Information & Resources

Find information and resources to help manage your pain.

Get Help & Support

Find the tools you need to
help you manage your pain.

Get Involved

Help make a real difference to people
in the UK living with chronic pain.

About Us

Find out about Pain Concern and how
we can help you.

Transcript — Programme 45: Helping us to help ourselves

Empow­er­ing patients from GP’s surgery to pain man­age­ment programme

To lis­ten to this pro­gramme, please click here.

Health­care pro­fes­sion­als and peo­ple with pain need to work togeth­er to man­age chron­ic pain con­di­tions, but how is this achieved in prac­tice? Paul Evans speaks to a GP, phys­io­ther­a­pist and clin­i­cal psy­chol­o­gist to find out more. We begin by hear­ing from, GP and pain spe­cial­ist, Neville McMul­lan about his work with Ulster Hos­pi­tal to improve access to pain man­age­ment pro­grammes by bring­ing them out of the hos­pi­tal and into the com­mu­ni­ty and giv­ing peo­ple the skills to man­age their own pain. Dr McMul­lan stress­es the impor­tance of get­ting patients out of a cycle of inac­tiv­i­ty and phys­i­cal deterioration. 

This is where phys­io­ther­a­py comes in as we hear from Ash­ley Mont­gomery, a phys­io­ther­a­pist at Ulster Hos­pi­tal. Mont­gomery describes how under­stand­ing the real­i­ty of chron­ic pain, being believed and get­ting the bal­ance between rest and activ­i­ty right can give peo­ple the con­fi­dence to take the first steps towards self-man­ag­ing their condition. 

Con­sul­tant Clin­i­cal Psy­chol­o­gist Jen­ny Maguire explains how accep­tance and com­mit­ment ther­a­py (ACT) builds upon CBT (cog­ni­tive behav­iour­al ther­a­py) to help peo­ple adjust to liv­ing with pain as a long-term condition.

Issues cov­ered in this pro­gramme include: Phys­io­ther­a­py, acces­si­bil­i­ty, com­mu­ni­ty health­care, activ­i­ty, exer­cise, ACT: accep­tance and com­mit­ment ther­a­py, CBT: cog­ni­tive behav­iour­al ther­a­py, psy­chol­o­gy, mul­ti­dis­ci­pli­nary, pain toolk­it, activ­i­ty-rest cycle, pac­ing, social life, con­fi­dence, flare-up, painkillers and alter­na­tive therapy.

Paul Evans: I’m Paul Evans and wel­come to Air­ing Pain, a pro­gramme brought to you by Pain Con­cern, the UK char­i­ty pro­vid­ing infor­ma­tion and sup­port for those of us liv­ing in pain. This edi­tion has fund­ed by the Big Lot­tery Fund’s ‘Awards for All’ pro­gramme in North­ern Ireland.

Dr Neville McMul­lan: We’ve been crit­i­cised, whether right­ly or wrong­ly, that ‘My pre­vi­ous GP only did this, and only gave me painkillers and only did X, Y and Z or the dose of the painkiller was increased.’ That’s not nec­es­sar­i­ly the right way to man­age pain appro­pri­ate­ly and we need to get the mes­sage across to the patient that the way to man­age your pain is not always to go up to next dose of painkiller or that stronger painkiller, but it’s real­ly to assess their pain ful­ly and then to edu­cate them that there may well be more than just the pain involved in their expe­ri­ence of the pain.

Ash­ley Mont­gomery: A lot of peo­ple come and they ask, ‘What is wrong with me? How long is it going to take to get bet­ter and what can you do?’ And there’s very few peo­ple that actu­al­ly say to us, ‘What can I do?’

Evans: In this edi­tion of Air­ing Pain we’re look­ing at how pain can­not be dealt with in iso­la­tion; how pain man­age­ment pro­fes­sion­als can be key to help­ing us help our­selves. And how a pilot scheme in Belfast could make pain man­age­ment pro­grammes more acces­si­ble. We’ll start at the doc­tors’ surgery, which is more than like­ly the start­ing point for most of us when chron­ic pain hits. Now a GP with a spe­cial inter­est pro­vides addi­tion­al ser­vices while still work­ing with­in the com­mu­ni­ty so, for instance, your local health cen­tre may have GPs with spe­cial inter­ests in dia­betes, epilep­sy, headache, car­di­ol­o­gy or, if you’re real­ly lucky, pain management.

