospital where patients are seen on the day of referral. This allows us to make an early assessment and to advise on the best course of pain management for each individual.

Where appropriate, a patient will be offered specialist intervention, such as an epidural injection, to treat the pain and help you get home faster. 

The team is responsible for the safe management of a ward-based epidural service and works with surgical teams to manage critical care and post-operative pain. A daily nurse-led clinical round takes place to oversee these patients.

Southend

We review many inpatients experiencing acute pain and we are available to see patients in surgical and medical wards throughout the hospital.

We provide advice and guidance to ward and medical staff with regards to a patient's pain management and supervise the safety of the pain-relieving techniques used.

Chronic pain is defined as pain which persists at least three months after the healing process has taken place and it becomes an illness with consequence for the family and the person suffering.

The pain team’s role is to assess and manage chronic painful conditions in order to allow the person suffering to improve their quality of life and function despite their problems. This can be difficult to achieve by one mode of treatment alone; therefore the team offers full initial assessments by a consultant, where an individualised treatment plan is initiated. This may include advice on:

• Lifestyle
• Drugs
• therapeutic modalities such as physiotherapy
• (occasionally) interventional treatments such as nerve blocks and epidurals.
• Monitoring and evaluation of progress is provided by nurse specialists in clinics run alongside the consultants’ clinics. 

Psychological effect

An essential element of chronic pain management is recognition and expert management of the psychological effect of the disease.  Psychological-biased modalities such as cognitive behavioural strategies based in the Acceptance and Commitment Therapy model (ACT) are delivered in the out-patients setting by psychological therapists and specifically trained nurse specialists.

Some patients are assessed as appropriate for a multi-disciplinary educational approach to help them live well with a pain condition. This may be in the form of a group-based pain management programme, or on an individual basis. 

Inter-disciplinary involvement in the chronic pain patient’s management is essential, and close links and cross-referrals are made between the pain team and other specialities in the hospital and in the community such as GP practices, physiotherapy, neurology, orthopaedic, rheumatology and psychology and psychiatric services. 

The department offers its service to patients with chronic persistent pain, including:

• Neuromodulation (including spinal cord stimulation)
• Intrathecal Pump Services
• Injection Interventions
• Pain Management Programme
• Medication management clinics (including opioid reduction)
• Physiotherapy
• Psychology (including CBT sessions)
• Reprogramming clinics for Neuromodulation patients
• Telephone clinics.

Referrals

If you feel you are in constant pain and would like help to manage this, you can ask your GP to refer you to your local outpatient pain management service.

Alternatively, if you’re receiving care with us, you can request to be referred through a consultant-to-consultant referral – please speak with your healthcare provider about this.

Pain Management team is a multidisciplinary team consisting of:

• Specialist pain consultants
• Specialist nurses
• Physiotherapists
• Psychologists
• Patient pathway co-ordinators (PPC)
• Anaesthetist
• Administrative and secretarial staff.

They all work with evidence-based clinical guidelines and protocols and work with surgical pharmacists and we liaise with many other teams including the critical care outreach team.

Spinal cord stimulation (SCS) delivers small electrical fields to specific parts of the spinal cord, which changes the way pain messages are sent to, and processed by, the brain. This may reduce some forms of pain, particularly neuropathic (nerve) pain. 

The SCS system consists of a small, implanted pulse generator that delivers very small amounts of electricity to a fine lead that is placed close to the linings of the spinal cord.  A small surgical procedure precisely places the lead in the epidural space. The lead is connected to a small combined battery and pulse generator that the consultant implants, usually under the skin of the upper buttock.

Once the stimulator has been set up, you use a handheld remote to adjust and control the stimulation programs. The majority of stimulation programs produce a pleasant tingling sensation (paraesthesia) that helps to reduce the pain signals.

Some stimulation programs do not produce a sensation that you can feel (sub-threshold) but may also reduce the pain. 

Living with persistent pain can be very challenging.  The physical symptoms such as pain and fatigue often go hand in hand with changes in mood and motivation which can act as barriers to taking part in enjoyable activities and activities that give a sense of achievement. 

The PMP aims to help those suffering from persistent pain to take control of their lives by focusing more on valued activities and less on the pain itself.   The emphasis is on increasing understanding of persistent pain and making lifestyle changes by working on fitness and mobility, hobbies, mood and social life.

The PMP does not involve medical treatments and its aim is to improve quality of life, not reduce pain intensity.

Generally, before attending a PMP, you will have tried many different unsuccessful treatments in your attempt to cure or manage your pain.  Enhancing self-management strategies to live as well as possible with pain is the overall aim.

What’s included in the PMP?

The following provides an outline of some of what is covered on a typical PMP: 

• Maintaining and/or improving general fitness, mobility, flexibility and posture.
• Pacing which is the ability to balance rest and activity to reduce flare-ups of pain.
• Relaxation techniques and mindfulness.
• Education about improving sleep quality.
• Identification of valued activities and goal setting.
• Acceptance.
• Enhancing psychological skills to help manage mood and unhelpful habits.
• Explaining persistent pain and its effects on the body, through education
• Increasing knowledge about pain medication to empower patients to reduce the use of unhelpful or inappropriate medication.

The programme is run by a multi-disciplinary team including nurse specialists, physiotherapists and a psychologist. Typically there are 10 people in each group and it runs for a number of weeks and you are expected to attend all sessions to gain the best outcome.

Intrathecal pumps are an implanted device that has a thin plastic tube inserted into the spinal fluid. Once it is filled with medication it bathes the nerves of the spinal cord thereby affecting spasticity or the amount and severity of pain you can feel.

Although we do not currently implant these devices, we are responsible for refilling a number of patients pumps and people travel from far and wide for our service.

Pump refills are scheduled on a regular basis based on your calculated refill date.  At refill appointments, the effectiveness of the treatment is assessed, and the pump rate or dosage can be adjusted accordingly if required. The pump stores the information about the prescription and this is reviewed via a programming device. When the reservoir is low or empty, the Neuromodulation nurse or pain consultant refills the pump by inserting a needle through the skin into the port located on top of the pump reservoir.

For information on pain medication and procedures, please visit the Faculty of Pain Medicine (FPM) website at https://www.fpm.ac.uk and click on information leaflets.