Wirral Chronic Pain Service

The difference between chronic and acute pain

What is the difference between chronic / persistent pain and acute pain?

Acute pain describes pain that comes for a short while and then clears up (normally around 3 months) once the injury is healed. It is a warning sign that our nervous system generates in response to a perceived threat (e.g. injury). It is a helpful response – it gets us to seek medical attention, rest and recover.

On the other hand chronic, or persistent pain describes pain that lasts longer than 3 months. Chronic pain does not mean it is more dangerous or threatening than other types of pain.

Why do people feel acute pain? (short term pain)

The brain has one goal: keeping us safe and helping us respond to threats. This protective reaction is called the stress response. The stress response has lots of ways to keep us safe, and experiencing pain is one way to do that. It is like an alarm system to make us aware of problems with the body, so we can fix them.

For example, if you fall and break your leg, the brain will automatically activate the stress response to keep you safe, and you will feel pain, so you know to go to the hospital. You will continue to feel pain so that you stay off the leg and allow it to heal.

Once the bone is healed (normally within 3 months) the pain will stop, because the brain knows the threat (the injury) is gone and you are safe, so the stress response switches off.

Why do people feel chronic / persistent pain? (long term pain)

We know that many patients who come to the Wirral Chronic Pain Service have been experiencing pain for longer than 3 months.

We are also aware that many patients have had long journeys before being referred to this service, being sent for lots of medical investigations, which might still be ongoing, to find a cause for their pain.

However, often these investigations come back normal, and everything with the body seems fine. This can cause lots of uncertainty, worry, and anxiety for patients as there doesn’t seem to be a clear cause for their pain.

Pain can be confusing. You will probably find you have good days and some days which are harder. We can think of pain being a bit like a rollercoaster.

Pain changes because persistent pain isn’t just about biological issues with the body like broken bones, tissue damage or injury. Many other things – including sleep, diet, emotions, thoughts, beliefs, relationships with others, stress, past experiences, work, etc - contribute to this.

This is important because that means you have the power to make changes so that the rollercoaster flattens out.

In summary, managing chronic pain is not just about giving you medication, operations, and scans. Why not watch this 5 minute video from Tame the Beast and see more about what our service does to support patients.

Is pain all in my head?

Well, yes it is, but not in the way that perhaps you feel it is. All pain responses involve the brain and central nervous system. The brain takes in lots of information, including information sent from all over our body, and works out how to respond. Pain is a response our brain generates to signals coming in from the body. See this short video which explains what we mean when we say this.

So, we are not saying that chronic pain is made up or exaggerated. Pain is complex and involves many, many factors. No one can determine how much pain you are in except you.

About the Wirral Chronic Pain Service

How does this service help patients manage pain?

This service takes a holistic view of you and your pain using the biopsychosocial model. This means we look at how biological factors (e.g. sleep, diet, injury, medicine, other health conditions), psychological factors (emotions, thoughts, beliefs, past experiences) and how social factors (relationships, meaningful activity, work, where we live) all interact and contribute to chronic pain.

To do this, we have a team of different clinicians each with their own area of expertise who work with patients understand them as a person, as well as their pain, to provide evidence-based pain management strategies.

We take a ‘shared decision making’ approach when looking at treatment options. This means we listen to you as the expert of your pain. We balance your experience and wishes alongside our expertise in what can (and cannot) help. Between us we can arrive at a shared decision about how our service might be able to support you to live better with pain.

We offer supported self-management to help you find a way to live well with pain. You can read more about supported self-management here: https://www.england.nhs.uk/personalisedcare/supported-self-management/

This means we ask you to be an active contributor to improving your life alongside pain. This approach is not right for everyone and so sometimes we suggest a different approach that does not involve what we can offer.

Please see our patient information leaflet for more information about what our service can offer.

Meet the Team

We work together as a multi-disciplinary team to best support you. Sometimes we work individually with support from other members of the team. This may include liaising with other services.

Administrators

Our admin team make sure the service runs smoothly and look after non-clinical matters.

Book patient appointments.

Act as the first point of contact for patients.

Check patients into appointments when they arrive.

Pain Physiotherapists

We have pain physiotherapists who specialise in the assessment, diagnosis, and management of chronic/persistent pain.

Look at how patients’ general health and previous investigations, such as blood tests and x-rays impact chronic/persistent pain.

Work with our patients to help you understand and how to manage pain, including what triggers pain.

Work with our patients to create individual pain management plans and help you improve your ability to do day to day activities using pain management strategies such as pacing and physical exercises.

Work with our patients to decide the most appropriate ways the service can help you manage pain. This might include being referred to one of our pain management programs or a referral to another member of our team.

Please note our chronic pain specialist physiotherapists work differently to other physiotherapists you might have seen in the past and will aim to provide a holistic approach to your care.