Dr Neville McMul­lan is one of just two such GPs in North­ern Ire­land. He works out of Cher­ry Val­ley surgery in Belfast, but also with the pain man­age­ment team in the Ulster Hospital.

McMul­lan: I’ve been involved with the Ulster Hos­pi­tal for the last three to four years. I do a week­ly clin­ic there every Wednes­day and I was brought in ini­tial­ly to try and improve the very long review times that a lot of these patients were expe­ri­enc­ing. They had their ini­tial con­sul­ta­tion and then it could’ve been upwards on three years before they had their review with the pain clin­ic, and that’s an unac­cept­able time lim­it. So, along with myself and the staff over the last three years, with­in about nine months we had that down to about a 6‑month review.

The prob­lem with chron­ic pain patients is that there’s no cure and I always try and com­pare it with the dia­betes mod­el: there’s no cure for dia­betes but we have to try and man­age them as best we can. So these patients do need to be reviewed and again, we can argue about what the best set­ting is to review these patients – they don’t all need to be done in a hos­pi­tal set­ting. But you know, your goal for a num­ber – but not all patients, this doesn’t hold true for every sin­gle pain patient – would be to give the patient the tools to man­age their con­di­tion them­selves, as best as pos­si­ble, and can dip in and out of some spe­cial­ist resources if they need to in the future. But ide­al­ly, they would be giv­en the empow­er­ment and the tools to man­age their pain rather than just get­ting more and more coco­damol from their GP.

Evans: What sort of tools would you give them?

McMul­lan: We actu­al­ly have a thing called the ‘pain tool kit’ which is a love­ly wee hand­book that is writ­ten in very sim­ple lan­guage that they can use. It talks about very basic con­cepts of pain man­age­ment, which they can man­age them­selves whether it’s through pac­ing and goal-set­ting and set­ting them­selves real­is­tic achiev­able tar­gets. It talks about phys­i­cal activ­i­ty and how impor­tant it is to keep things mov­ing and keep things mobile. It’s the old adage: ‘If you don’t use, you lose’. We would use phys­io­ther­a­pists quite a lot through the Ulster Hos­pi­tal to encour­age patients to break through this chron­ic pain cycle where they get into this chron­ic mis­use of the limbs or what­ev­er it may be, and the mus­cles then waste away and they don’t have any sup­port for their spine or what­ev­er the pain may be.

Evans: Dr Neville McMul­lan, GP with a spe­cial inter­est in pain man­age­ment. Ash­ley Mont­gomery is a phys­io­ther­a­pist at the Ulster Hos­pi­tal. She works with its pain man­age­ment pro­gramme led by con­sul­tant clin­i­cal psy­chol­o­gist Jen­ny McGuire

Jen­ny McGuire: The pain man­age­ment pro­gramme in the Ulster is an eight-week grid-based pro­gramme; it’s three hours every week over eight weeks, and it’s mul­ti­dis­ci­pli­nary so I work into it, Ash­ley works into it from the phys­io­ther­a­py end of things, and one of the pain con­sul­tants works into it as well from the med­ical end of things. So it’s a mul­ti­dis­ci­pli­nary treat­ment pro­gramme based on accep­tance and com­mit­ment therapy.

Evans: Accep­tance and com­mit­ment therapy?

McGuire: Accep­tance and com­mit­ment ther­a­py is one of the new­er third wave cog­ni­tive ther­a­pies so it has sort of built, if you like, on the foun­da­tions that were there in tra­di­tion­al CBT, and what we found is that this type of ther­a­py can have bet­ter out­comes and work bet­ter with long-term conditions.

Evans: Now CBT, cog­ni­tive behav­ioral ther­a­py, these are talk­ing ther­a­pies but if we’re in pain, we don’t need to talk about it, we need it fixed.

