Centre of Pain Education (COPE)

"Chronic pain is pain that either persists beyond the point at which healing would be expected to be complete, or that occurs in disease processes in which healing does not take place. (...) It can be experienced by those who do not have evidence of tissue damage"
Clinical Standards Advisory Group, 2000

Some types of pain last a long time and, as yet, have no cure. We call these pains long-term or persistent. Unfortunately medical treatments for persistent pain do not always work as well as we would like. People are then left with a difficult problem of continuing pain and all the negative effects pain can have on every part of life, including work, relationships, social life, mobility, mood and sleep. Attending a pain management programme can help people cope with the challenges and difficulties that living with persistent pain brings.

If you have pain, which has continued more than six months it would be defined as chronic pain.

Patients referred to COPE will be invited to attend the introductory pain education programme. The two and a half hour long education session, includes:

• Understanding persistent or chronic pain
• Strategies for coping with pain
• Information about the eight week pain management programme and other COPE services.

The introductory programme is held every five weeks and is limited to 20 participants. It is delivered by at least two members of the COPE clinical team, which includes a clinical physiotherapist specialist, a clinical nurse specialist and a clinical psychologist.

Why is it important?

As medical treatments for persistent pain do not always work as hoped, people are often left with continuing pain which begins to impact on other parts of their life, such as work, family, social life, sleep and mood.

The aim of the programme is to help you to understand how chronic pain works and introduce you to a range of skills for managing your pain. We hope that this will help you to improve your quality of life and cope with the challenges that persistent pain can present.

The session will also give you the opportunity to find out more about our eight week pain management programme and decide if you would like to be considered for this.

What you can expect

The session lasts for two and a half hours and includes a refreshment break. Pillows and mats are available for those who need to take time out to rest during the session. For those people for whom sitting time is restricted we will encourage you to move about whenever you need to.

What happens after the introductory programme?

If you wish to attend the pain management programme or discuss what other help may be available you will be invited to make an appointment for multidisciplinary assessment at COPE.

If you do not contact us within three weeks of completing the introductory programme we will assume you do not want or feel that you need further help from COPE and you will be discharged back to your GP or the original referrer.

Please note: this is not a support group and no one will be asked to share information of a personal or sensitive nature. Anything which you do disclose will be kept confidential by the COPE team, and although we will ask other participants to respect your confidentiality, we cannot guarantee this. You will have the opportunity to discuss any personal issues confidentially at the multidisciplinary assessment if you choose to opt in to this.

Our eight-week Pain Management Program is designed to enhance your physical function, improve your quality of life, and alleviate emotional distress.

The course consists of eight weekly sessions scheduled from 9:30 AM to 12:30 PM, supplemented by two additional follow-up appointments throughout the year. These sessions include a mix of talks, discussions, and practical skills, ensuring a comprehensive learning experience. We limit the program to 12 participants to maintain an intimate and focused setting.

Commitment is key to your success in our program. We ask for your commitment to attend all sessions, complete any assigned homework, and actively implement the strategies learned to help create meaningful changes in your lives.

Alongside our standard pain management programme, we now run a specialist eight-week programme for those living with hypermobility syndromes. We will discuss any suitability for this course at your initial assessment.

The programme includes:

· Understanding Pain: Educational insights into the science of pain.

· Graded Exercise Program: Customised physical activity plans to improve strength and flexibility.

· Stress Reduction: Techniques for relaxation and stress management.

· Medication Management: Guidance on effective use of medications.

· Sleep Improvement: Strategies to enhance sleep quality.

· Emotional Management: Tools for coping with and managing emotions.

· Goal Setting: Identifying meaningful activities and setting achievable goals.

· Support Networks: Special sessions for family and friends to foster understanding and support.

· Flare-Up Management: Approaches to handle setbacks and manage pain episodes.

· Personalised Care: Adaptations to meet individual needs and preferences where possible.

· Communication: Tools for developing effective communication to help you live well.

Who is the programme suitable for?

If you can answer 'yes' to several of the following questions, the pain management programme may be suitable for you:

· Have you had pain for most of the time for more than six months?

· Have you stopped doing many activities because of your pain?

· Does your pain make you feel irritable, anxious or depressed?

· Are you afraid that exercise and movement will make your pain worse?