Pain Psychologists

We have a team of psychologists who work with patients to help you understand how psychological and social factors such as thoughts, feeling, and relationships influence chronic/persistent pain. This is overseen by a Principal Clinical Psychologist. Examples of patient-facing work a psychologist might do:

Conduct initial biopsychosocial assessments with you to collaboratively understand how pain impacts daily life and mental health.

Offer one-off consultation to help you make sense of your psychological problems.

Signposting to mental health services.

Conducting one to one or group sessions using evidence-based therapies to help you manage thoughts and feelings that come up when living with pain.

Provide psychoeducation on how psychological and social factors such as stress, anxiety, or relationships impact pain.

Deliver psychologically-focused elements of the pain management programme.

Deliver a mindfulness group.

Please note we are aware that seeing a psychologist can cause anxiety for some patients. However, if you are referred to see a psychologist, it does not mean the pain is in your head or that you have mental health problems.

Please see our leaflets section for more information about what the psychology team do.

Therapy Assistant

The therapy assistant works with the whole chronic pain team, to assist with all aspects of patient care.

Coming onto our pain management programmes to set up the rooms and do chair-based exercises and stretch and refresh sessions.

Cofacilitate our mindfulness classes and set up the rooms.

Working with you one to one to do chair-based exercise classes.

Occupational Therapists

Our specialist OT works to help you improve your ability to complete tasks at home or work which are difficult due to chronic pain.

Working with you to help you identify what activities matter most to you.

Work with you to develop strategies to make these valued activities easier and more fulfilling, to improve quality of life and function.

Work with you to help you adapt your environment and provide problem solving strategies.

Use our knowledge and links within the community to provide opportunities to learn new skills and improve social support.

Conduct one to one mindfulness sessions with you to help you manage stress.

Pharmacist

The pain pharmacist in our team will explain the medications that may help manage different types of chronic pain.

Working with you to conduct one to one medication reviews to look benefits of medicines as well as potential side effects.

Provide education about pain medications on our pain management programs.

Medical Doctors

Our pain specialist medical consultants come from the anaesthetic branch of medicine. We focus on complex medical diagnoses, often mixed with pain conditions and sometimes interventional pain medicine (injections). We are also experts at using combinations of medicines that can help pain. We have a good knowledge of all aspects of pain and the science behind it.

Understanding your appointment letter

We know sometimes it can be difficult to understand who you are seeing at your appointment, particularly as we have lots of different staff in our team.

Please consult your letter which will tell you which clinician you have an appointment with.

Example pain clinic appointment letter

Preparing for your appointment

What will happen during your first appointment?

We will use your referral, as well as any other relevant information available to us, to tailor the first appointment to what might be helpful for you.

You will be seen by a member of the pain team. The aim is to get to know you and how you experience pain. The aim is to work out whether we are the right service for you and how we might support you to live better with pain. This is usually done by a physiotherapist, although we might ask other clinicians to see you where we think this would be helpful.

One of our chronic pain physiotherapists might conduct a physical examination to understand your pain (we will always get your consent before doing this). Please note physical examinations are not always needed but your clinician should talk about this with you.

Discuss functional rehabilitation (getting your body as fit and strong as it can be).

Talk about brain retraining and how the nervous system can change in response to pain.

Talk about how pain impacts on you (sleep, thoughts, feelings, relationships, work etc.).

Discuss stress reduction techniques like mindfulness.

Talk about medicines.

Discuss how psychological techniques can help you manage pain.

Explore Pilates or yoga.

Talk about your suitability for group-based rehabilitation (Pain Management Programmes).

Suggest further tests or opinions, including whether scans or injections might or might not be helpful.

Signpost you to other organisations or support groups that may help you manage pain or other aspects of your life.

Talk about referring you to other members of our team.

Tips to help you get the most from this appointment

Be open minded and try to take on board any new ideas about pain and how to manage it.

Answer any questions honestly and don’t be afraid to ask our clinicians questions.

Don’t be afraid to tell us if a strategy we suggest isn’t working or is difficult for you (this will help us change things, so they are more likely to work).

Remember you can write things down if you like and if you have questions write those down before you come so you don’t forget anything.

Wear comfortable loose-fitting clothes – this will make it easier for us to examine you if needed.

Think about what you might like to get from our service.

Completing our questionnaires

At different time points in your treatment with us, we might ask you to complete questionnaires to help us understand your pain and how it affects you. These questionnaires cover all aspects of the biopsychosocial approach and can add to any discussion or examination that our clinicians will engage you with. These are an important part of evaluating progress and understanding your baseline, so it is important that you answer them fully. Do not spend too long thinking about each answer, just go with your best guess. Please try to answer all questions as not answering can invalidate the answers.

We also use these questionnaires as part of routine service evaluation and to evidence that what we offer patients can work to improve different aspects of their pain experience and quality of life.

Please remember to return your completed questionnaires as directed.