McGuire: I think in an ide­al world if it was that straight­for­ward, that’s exact­ly what would hap­pen, but I think as you prob­a­bly know Paul, from your own expe­ri­ence, pain is a very, very com­plex thing to live with. It’s not just the phys­i­cal com­po­nent of pain: pain impacts on you emo­tion­al­ly; it impacts on you psy­cho­log­i­cal­ly; it impacts on the choic­es that you make in your life; it impacts on the real­i­ty of what you can and can’t do in your life. So pain is not just a phys­i­cal expe­ri­ence. So, if you con­sid­er all of that, then clin­i­cal psy­chol­o­gy has a lot to bring when you think about liv­ing with a chron­ic con­di­tion like pain, like chron­ic pain.

Evans: But I’ve said this many times over, I’m prob­a­bly bor­ing peo­ple to death with this: when you feel low and as you say incred­i­bly depressed and the pain is doing all these oth­er things, the last thing you want to be told is to see a psy­chol­o­gist because we’re not mad; we’re per­fect­ly nor­mal peo­ple but we’re in pain.

McGuire: I think that’s one of the things clin­i­cal psy­chol­o­gy comes up against in chron­ic pain: some­times the assump­tions that are there about psy­chol­o­gy and as soon as psy­chol­o­gy is men­tioned, I know we’ve had peo­ple in our pro­grammes that have said to us when they’re sit­ting there in the con­sult­ing room and the pain con­sul­tant says, ‘Maybe you should think about hav­ing a talk with our clin­i­cal psy­chol­o­gist.’ The auto­mat­ic assump­tion is, ‘Is he try­ing to say this pain is all in my mind? Do they think I’m mak­ing this up?’ It’s almost like their pain expe­ri­ence is inval­i­dat­ed in some way and, actu­al­ly, that couldn’t be fur­ther from the truth of what it is. I think there is a recog­ni­tion now, and if you look at most of the pain ser­vices across the UK, there will be clin­i­cal psy­chol­o­gy attached to them, that this is a long-term con­di­tion that is very, very dif­fi­cult to live with and it spills out into dif­fer­ent types of areas in your life: it impacts on your self-esteem; it impacts on rela­tion­ships; it impacts, as you’ve said, on your mood, on your func­tion­ing. So it makes sense that there would be a clin­i­cal psy­chol­o­gist involved in your care as part of a mul­ti­dis­ci­pli­nary team.

Evans: Many peo­ple as they start their pain jour­ney, they will not be see­ing you at the very begin­ning. In fact, it’s very, very late in the pain journey.

McGuire: That’s some­thing that we are very aware of and it’s some­thing we do talk about as a team. By the time a per­son gets to a pain clin­ic – and the gate­way to our pain man­age­ment pro­gramme is through the pain clin­ic so it’s not wide­ly acces­si­ble – and by the time peo­ple some­times get to the pain clin­ic, they maybe try dif­fer­ent med­ica­tions for a while or there’s oth­er inves­ti­ga­tions to be done before there is a clear diag­no­sis of chron­ic pain or a con­di­tion with chron­ic pain and it’s then that the pain man­age­ment pro­gramme is talked about. So it is late in the jour­ney and I think that’s some­thing that comes back to maybe resources and where cer­tain health­care pro­fes­sion­als are being placed in the path­way of care for chron­ic pain. I cer­tain­ly think in our team, the nurs­ing staff and the doc­tors are more and more now hav­ing that con­ver­sa­tion about self-man­age­ment and about the pain man­age­ment pro­gramme ear­li­er, even though the refer­ral might not hap­pen until oth­er inves­ti­ga­tions and things like that are done. But I do think over­all it needs to be moved ear­li­er in a person’s expe­ri­ence of pain.

Evans: Ash­ley, you’re a phys­io­ther­a­pist. Are peo­ple sent to see you too late in their pain journey?

Mont­gomery: I work in a ser­vice that is an acute ser­vice, so I work in a hos­pi­tal site: so I would see peo­ple very ear­ly on in their jour­ney, in oth­er words: peo­ple direct­ly from the emer­gency depart­ment, direct­ly from orthopaedics. Then the oth­er side of our ser­vice is peo­ple who come along with chron­ic pain con­di­tions and that’s via the pain clin­ic or through the rheuma­tol­ogy ser­vice. So I see two types of patient groups: I see the acute pre­sen­ta­tions and also I see peo­ple who are already on the pain jour­ney, who are already expe­ri­enc­ing chron­ic pain over a long peri­od of time, and they’re very dif­fer­ent groups of patients. And my man­age­ment of that patient and the care of that patient is very different.

