NHS Community Pain Service and Pain Clinic Plus work with people living with pain to provide help that is tailored to the individual, enabling them to make meaningful changes and 'live well' despite persistent pain. Here they tell us more about their approach to 'good help'.
Many models of pain management, and indeed traditional medical models of interaction, put the clinician in the ‘expert’ position, offering a fix-it style. Our service, however, is embedded in a community setting, and our approach views interactions between health professionals and patients as a ‘coming together of expertise’. We work with our patients to identify their best hopes for themselves, to think with them about what really matters to them, and to identify what a ‘good’ journey with us might look like. We do this on a one-to-one basis, through group programmes and/or peer support, with our 'expert patients'. Our belief is that patients already know something about what ‘living well’ looks like for them. We actively seek out strengths and skills in our patients, aiming to amplify and utilise this expertise to help build purpose, despite pain.
We do this by combining a clinical service ( formed of medics, psychologists, physiotherapist and occupational therapists) with 'expert-patient' led offerings such as peer support (Pain Clinic Plus) and a volunteer-led wellbeing choir. These groups work collaboratively with the clinical team ensuring that those living with pain are at the heart of the service.
Each attendee will have different aims and each will have a different experience of the service, in line with what they want to get out of it and what is important to them. The emphasis on the service was always intended to be organic with patients, and many of the outcomes of the Community Pain Service are geared towards measuring growth in wellness rather than reduction in intrusive symptoms.
After celebrating the 10 year anniversary of Pain Clinic Plus (PC+), a vibrant, thriving and fully peer-led service, earlier this year, we can clearly see the impact this partnership is having. The partnership between our NHS service and PC+ exemplifies how the NHS and volunteers can work together safely and effectively, acting as a 'lifeline' for many; inspiring the belief that life can be lived well, despite pain.
For many, what we offer is a platform or stepping stone – a safe place in which to build social skills and confidence again, and from there try other things, things that are meaningful to them – e.g. tackle a house move, find a job, volunteer etc. We see people grow and flourish, and build a better quality of life alongside the presence of pain in their lives.
The impact of this approach has also been witnessed by others, for example some local GPs report less reliance on appointments, and a shift away from passivity and 'fix me' dynamics. We’ve been nationally recognised with an innovation award in 2013, and published in the British Journal of Pain where we demonstrated the evidence that our approach seems to improves self-efficacy, function and mental wellbeing in our setting.
Unlike many interventions, we’ve developed an approach that is sustainable - a support network which thrives under its own steam, with minimal input from the clinical team. Furthermore, staff and volunteers seem to stay with the service and don’t ‘burn out’. Instead, they are inspired by the people and colleagues they are working with.
Our staff and volunteers have training in Solution Focused approaches, an orientation towards people that assumes they are motivated, resourceful, and that they are the best person to say what 'better' looks like for them. It is a way of listening (and responding) that focuses on expertise, strength, resource and values. It is also a way of asking questions which draw out and amplify possibilities that fit with the patient’s wishes and hopes. We are ‘experts by invitation’ when talking with people, both in terms of our clinical skills, and in the case of our volunteers, their lived experience and tried and tested tips. This approach frames all our consultations, including diagnostic assessment.