• Reference Number: HEY1163/2021
• Departments: Pain Medicine
• Last Updated: 11 August 2021

Introduction

This service works specifically with chronic pain patients around chronic pain related issues. Being referred to a clinical psychologist within the Specialist Pain Service does not mean that the team believe your pain to be ‘fake’ or ‘all in your head’. As a service, we acknowledge that your pain is real and the clinical psychologist aims to work with the psychological impact that your pain has on your life and to improve your overall wellbeing.

It can often be difficult to diagnose or effectively treat chronic pain with medical intervention and many individuals reach a point where further investigations and treatments are no longer helpful. It is normal for chronic pain to have a significant impact on mood and due to the connection between your brain and pain.  It is important to understand and work with the processes your brain is responsible for such as thoughts, feelings and behaviours as a way to move forward with managing your pain.

Common reactions to chronic pain may be feeling frustrated, upset, or worried about the future. These emotions can contribute to the ‘pain cycle’ that can keep people ‘stuck’ in a difficult place.

What happens when I am referred?

First a member of the Specialist Pain Multi-Disciplinary Team (MDT) will identify a potential need for the role of individual psychological therapy as part of your pain management. The psychology service accepts referrals from the specialist pain consultants, nurses and physiotherapist. You must have consented to this referral before it is accepted; it is your decision if you wish the referral to be made and are welcome to ask your referring professional any further questions you may have about the service.

The clinical psychologist will first complete an assessment with you to determine if individual psychological input focused around pain is likely to benefit you. They will ask you about how pain has impacted on your life and mood and explore your personal and social history and current circumstances. It might be that following assessment, the clinical psychologist has identified that a different service would better suit your needs and will refer you accordingly e.g. if you are presenting with a mental health difficulty that is identified as the main source of your distress, referral to mental health services would be more appropriate.

You may wish to bring a family member, friend or carer to your assessment session. This is perfectly fine and it can sometimes be helpful to hear things from another person’s perspective. We normally ask however that for subsequent sessions that you attend alone as it is important that a safe and private space is provided for you to discuss whatever may be troubling you.

Who, when and where?

If the assessment process suggests you would benefit from a short-term course of psychological therapy sessions, you will go on a waiting list to receive this treatment. From time to time, there may be trainee clinical psychologists on placement with the service who are also capable of carrying out the identified psychological work, under the supervision of a qualified clinical psychologist.

Normally you will have 6 – 10 hour long sessions with the clinical psychologist. The course of input may be shorter or longer depending on your individual need. These sessions are face-to-face and will generally occur on a fortnightly basis on Wednesdays at East Riding Community Hospital.

Due to the current situation managing the outbreak of COVID-19, we now offer patients a choice of either face-to-face or telephone appointments; we will ask you for your preference when we contact you to arrange the first appointment.

You may decide following assessment or at any point during your psychological work that you do not wish to continue. This is ultimately your decision and is something that should be discussed with your clinical psychologist.

The aim of pain psychology

The clinical psychologist will work closely with the other specialist pain professionals involved in your care as part of the multi-disciplinary team, including consultants, physiotherapist, and specialist nurses.

Individual psychology is just one part of your input from the Specialist Pain Service. We aim to provide a holistic approach to your care and there is an expectation that you are most likely to benefit if you are engaging with all elements of the support offered by the multi-disciplinary service. The aim of individual psychology appointments is to help you understand the difficulties pain brings to your life and develop a range of helpful coping strategies to help you manage your pain. These can continue to be used once the sessions come to an end.

You and your clinical psychologist will agree the number of sessions you expect to have to complete your focused goals in your first session. Throughout the work you complete together, it will be expected that you attend and engage in sessions.

An important part of psychological work, and where the majority of positive and lasting change happens, is when you complete out-of-session homework tasks designed by yourself and your clinical psychologist. It is important that these skills are practised in your day-to-day life, so you can build motivation and confidence to continue implementing them yourself once your sessions come to an end. The work aims to help you to become your own pain psychologist – you are the expert on you.

Clinical psychologists can help you to determine what your ‘SMART’ (Specific, Measurable, Achievable, Relevant and Timely) goals are at the start of the work together to help focus the sessions and help you to achieve what would be of most benefit for you.

The clinical psychologist may use a combination of different evidence-based psychological approaches to meet your needs, including cognitive behavioural therapy, acceptance and commitment therapy, and compassion focussed therapy.

Why might pain psychology be for me?

Clinical psychology for chronic pain can help with a variety of problems, including but not exclusive to:

• Improve understanding of chronic pain and how to manage it
• Managing reduction of pain medication if this is advised by the Specialist Pain Team
• Developing strategies to cope with stress and difficult emotions such as fear, frustration and sadness.
• Managing difficult emotions that are caused by, or contribute towards pain
• Adjusting to loss of role(s) due to chronic pain
• Considering how historical and current factors may influence your pain and making breaks in the ‘pain cycle’
• Exploring difficulties within work, social life and relationships due to the impact of chronic pain
• Improving mobility and working together with the physiotherapist
• Help you to lead a life that is as normal as possible; identifying value-based activities and helping you return to these at a manageable pace.

Please note that this service cannot provide urgent mental health support; If you require crisis support, we urge you to contact the 24/7 Mental Health Crisis Team on 0800 138 0990. If you are in imminent danger, phone 999.