Evans: Tell me if I’m wrong, but I sup­pose the dif­fer­ence being a phys­io­ther­a­pist with some­body with acute pain is that you’re help­ing them get bet­ter, where­as some­body with chron­ic pain, you’re help­ing them just man­age it?

Mont­gomery: Yeah, if some­body was to come to me from the emer­gency depart­ment after hav­ing sprained their ankle, I’m there to help them to get bet­ter. Some­body that comes through the pain ser­vice that has been round many ser­vices prob­a­bly by that stage and they’ve been diag­nosed with a chron­ic pain con­di­tion, whether it be a rheuma­tol­ogy-based con­di­tion or fibromyal­gia or chron­ic low-back pain, it’s a very dif­fer­ent man­age­ment of that con­di­tion and the jour­ney for that patient is very dif­fer­ent accord­ing­ly. And my approach would be very dif­fer­ent because it’s not about cur­ing, it’s not that bio­med­ical ‘mot­to’ where you’re going to make them bet­ter, it’s more about help­ing them to under­stand their pain and intro­duc­ing self-man­age­ment strate­gies and tools to help them on that journey.

Evans: What sort of self-man­age­ment strat­e­gy tools would you introduce?

Mont­gomery: I think a lot of peo­ple come, hope­ful­ly you’ll agree Jen­ny, and they ask, ‘What is wrong with me? How long is it going to take to get bet­ter and what can you do?’ And there’s very few peo­ple that actu­al­ly say to us, ‘What can I do?’ I actu­al­ly intro­duce it that way: ‘Well, this is my under­stand­ing of your con­di­tion, how your pre­sent­ing, this is what I can do and this is what I think we should pro­ceed with in terms of self-man­age­ment.’ In self-man­age­ment, I think there’s dif­fer­ent aspects to it – cer­tain­ly peo­ple actu­al­ly under­stand­ing what chron­ic pain is, under­stand­ing that it’s not in their head, that’s a real­ly real expe­ri­ence for them and that their pain is real is very impor­tant. I think also, not just that under­stand­ing but the fact that some­body can actu­al­ly under­stand and believe them that they actu­al­ly are expe­ri­enc­ing pain – that’s very impor­tant in terms of them accept­ing their own con­di­tion. Then there’s dif­fer­ent aspects in terms of activ­i­ty: pac­ing. Phys­ios have got a rep­u­ta­tion I sup­pose in terms of ‘Get peo­ple with pain mov­ing; they’ll feel bet­ter for it.’ [Laughs] But I come from a more bal­anced approach in terms of the bal­ance between rest and activ­i­ty – it’s impor­tant with patients that are expe­ri­enc­ing chron­ic pain.

The oth­er thing is, with self-man­age­ment, it’s not just the under­stand­ing, but it’s actu­al­ly the patient learn­ing to accept where they’re at. It’s not a sign of defeat, it’s not them giv­ing in, ‘Now, OK. I’ve got this con­di­tion.’ It’s actu­al­ly the start of a process that helps them live with their pain. That’s why we fol­low the ACT prin­ci­ples because, for them to actu­al­ly com­mit to that and start to make changes and to make adjust­ments, that’s the first step. That’s real­ly, real­ly impor­tant and whether that be in rela­tion to phys­i­cal activ­i­ty or whether that be in rela­tion to emo­tions or feel­ings or fears, it encom­pass­es both of those.

Evans: ACT is accep­tance and com­mit­ment ther­a­py, we’ve talked a lit­tle bit about accept­ing it, but how much of a bar­ri­er is that to accept something… .

Mont­gomery: That you don’t want?

Evans: Or that we think that the doc­tors are there to make us bet­ter, accept­ing some­thing that is mak­ing your life worse?

