Living with Chronic Pain
Delyth Meirion- Owen
Session Learning Outcomes
• To gain an understanding of chronic
• To identify how CP can impact upon
the life of an individual
• To identify examples of local and
national support available .
• To discuss the role of the nurse in
relation to self care and
• To explore the potential challenges
to the role and effective
• General overview of
• (5 MINs)
• Pain is defined as an unpleasant sensory and emotional experience
associated with actual or potential tissue damage.
• Chronic pain is pain that persists over a period of time, typically for
at least three months.
• A recent estimate reports 7.8 million people in the UK suffer
moderate to severe pain that has lasted for more than six months.
• Studies suggest that it is more commonly reported by women and
those from socially or financially disadvantaged groups.
Pain is classified according to duration
• Acute Pain –sudden onset ,
continues until healing begins.
May be intense , intolerable.
Associated with medical
condition or injury.
• Response area in the brain
initiates an autonomic response .
• The thalamus, hypothalamus &
reticular formation promote
hypertension & tachypnoea in
response to pain.
• Chronic pain- pain continues
even after healing is complete.
May be intense , little or no
autonomic response .
• Pain exists after injury or disease
has ceased. Often considered as a
syndrome ‘ a medical condition in
its own right’. (Melzack & Wall
What is the impact of chronic pain?
Fatigue /lack of stamina
Weak muscles and loss of fitness
Stress ,anxiety, tension
Anger ,Fear ,Frustration
Low mood/negative thinking
Time off work , Family & Money
Why? To select the most appropriate pharmacological & non pharmacological
interventions. Every pain assessment must include the following information;
• Location of pain-
• Duration of pain-
• Onset- Frequency –
• Aggregating factors-
• Relieving factors-
• Sleep patterns-
• What additional questions
could the nurse ask ?
The McGill Pain Questionnaire .(Melzack 1975)
Four Dimensions of the Pain Experience.
Adapted from Manias et al. 2002
Psychological and emotional response to pain?
• The patient’s expectations of any potential treatments
• The patient’s concerns of the cause of their pain
• Any personal or spiritual beliefs
• Acceptable pain levels
• Pain levels that will allow the patient back to work
• Feelings of stress and Anxiety
• Any coping mechanisms
• The patient’s preference regarding any treatment options.
The nurses Role in supporting clients with
chronic pain living in the community.
• Patient Education
• Lifestyle Adjustments
• Access to social Supports
• Empower patients to access psychosocial
support. (Wright 2015)
Community or practice Nurse Involvement
• Optimizing the control of chronic pain
• Pain diary evaluation- to monitor effectiveness of
• Education re treatment compliance
• Monitoring for side effects
• Pain Intensity measurement – (number rating scale
0-10. Aim 0-4. 4 representing mild discomfort .)
Nurses role in patient education
• Encourage patient to keep a pain
• To monitor effectiveness of
• To monitor effectiveness of other
pain management interventions.
• Early identification of problems
• Problem solving .
Role of the nurse –in non malignant pain
• Liaise with primary care (GP) &
secondary care (Hospital, MDT) -
maintain and improve communication.
• Teaching patient- pain self assessment.
• Pain Diary- monitor effectiveness –
complementary therapies, i.e.
acupuncture, biofeedback, relaxation
• Devise an action plan in the event of
sudden onset of severe pain. Access to
emergency services. ( Wright 2015)
What support is available for people with pain?
• Pain clinics -For assessment and possible pain management,
gain with advice on living a fuller life in spite of pain.
Sometimes a Consultant with an interest in pain will prescribe
drugs or give injections to try to control pain. Other clinics
have teams of doctors, psychologists, nurses,
physiotherapists, occupational therapists.
