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This document brings together a number of resources clinicians can use to support the appropriate use and review of opioids used for chronic pain.

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GMMMG Communication Standards for Opioid Medicines Prescribed at Discharge

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GMMMG Communication Standards for Opioid Medicines Prescribed at Discharge

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Healthcare professionals must minimise the contribution of secondary care to the opioid load within the GM system. Opioids should be used judiciously — administered when necessary and discontinued when no longer required.

These discharge communication standards aim to enhance communication between secondary and primary care, prevent inappropriate opioid use, and ensure opioids are not unnecessarily continued.

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How to navigate the Greater Manchester Pain Management Resources Hub.

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Empowering Chronic Pain Management: A Patient Advocate’s Journey with Health Innovation Manchester

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Empowering Chronic Pain Management: A Patient Advocate’s Journey with Health Innovation Manchester

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Debra Baxter, a very passionate patient-advocate shares with us her experience of working with Health Innovation Manchester to develop a patient information leaflet for people living with chronic pain.

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Health Innovation Manchester - Helping the people of Greater Manchester to become healthier sooner

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Empowering Chronic Pain Management: A Patient Advocate’s Journey with Health Innovation Manchester - Health Innovation Manchester

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Debra Baxter, a very passionate patient-advocate shares with us her experience of working with Health Innovation Manchester to develop a patient information leaflet for people living with chronic pain.

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People living with chronic pain want you to know...

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People living with chronic pain want you to know...

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This document has been developed by people living with chronic pain with support from Health Innovation Manchester.

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Active Partnerships is a nationwide physical activity and sport network that exists to create a healthier, fairer nation.

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Active Partnerships | Active Partnerships

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For all your requests related to sport and physical activity, we have a contact who can help you throughout the whole of England. Use the map below to locate your Active Partnership contact or use the dropdown menu below.

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Using the NO TEARS tool for medication reviews.

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A 76 year old man who used to see your recently retired partner presents with his repeat medication slip. He takes six drugs regularly, five of which need reauthorising.

What issues you should cover

At least a third of patients in Britain aged more than 75 years are taking four or more drugs. Adverse drug reactions are implicated in 5% to 17% of hospital admissions. Hence the dictum "first, do no harm" becomes prescient. Doctors need to be able to critically assess a patient's treatments. Waste is substantial: £19 000 ($35 000; €29 000) worth of drugs were returned to pharmacies over an eight week period in Gwent.

Need and indication -Does he know why he takes each drug? Does he still need them? Was long term treatment intended? Is the dose appropriate? Has the diagnosis been refuted? Would non-pharmacological treatments be better?

Open questions -Give him the opportunity to express his views by asking questions: "I realise a lot of people don't take all their tablets. Do you have any problems?" "Can I check that we both agree what you're taking regularly?" or "Do you think your tablets work?" Compare his replies with the number of prescription requests.

Tests and monitoring-Assess disease control. Are any of his conditions undertreated? Get advice on appropriate monitoring from prescribing guidelines such as the British National Formulary or the US Physicians' Desk Reference and other primary care documents.

Evidence and guidelines-Has the evidence base changed since his prescription was initiated? Do the prescribing guidelines indicate that any of his drugs are now less suitable for prescribing? Is the dose appropriate? (For example, dose optimisation of angiotensin converting enzyme inhibitors in cardiac failure.) Are other investigations now advised, such as echocardiograpy or testing for Helicobacter pylori?

Adverse events -Does he have any side effects? Is he taking complementary medicines or over the counter preparations? Check for interactions, duplications, or contraindications. Remember the "prescribing cascade" (misinterpreting an adverse reaction as a new medical condition).
The NO TEARS tool
N eed and indication

O pen questions

T ests and monitoring

E vidence and guidelines

A dverse events

R isk reduction or prevention

S implification and switches
Useful reading
Task Force on Medicines Partnership. Room for review. A guide to medication review: the agenda for patients, practitioners and managers. London: Medicines Partnership, 2002

Rochon PA, Gurwitz JH. Optimising drug treatment for elderly people: the prescribing cascade. BMJ 1997;315:1096-9

Zermansky AG, Petty DR, Raynor DK, Freemantle N, Vail A, Lowe CJ. Randomised controlled trial of clinical medication review by a pharmacist of elderly patients receiving repeat prescriptions in general practice. BMJ 2001;323:1340-3

Risk reduction or prevention -If time allows, update opportunistic screening. What are his risks, such as of falls? Are the drugs optimised to reduce these risks?