Mont­gomery: I think it comes back to what accep­tance means and I think some­times accep­tance gets con­fused with res­ig­na­tion, putting up with, and in ACT accep­tance is not that. Accep­tance is more around how you make room for this change that has come into your life. You don’t have to like it, you don’t have to want it – if some­body came along with a mag­ic wand and said, ‘We can get rid of this’, you can absolute­ly say, ‘Yes please, I’ll take it.’ But it is about mak­ing room, I sup­pose, for some expe­ri­ences in your life that are unwant­ed and unasked for. Some­times those are neg­a­tive things and some­times they’re pos­i­tive things and it’s about mak­ing room for all of those expe­ri­ences, whether you see them as pos­i­tive or whether you see them as neg­a­tive. And it is very dif­fi­cult because when you’re in pain, your nor­mal response is to do some­thing to make it stop and if you can’t do that by your­self, you seek med­ical input. And we’re in a cul­ture, I sup­pose, where there’s an expec­ta­tion that the doc­tors will at some point find some­thing to fix us, to ease it or to make it go away. I think it’s a very hard real­i­ty, some­times, with chron­ic pain par­tic­u­lar­ly when peo­ple some­times have seen so many dif­fer­ent doc­tors and they’ve tried so many dif­fer­ent med­ica­tions and the pain is still there. Some­times they’re also liv­ing with quite bad side effects from the med­ica­tion that they’re on.

I think it can be a real cross­roads real­ly with chron­ic pain to get to a point where you realise that the doc­tor may not, at this moment in time, the doc­tor may not be able to do any­thing more. Dif­fer­ent peo­ple get to that point at dif­fer­ent stages and some peo­ple may nev­er get to that point – everybody’s jour­ney is dif­fer­ent and I sup­pose where we would work from is with the accep­tance end of it. It’s about mak­ing room for this thing in your life that you didn’t ask for and you don’t want and it’s hav­ing quite a lot of impact on your qual­i­ty of life – on work­ing life, on finances and all that kind of thing – but how can you make room for it and try and live your life along­side it. So as well as accept­ing and mak­ing room for this con­di­tion that has come into your life, it’s also about recon­nect­ing with your val­ues, with those things that are close to your heart. Very often we find with chron­ic pain, in your effort to try and man­age the pain or to try and reduce the pain or try to have some con­trol over the pain, all of a sud­den the things that real­ly mat­ter to you in life are the things that start get­ting cut out: so you don’t see your friends, you become less active, you may be say­ing no to things that you could do just in case it would be a bad pain day or it might flare things up, so you start actu­al­ly dis­con­nect­ing from things that are pre­cious to you. So ACT is about both of those things: it is about mak­ing room for some­thing that maybe is dif­fi­cult to live with, explor­ing your rela­tion­ship with your pain, but also recon­nect­ing to those things that actu­al­ly mat­ter to you, with your values.

Evans: In those con­di­tions, pain is rul­ing your life, pain is man­ag­ing your life – it’s mov­ing away from that so your life is man­ag­ing the pain?

Mont­gomery: That your life is liv­ing with the pain; there will be times where the pain feels more dom­i­nant. So if you’re in the mid­dle of a flare-up, the real­i­ty of that is you have very min­i­mal choice if you’re in the mid­dle of flare-up pain but if you’re maybe at oth­er points, we talk about ‘wig­gle room’. Your wig­gle room might increase on oth­er days com­pared to the amount you might have on flare-up days, so it’s increas­ing your flex­i­bil­i­ty and liv­ing with the pain so that day-in, day-out, depend­ing on how your pain is, you can still make choic­es that are in the direc­tion of your val­ues, that are in the direc­tion of what actu­al­ly real­ly mat­ters to you, rather than it being an ‘either or’ – ‘I either have to do the things that real­ly mat­ter to me or I’m in pain and I can’t.’ It’s not, it’s a ‘both and…’.

Evans: One of the things that must go along with that – you men­tioned ‘pac­ing’. ‘Boom and bust’ is an expres­sion that every­body with chron­ic pain will have experienced?

