GP Persistent Pain Management Top Tips

1. Self-management is the key

• Explain that successful pain management is dependent on the patient taking control of their own wellbeing. We can support and guide them to take positive steps towards this.

2. 'Management not Cure' so take your time but be positive

• Emphasise that treatment focuses on improving Quality of Life despite having ongoing symptoms. Be positive and reassuring that this is possible but also realistic about what may or may not be achievable.

3. Know some pain management concepts

• Understand the pain management approach. Addressing deregulated stress is key. Work with the patient to develop helpful habits, relax, look at mindfulness and make lifestyle changes. It is good to be able to explain persistent pain. There are excellent resources for patients and clinicians at MyHealth-Devon: Pain.

4. Focus on quality of life not pain

• There is good evidence that Pain management is most effective when the focus is moved onto quality of life rather than pain.
• Maximum benefit is gained in formulating a management plan in partnership with the patient. Empower them to focus on what's important including; sleep, mood, occupation, relationships, hobbies, socialising and exercise. Be realistic.

5. Encourage the patient to stay or get active

• Being active is important. Patients often develop stiff and guarded movement patterns so focus on relaxed and loose movement. Encourage patients to recognise and address activities that they may be overdoing or avoiding.

6. Continuity of care is important where possible try to offer appointments with the same Doctor

7. Be aware of and treat anxiety and depression

• On-going stress of any form significantly affects pain and its management. Mental Health stability is essential for pain management to be of benefit. If necessary refer to mental health or DAS services

Medication

8. Keep pain relief simple and only persist with effective medications

9. Opiates are NOT indicated in non cancer pain

• Do not continue with ineffective medication. Avoidance of opioids is advised. British Pain Society: Opioids

10. Is there a neuropathic element to the pain?:

• NICE offers some useful guidance on the treatment of neuropathic pain management

Sooth the Pain. Also consider other treatments such as warmth, ice, TENS, and acupuncture, which are helpful for some patients, and relaxation techniques, which are useful for most.

If you have any questions please do not hesitate to contact one of us at 01237 420277 or email; ndht.pain@nhs.net

Publication Date: November 2019