· Are you worried about the painkilling medication you are taking but do not know how else to cope?

· Are you not sleeping because of your pain?

· Are the people closest to you affected by your pain?

· Have you lost confidence because of your pain?

· Do you feel that you are not coping?

· Is the struggle to control your pain dominating your life?

What are the requirements to attend a programme?

To participate effectively in our group programme, individuals must be proficient in English and capable of engaging in group activities. Participants should also be able to manage their self-care independently during sessions. We provide support for those with mild hearing, visual, or literacy challenges to ensure accessibility to the program.

For those unable to participate in the group setting, we may be able to offer personalised sessions with our specialist nurse, physiotherapists, or clinical psychologists in a small number of cases. Additionally, for non-English speakers, we may be able to provide one-to-one programs with the assistance of a translator. We also signpost to other appropriate services if indicated.

Q. Does it work?

A. Research demonstrates that our pain management program can significantly alleviate the disability and distress associated with chronic pain. We know that chronic pain often stems from an overactive or hypersensitive nervous system. By applying strategies proven to desensitise this system, many participants have successfully reduced their chronic pain levels.

Our program consistently monitors clinical outcomes, revealing that attendees experience enhanced physical abilities, reduced depression, and anxiety, diminished overall pain, and increased confidence in managing chronic pain effectively.

Q. What do I do if I think the eight week programme is for me?

A. If you would like to be considered for the programme, you will need to ask your doctor to refer you to COPE. We will then invite you to an introductory pain education programme. After this, you will need to actively opt in, and contact COPE by email or phone, to arrange a multidisciplinary assessment appointment with the team.

Q. What if I find the idea of attending a group too difficult?

Research shows that there is great therapeutic power in being involved in a group setting. We do understand however that for some, a group can be intimidating or overwhelming, and may discourage you from attending. We will discuss any challenges or barriers you may be experiencing at your assessment, and decide together what we feel is the best course of action moving forward.

Q. What does the assessment involve?

A. You will attend a two-hour multidisciplinary assessment, with a psychologist and physiotherapist. If the programme is considered suitable for you, you will be placed on the waiting list. Alternatively, if the programme does not appear to best suit your needs, we will discuss with you what other services may be appropriate.

Q. What happens after the programme?

A. It is expected that you will take away the strategies that you have learned throughout the course, and apply them to your daily life after the programme ends. After the programme ends, you will be given two further follow-up dates, at three months and nine months post programme end. These sessions can be a useful opportunity to discuss any set-backs or barriers preventing you from moving forwards with both us and your peers. We are here in these sessions to offer advice for continuing as you are, or to help you get back on track should you be experiencing any challenges.

Referral forms

• SWL Pain Clinic Referral Form (Nov 2023)

Leaflets

• Information for referrers [pdf] 348KB
• General patient information leaflet [pdf] 402KB

Books

• Nicholas, M., Molloy, A., Tonikin, L., Beeston, L., (2003): Manage Your Pain
  Souvenir Press, London ISBN 0-28563-679-0
• Cole, F., Macdonald, H., Carus, C., Howden-Leach, H., (2005): Overcoming Chronic Pain: a self-help guide using CBT
  Robinson Publishing, London ISBN 1-84119-970-2

CDs

• Berry, N., (2001): Living with Chronic Pain
  A CD or cassette tape produced by consultant clinical psychologist Neil Berry.
  To order, please send a postal order or cheque made out to "Pain CD" for £5 to PO Box 84, Blackburn, BB2 7GH. Please indicate whether you require a CD or cassette.
• Oxford Cognitive Therapy Centre, (1997): How to Relax 
  A CD or cassette
  To order, please send a cheque made out to OCTC for £2.50 indicating if you require a CD or cassette to: Booklets Secretary, OCTC, Warneford Hospital, Oxford OX3 7JX. Tel: (01865) 223986, Fax: (01865) 226331, E-mail: octc@obmh.nhs.uk, Web: www.octc.co.uk (opens in a new window). Please note that orders cannot be accepted without payment.

Websites

• British Pain Society: www.britishpainsociety.org (opens in a new window).

• https://www.flippinpain.co.uk/

• https://www.hypermobility.org/

• http://livewellwithpain.co.uk/