McGuire: Yes we often touch on this. We dis­cuss it very open­ly in the group as well. I very much come from an under­stand­ing where peo­ple with chron­ic pain, it lit­er­al­ly impacts not just on every­day life in terms of their emo­tions and the psy­chol­o­gy side of it, I sup­pose, but also phys­i­cal­ly. In oth­er words, when peo­ple with­draw they become less phys­i­cal in terms of they don’t go out walk­ing, they don’t socialise – even the sim­plest things like breath­ing can be affect­ed by their chron­ic pain. And pos­ture because they’re sit­ting down more, they’re afraid to move. Things like bal­ance – some peo­ple become more depen­dent on walk­ing aids because as they with­draw, as they become more seden­tary, and because their pain has dic­tat­ed that to them, all the time what’s hap­pen­ing is they’re becom­ing more de-conditioned.

But some the­o­ries would say, ‘Right, get peo­ple going, get them mov­ing, get the adren­a­line going, get the sero­tonin released, it’ll make them feel bet­ter, it’ll give them con­fi­dence, it’ll impact on their pain and that will be well and good’. And that is true to some extent, but a lot of peo­ple with chron­ic pain, par­tic­u­lar­ly by the time they’ve come along to the Pain Man­age­ment Pro­gramme, I think it would be very unpro­fes­sion­al of me to sud­den­ly get peo­ple up and mov­ing when they haven’t moved in maybe 5–10 years and they’re still on a zim­mer rol­la­tor and I’m expect­ing them to do step-ups. So I intro­duce very much the basics; I call them my build­ing blocks and we talk about breath­ing and about improv­ing their breath­ing pat­tern, we talk about pos­ture, we talk about bal­ance, we intro­duce that, we allow them to self-assess that for them­selves. It’s not about com­ing along and doing lots of exer­cise, but it’s intro­duc­ing these basic tools or these basic aspects of phys­i­cal activ­i­ty first of all, and then hope­ful­ly that allows peo­ple to get more con­fi­dence and get the basics right. There’s no point in me encour­ag­ing peo­ple to go for a walk if they find that even going up a few steps is dif­fi­cult because their bal­ance reac­tions are down. So it’s very much, rather than ‘boom or bust’, it’s very much ‘I’d like to get the basics right’, build­ing that and allow peo­ple to gain con­fi­dence in their own abil­i­ty and then intro­duce oth­er strate­gies like the ben­e­fits of more phys­i­cal work like going out walk­ing, like going swim­ming, because that’s where the oth­er aspects of, I sup­pose whether you call it pain con­trol or the ‘pain gate the­o­ry’ come in, and how mov­ing can impact on your pain expe­ri­ence as well as the psy­cho­log­i­cal talk­ing therapies.

Evans: Well that’s easy, that’s absolute­ly set­tled now, we all know how to do it. The prob­lem is that when some­body with chron­ic pain feels well, they want to do it all today. How do you break that barrier?

McGuire: We actu­al­ly spend quite a long ses­sion talk­ing about flare-ups and we talk about the impact of a flare-up. That impact can be very emo­tion­al and it can be very phys­i­cal. We strip it right back and often­times peo­ple with a flare-up can get warn­ing signs and also trig­gers, so it’s actu­al­ly tak­ing it back and allow­ing peo­ple to become more famil­iar with those warn­ing signs and start to read them and take action, because, like you said, a lot of peo­ple with chron­ic pain think, ‘Oh this is a good day, I have to do this, I have to get the house cleaned or I have to go meet some­body’ and then they suf­fer for it for anoth­er 2 weeks. So it’s actu­al­ly talk­ing about get­ting that bal­ance again. It’s actu­al­ly being more aware of what your body is telling you, but also then putting it into prac­tice so that instead of, yes maybe that day you get a sense of achieve­ment, you feel good for it and maybe some­one says to you, ‘Well that’s great, you got that all done.’ But then for two weeks you’re off kil­ter and you feel mis­er­able and you’re sore and you can’t do any­thing then. It’s about giv­ing peo­ple the tools to recog­nise that, but also talk­ing them through in terms of those man­age­ment strate­gies and that’s in rela­tion to that com­mit­ment to actu­al­ly take onboard what they’re telling them­selves. Patients are the experts in this; they recog­nise very famil­iar pat­terns, par­tic­u­lar­ly in groups, they’re very quick at say­ing, ‘That’s me, I can under­stand that and I do exact­ly the same.’ And they actu­al­ly come up with very good cop­ing mech­a­nisms and cop­ing strate­gies and give very good exam­ples. And some of them actu­al­ly chal­lenge each oth­er in terms of, ‘Well, why did you do that? You could do it this way or do it that way’. So that’s not just from a physio head, that’s from a psy­cho­log­i­cal head in terms of being, you know, look­ing at it and strip­ping it back and look­ing at how it impacts you, not just phys­i­cal­ly but emo­tion­al­ly as well.