• Pain Management Service The Walton Centre for Neurology and Neurosurgery
NHS Foundation Trust
• Chronic Pain Clinic Warrington and Halton Hospitals NHS Foundation Trust
• Chronic pain Royal Liverpool and Broadgreen University Hospitals NHS Trust
• chronic pain MDT Royal Liverpool and Broadgreen University Hospitals NHS Trust
Support for people with Chronic Pain
• Pain Management Programmes (PMP)
• A psychologically-based rehabilitative treatment for people with chronic pain
• It is delivered in a group setting by an interdisciplinary team of experienced health
care professionals working closely with patients.
• Some Pain Centres may run Pain Management Programmes that aim to teach a
group of patients with similar problems about pain, how best to cope with it and
how to live a more active life, others may offer acupuncture and other
• The aim of the PMP is to reduce the disability and distress caused by chronic pain
by teaching physical, psychological and practical techniques to improve quality of
life. It differs from other treatments provided in Pain Clinics in that pain relief is
not the primary goal, although improvements in pain following participation in a
Pain Management Programme have been demonstrated.
• Referral to a Pain Management Programme is usually via the local pain clinic.
Pain Management Programmes
• Pain management strategies may be behavioural, cognitive ,
physical, pharmacological or other .
• Behavioural-contingency management , graded exercise,
relaxation, progressive muscle relaxation.
• Cognitive- Imagery, Meditation and Prayer, Information, stress
• Physical – Surgical, TENS, Acupuncture, massage, reflexology.
• Pharmacological-non opioid analgesics (paracetamol), opioid
analgesics ( morphine) , direct action drugs( sedatives, anti
• Other- Hypnosis, support groups, internet , self help groups,
alternative therapies. Marks et al (2015)
‘Self Management for life’
• The programme has seven weekly sessions, lasting 3 hours each.
• The aims of the programme
• Develop skills and techniques to cope with daily challenges
• Gain practical solutions for day-to-day issues
• Set health goals to improve an individuals wellbeing and quality of life
• Develop and implement an action plan
• Provide more information about the condition , to enable people to make
• To Liaise between the GP and healthcare team on an individual plan for
• To increase confidence within the patient and encourage them to play a
key role in management of their health.
The Expert Patients Programme
• The EPP is a course
designed for adults living
with any long-term health
• The EPP aims to help
people take control of their
health will by learning new
skills in order to manage
their condition on a daily
What are the challenges in self care management?
• Individual tolerance of pain
• Treatment compliance
• Assessment is not a simple process
• Pain Questionnaires , commonly use
descriptive words, ( meaning, culture,
• Assessment tools are not sensitive to
age, disability or culture.
• Reliance upon reports of significant
• Pain is often under treated –
• Focus on underlying physical
• Negative Stereotypes
• Addiction fears
• Inappropriate use of non
• Professional perception of acceptable
pain behaviour and treatment.
• Communication problems.
• Working with vulnerable clients
• Symptom Identification e.g. HIV.25/05/2015 20
• The British Pain Society ( useful addresses) https://www.britishpainsociety.org/useful-
• Chronic Pain, A self Help Guide. http://www.moodjuice.scot.nhs.uk/chronicpain.asp
• Self Management UK. http://selfmanagementuk.org/
• NHS Choices. Live Well.
• Pain Tool Kit – 2009.
• Pain Management programme . http://www.thewaltoncentre.nhs.uk/112/pain-management-
• Health Survey for England (2011). http://www.hscic.gov.uk/catalogue/PUB09300/HSE2011-
• Merskey H, Bogduk N (eds).(1994)Classification of Chronic Pain. International Association for
the Study of Pain, Seattle,. Part III, Pain Terminology, updated in 2011.www.iasp-
• Donaldson L. (2009) Pain: Breaking through the barrier. Chapter in 150 years of the Annual
Report of the ChiefMedical Officer: On the state of public health 2008. DH, London.
MarksF, Murray,M, Evans,B. Estacio, E,V. (2015) Health Psychology , Theory ,Research and
Practice. Lonson. Sage.
Wright ,S. (2015) Pain management in Nursing Practice. Los Angeles. Sage.