Reviewed on : 24 May 2022

Reviewed by : Kate Cogman Contracts Manager CWCCG

Expires : 24 May 2024

Connect Health Pain Service

Connect Health works with each patient to support them in finding the most effective and evidence-based approach to improving their ability to manage their pain on a day-to-day basis.

Connect Health

Multidisciplinary team:

Physiotherapists, Occupational Therapists, Nurses, Well Being Practitioners (CBT) and Consultant in Pain Management

Locations:

• New patient assessments completed remotely via telephone following which face to face appointments can be accessed.
• Face to face appointment at Oasis Health centre, Cheylesmore Surgery.

Referrals

Referrals are accepted for patients who reside within the Coventry and Rugby area.

Referrals should be made via ERS where they will be triaged by a member of the Connect health clinical team.

If the referral is rejected or further information is required Connect Health will get in touch directly with the referrer.

Inclusion criteria:

• Referral via patients GP and/or community MSK Service for Coventry and Rugby registered patients and in addition via the secondary care pain service for those already receiving treatment and requiring ‘step down’.
• Have a diagnosis where possible
• Chronic Pain for greater than 6 months
• Have had investigations by the referring GP to ensure diagnosis is of chronic non-malignant pain.
• Not be under another team/provider for the same problem unless considered appropriate and core to the patients treatment plan.
• Patients must be a minimum of 18 years old.
• Pain must be mainly somatic (physical feeling/ experience) or of benign origin, present most of the time with varying intensity.
• Patients must have no further investigations or treatments planned.
• Patient should be medically stable.

Exclusion criteria:

• Patients with an  MSK  condition  that  have  not  been  triaged  by Community Musculoskeletal Services physiotherapist.
• (Patients do not need to have had a full treatment plan within this service if early access to a chronic pain service is deemed necessary).
• Chronic pain for less than 6 months duration
• Known pathology requiring further investigation
• Suspected cancer or cancer related pain
• Palliative pain
• Post-operative or post traumatic complications
• Suspected Fracture / Infection
• Pre-natal Back Pain/pelvic pain
• Chronic Fatigue Syndrome (unless their primary presenting symptom pain)
• Presence of red flags e.g. Cauda Equina Syndrome
• Patients receiving care from another pain management service
• Patients under the age of 18 years old
• Patients not registered with a GP
• Patients requiring a surgical opinion

Assessment

Assessment is with a Clinical Specialist in a 45 minute appointment to develop care plans with the patient, following which a letter is sent to GP detailing outcome and copied to the patient.

Patient reported outcome measures including EQ5D, Brief Pain Inventory and Pain Self Efficacy Questionnaire are collected at assessment, discharge, 3 months and 12 months post discharge.

Adjustments can be made for patients if required including interpreting facilities, information provided in different languages, text changed for people with sight difficulties or dyslexia for example Care plans

Treatment pathways:

• Pain education/ self management – Pain Management Programme 18 hour or individual sessions if patient unable to attend group sessions
• CBT sessions, pain focused, maximum number of 6 provided via telephone
• Medical interventions following NICE guidelines and local Coventry CCG policy
• Medication reviews, telephone based unless due to hearing or language difficulties we can arrange face to face

Pain Management Programmes

Current venue: Moat House Leisure & Neighbourhood centre Winston Ave CV2 1EA

• 18 hour programme, delivered in 3 hour sessions once a week for 6 weeks
• Delivered remotely or face to face depending on patient choice.
• Led by 2 members of the team with a skill mix of a clinical specialist and wellbeing practitioner.
• Usually invite 10-15 patients
• Handbook provided
• Focused on self management strategies to reduce the impact of pain and live well with pain.
• Basic exercises introduced, focused on global reconditioning aligned to goals and values.
• Relaxation, mindfulness and acceptance commitment therapy (ACT) also introduced.

It can be helpful to signpost people to support the understanding of chronic pain and the differences with the treatment of acute pain.

Additional Resources Helping the patient to understand the mechanisms of chronic pain:

• Understanding pain in 5 minutes Youtube

• Why things hurt – Lorimer Moseley TED talk

• Tame the Beast – www.tamethebeast.org

• Livewellwithpain.co.uk ‘Life after Opioids’

• Paintoolkit.org

• Flippinpain.co.uk

Medical interventions

Led by our consultant in Pain Management Dr Ayman Eissa

Performed in mobile injection unit at Oasis Health Care

In line with NICE guidelines and local Coventry policy (see link right)

Low back pain/ neck pain: Diagnostic medial branch blocks only, currently. If successful we then refer into secondary care for consideration of a Radiofrequency Denervation.

Epidurals – only for acute (less than 12 weeks at point of referral) and severe sciatica

Interventions for other joints: Suprascapular nerve block, Genicular nerve block

Medication Reviews

Telephone based with an Independent Non-Medical Prescriber

Recommendation letter sent to GP

Common referral triggers:

• Current pain medication not effective – expectations of pain medication
• Causing side effects
• High doses of Opioids in excess of 120mg in 24 hours
• Patient keen to reduce pain medication and look at other ways of managing pain

Supporting patients to wean off Opioids

Medication review triggered due to high dose of Opioids being taken, current dose is ineffective, or GP and or patient has requested support

Develop Opioid reduction plan – Faculty of Pain Medicine recommend a 10% reduction every 2 weeks

In reality there is no single right way to approach reducing Opioid medications (It is ideally done as gradually as possible, this might mean reducing your daily dose by the smallest amount possible every week or two)

Normalise withdrawal side effects and offer reassurance that they will ease

Normalise increases/ changes in symptoms but again these can settle, promotion of self management and self care.

Additional Resource:

www.fpm.ac.uk Opioids aware

Contact us:

Connect Health

Floor 3 The Light Box

Quorum Business Park, Benton Lane, Newcastle Upon Tyne NE12 8EU

Web:   www.connecthealth.co.uk

Emai:l PMS.mailbox@nhs.net

Tel:      0800 034 0406