Mont­gomery: I think some­times it is about very much hand­ing choice back to peo­ple that are liv­ing with the con­di­tion and, as you’re say­ing, if you have a good day then the pressure’s on to do every­thing in that good day and then inad­ver­tent­ly you do too much, your pain flares up and you’re out of action for what­ev­er length of time. And some­time it’s about hand­ing that back as a pat­tern and say­ing, ‘How much does that way of doing things fit with your val­ues?’ Yes, on that one day you might get all of your iron­ing done and you get your house cleaned and you get your…whatever tidied out but for the rest of the two weeks you’re too sore to see your friends, you’re too sore to play with your chil­dren. So think about how you’re man­ag­ing and what way of man­ag­ing fits best with what actu­al­ly mat­ters to you.

Evans: But you see, one of my strate­gies – you can tell me whether I’m right or wrong – is that I will do what I want to. I will take the hit just for that after­noon climb­ing a moun­tain, or some­thing like that.

Mont­gomery: And is that some­thing that’s close to you heart, that get­ting out and climb­ing the moun­tain and actu­al­ly going, ‘Yes I’ve done that. I know I’ll pay for it but it’s some­thing that’s real­ly pre­cious to me.’ Is that a strong value?

Evans: Yes, it is.

Mont­gomery: And that’s, again that’s some of the choic­es that you make and we’ve had exam­ples in our group where peo­ple will some­times do things – maybe it’s an activ­i­ty, maybe it’s some­thing with chil­dren – where they know they are going to be very, very sore after it but they will do it because the val­ue and the impor­tance of that in their life over­rides what the pain is telling them about the neg­a­tive con­se­quences of doing it. And it’s real­ly impor­tant to hold on to stuff like that because the pain will still be there. What you’ve just talked about there, that’s the stuff that makes life worth living.

Evans: How much pain does one need to be in to come to a pain man­age­ment programme?

Mont­gomery: We don’t put a lev­el on it. As far as we’re con­cerned, your pain is what­ev­er you tell us it is so we very much come from, as Ash­ley said, you are the expert in your pain. We might have ways of think­ing about your rela­tion­ship with pain or pro­vide a space in the pro­gramme to maybe crit­i­cal­ly eval­u­ate and reflect on that a bit, and we cer­tain­ly have hints and tips around what you can do to get going again, but you’re the expert in your own pain so you take the parts that fit for you, that have mean­ing for you. It’s not pre­scrip­tive; it’s very much led by people’s own pain knowl­edge and pain experience.

McGuire: Yeah, and it’s not about the lev­el of pain or the fre­quen­cy of pain, it’s more how that per­son is feel­ing the impact of that pain on their life, so it’s not just that unpleas­ant phys­i­cal expe­ri­ence, but it’s that unpleas­ant emo­tion­al expe­ri­ence they’re hav­ing along­side that. And when that’s start­ing to impact on their every­day life that’s when we feel the pain man­age­ment pro­gramme can be ben­e­fi­cial for the patient, so it’s not about how severe it is or how fre­quent it is, it’s more the impact that pain is hav­ing on that person’s day-to-day life.