Getting to your appointment

The Wirral Chronic Pain Service is located in Elm House, which is part of Clatterbridge Hospital. Our address and postcode are as follows:

Elm House, Clatterbridge Hospital, Clatterbridge Road, Wirral, Merseyside, CH63 4JY

Please see our YouTube video which might help you find your way to Elm House once you have reached the Clatterbridge site.

Directions:

Travelling south

Leave the M53 at Junction 4 and take the fourth exit off the roundabout onto the B5151.
Follow the B5151 until you reach the roundabout. Leave the roundabout at the second exit and onto the hospital site. Take the third exit and follow the road until you reach the hospital entrance on the left.

Travelling north

Leave the M53 at Junction 4 and take the first exit off the roundabout onto the B5151.
Follow the B5151 until you reach the roundabout. Leave the roundabout at the second exit and onto the hospital site. Take the third exit and follow the road until you reach the hospital entrance on the left.

Car parking

Please view this link to the web page for pricing and other information about car parking at Clatterbridge Hospital

There is a patient car park (signposted “Car Park J”) situated in front of Elm House.

We would advise you bring the correct change if you have mobility or fatigue issues as the contactless machine may be too far to walk for some people.

Concessions for blue badge holders: If you have a valid blue badge, you are entitled to free parking at the Clatterbridge site. To do this, you will need to show your blue badge at the cash office located in the main building of Clatterbridge Hospital.

Parking passes: If you are attending one of our Pain Management Group Programs (PMP), we can offer you a parking pass that gives you free parking for the duration of the program. Unfortunately, we are not able to offer this for other types of appointments.

Concessions for patients on benefits: Patients on certain benefits may be eligible to have their parking costs reimbursed through the NHS Healthcare Travel Costs Scheme (HTCS).

For more information click this link.

What to do when you first arrive at our building for an appointment?

When you arrive at Elm House, please let the clerk on reception desk know that you are here. They will check you in and then direct you to the correct waiting area. A picture of the main reception is shown in the picture below. If there is no-one available on reception, please follow the signs to the correct waiting area.

We work across the two corridors (Pain Clinic and Pain Therapies Unit) so your appointment could be on either corridor, even if you have been here before.

Pain management programme

What does the pain management programme involve? Our group pain management program takes place over several weeks, with patients expected to attend on two days a week. The programme includes input from different members of our team, including physiotherapy, psychology, occupational therapy and pharmacy.

It covers a range of useful topics that have been shown by research to be effective for helping people manage persistent pain including:

Understanding the physiology of pain.

Things that can influence pain.

Sleep and pain.

How pain changes our relationship with thoughts.

The benefits of activity.

and much more.

You and a clinician from the team can decide if this is the right treatment option for you at this time. Like all aspects of our self-management service, this involves taking an active approach, being open and working towards lifestyle changes that we know benefit pain management.

If you are nervous about attending groups, please be assured that everyone in the room will feel nervous. We know from research that people living with pain get more out of a group intervention than they do from individual sessions.

Stress reduction techniques to help you manage pain

Living with persistent pain can be very stressful at times. Stress is also one of the many things that can impact chronic pain. Often people report that their pain condition flares up or is made worse at a time of acute stress. This is normal and happens to everyone – we have made a short video on this (see below).

Therefore, it is important to try and find ways to manage stress in order to help cope with pain.

What is mindfulness?

Mindfulness is technique that helps people manage stress by teaching them to focus their attention on the present moment. This means acknowledging what they are thinking, feeling, and experiencing, right now, with non-judgement and curiosity (even if they are experiencing something difficult like pain). This helps people reduce stress by learning that difficult experiences (like worries about pain, anxiety, or physical pain) are part a normal part of our changing experience in the moment which helps them distance themselves from these experiences (this distance from difficult feelings is called cognitive diffusion).

Disclaimer:

Mindfulness can bring up difficult thoughts and feelings which can cause distress. If this happens to you, maybe now is not the right time to use mindfulness or perhaps you need some support with managing what comes up.

Click the links below to be taken to some mindfulness meditations that are useful for people with chronic pain.

What is diaphragmatic breathing? (deep breathing)

Deep breathing is another good way to reduce stress around chronic pain. Because they activate the built in soothing system in the brain which is designed to help you feel more relaxed. However, the links below will take you some of the exercises we use on our programs.

What is progressive muscle relaxation? (PMR)

PMR is a technique that helps people reduce stress by having them scan tense and relax their muscles in a sequence. It is particularly useful for those who live with chronic pain as it can help you identify when you feel stiff or tense. This technique also activates the soothing system in the brain and will help you feel more relaxed. Click the links below to be taken to a guided PMR activity.

Disclaimer: in this service we recommend doing activities like they will help you manage stress and will not increase your current pain.

However, if you have a new injury, e.g. you fell over yesterday and twisted your arm, we recommend that you speak with your GP before trying this activity.