Evans: Phys­io­ther­a­pist Ash­ley Mont­gomery and con­sul­tant clin­i­cal psy­chol­o­gist Jen­ny McGuire at the Ulster Hos­pi­tal. I’ll just remind you that whilst we in Pain Con­cern believe the infor­ma­tion and opin­ions on Air­ing Pain are accu­rate and sound, based on the best judg­ments avail­able, you should always con­sult your health pro­fes­sion­al on any mat­ter relat­ing to your health and well­be­ing. He or she is the only per­son who knows you and your cir­cum­stances and there­fore the appro­pri­ate action to take on your behalf. Don’t for­get that you can still down­load all the pre­vi­ous edi­tions of Air­ing Pain or obtain CD copies direct from Pain Con­cern. If you’d like to put a ques­tion to Pain Concern’s pan­el of experts or just make a com­ment about these pro­grammes then please do so via our blog, mes­sage board, email, Face­book, Twit­ter or pen and paper. All the con­tact details are at our web­site which is

Now, back to what I said ear­li­er about GPs with spe­cial inter­ests able to work with­in the com­mu­ni­ty. Dr Neville McMul­lan with his spe­cial inter­est in pain man­age­ment and links with the Ulster Hos­pi­tal pain team has his own view on bring­ing pain man­age­ment ser­vices clos­er to the peo­ple who need them.

McMul­lan: Of the patients I would see reg­u­lar­ly in the hos­pi­tal set­ting, and cer­tain­ly the review clin­ics, they could be man­aged equal­ly well in a com­mu­ni­ty set­ting and with mul­ti­dis­ci­pli­nary input, which would prob­a­bly appeal more to the patient rather than hav­ing to trek up and find park­ing at the hos­pi­tal and the has­sle of get­ting an appoint­ment and so on. So if we could do it in a more local and neu­tral set­ting, a neu­tral venue with appro­pri­ate peo­ple see­ing the patients, then my feel­ing would be this would be the right way to go.

Evans: What are you talk­ing about? Church halls? Leisure cen­tres? Sport centres?

McMul­lan: I’d have no prob­lems with any of those! Neu­tral ter­ri­to­ry means it doesn’t have to be in a health­care set­ting. We are cer­tain­ly keen to push the phys­i­cal activ­i­ty side of things for health pre­ven­tion in lots of oth­er dis­ease areas: where there’s car­dio­vas­cu­lar or dia­betes or obe­si­ty, so cer­tain­ly a leisure cen­tre would be an ide­al set­ting to run clin­ics from. Why not?

Evans: How is that progressing?

McMul­lan: There are pain man­age­ment pro­grammes in place with­in the Ulster Hos­pi­tal. There are some pilots that GPs are now able to refer into which are hope­ful­ly going to devel­op into more per­ma­nent pro­grammes, but we’ll have to wait and see on that. There are oth­er pain man­age­ment pro­grammes run­ning in the Belfast Trust as well and they are mul­ti­dis­ci­pli­nary in nature too, but they are cur­rent­ly in a hos­pi­tal set­ting and not in the com­mu­ni­ty. So there’s work to be done; there’s def­i­nite­ly scope for those clin­ics to be built upon or devel­oped. One of my oth­er big, burn­ing issues is to get near­ly a pub­lic health cam­paign going about edu­cat­ing – cer­tain­ly in the mus­cu­loskele­tal field – of the need for patients to be phys­i­cal­ly active. We touched upon that ear­li­er, that they need to be engag­ing in a form of activ­i­ty to keep their mus­cles and joints work­ing. But there’s a real need to edu­cate health­care pro­fes­sion­als. I think one of the worst things that can hap­pen to any patient is to go along to their GP and their pain isn’t tak­en seri­ous­ly. I was at a meet­ing recent­ly with some patients with endometrio­sis and one of the biggest prob­lems with see­ing their GP was that they felt they weren’t being believed. And I think that’s very impor­tant that the patient’s word is tak­en as this is their pain and this is how the pain affects them. I think if they can be lis­tened to and believed and then we can come to some sort of way to man­age their pain bet­ter, then patients will get a lot more out of that rather than being dis­missed with a stronger or an alter­na­tive painkiller.


  • Dr Neville McMul­lan, GP, Belfast
  • Ash­ley Mont­gomery, Phys­io­ther­a­pist, Ulster Hospital
  • Jen­ny Maguire, Con­sul­tant Clin­i­cal Psychologist.


it’s real­ly cool info i am amazed to see this real time com­bo thanks for shar­ing such stuff

Comments are closed.