Simplification and switches -Can treatment be simplified? Does he know which treatments are important? It may be better to replace low doses of several agents by one full dose. Explain any switches that increase the cost effectiveness of treatment.

What you should do

Read code and document the discussion. It will make the next review easier and may be important medicolegally.

Overlap of the parts of the NO TEARS tool means you can adapt it to your consultation style, increasing the chance of identifying a problem. For example, consideration of bone protection in patients taking steroids may be an adverse effect for one doctor, but another may deal with it at the guidelines or prevention stage.

Identify important or controversial issues that may need to be covered at a subsequent consultation (adjust the number of authorised repeats accordingly).

Agree a recall system with your colleagues. This should include a facility for amending the repeat prescription after home visits, discharge from hospital, and outpatient clinic attendances.

In the United Kingdom the Task Force on Medicines Partnership has described various levels of medication review (see Useful reading). Although a pharmacist may do some types of review, it is important to remember that signing a script makes you ultimately responsible. A structured approach to repeat prescribing should improve the confidence of doctor and patient.

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10-minute consultation: Using the NO TEARS tool for medication review

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A 76 year old man who used to see your recently retired partner presents with his repeat medication slip. He takes six drugs regularly, five of which need reauthorising. At least a third of patients in Britain aged more than 75 years are taking four or more drugs.

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Nothing inspires us more than hearing from someone who has gone through something similar to ourselves, and found a positive way through it. These true stories from people living with persistent pain will move you, surprise you, and inspire you to explore ways of living your life to the full.

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Nothing inspires us more than hearing from someone who has gone through something similar to ourselves, and found a positive way through it. These true stories from people living with persistent pain will move you, surprise you, and inspire you to explore ways of living your life to the full .

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Wellbeing walks run all over the country and can be found by popping your postcode into the Ramblers Wellbeing walks website.

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Better wellbeing is just a step away

Ramblers Wellbeing Walks are free, short walks that take place all across England. They're designed to help you take the first step towards better health, wellbeing and happiness - and with hundreds of walks happening every week, you're sure to find one right on your doorstep.

There's no need to book or plan a route. All you need to do is pull on your shoes and come join us!

More than just a health walk

A good walk is so much more than just stretching your legs. It's a chance to unwind, meet new people and discover nature on your doorstep. Everyone's welcome at Ramblers Wellbeing Walks: we're a friendly bunch and you're guaranteed a warm welcome. And when you're finished strolling, why not stick around for a chat and a cuppa.

A perfect first step

Our shortest walks are just 10 minutes long and range from a slow to steady pace along tried-and-tested routes. And mobility limitations aren't an issue - our routes our open and accessible to all. Use a wheelchair or want to check the route is right for you? All you need to is drop the walk organiser a message, they'll be happy to help.

Ramblers Wellbeing Walks make getting active easy

All of our Wellbeing Walks are led by experienced volunteers so there's no need to plan your route. And because they're all accessible on foot or by public transport, getting to them is easy. You don't even need to register: just find one of our walks online, grab your shoes and come along to a walk near you

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Our Wellbeing Walks make getting active easier, for everyone. Because you'll be walking with others, you'll feel safe, be supported, and have fun along the way.

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Primary Care Knowledge Boost Podcast - Polypharmacy

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Primary Care Knowledge Boost Podcast - Polypharmacy

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Doctors Lisa and Sara talk to Senior Pharmacist Sarah Hafeez about Polypharmacy. She explains the difference between inappropriate and appropriate polypharmacy before talking through some typical cases that illustrate several examples of common scenarios.

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Doctors Lisa and Sara talk to Senior Pharmacist Sarah Hafeez about Polypharmacy. She explains the difference between inappropriate and appropriate polypharmacy before talking through some typical cases that illustrate several examples of common scenarios. This leads to discussions on prioritising concerns, weaning/stopping medications, counselling patients on the effects of Opioids and Gabapentinoids and involving community teams aiming for successful reductions of addiction forming medications.

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Greater Manchester Pain Management Workshop: Knowledge & Skills, Less Pills

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Greater Manchester Pain Management Workshop: Knowledge & Skills, Less Pills

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This workshop focuses on the wider resources and services available to help clinicians to support individuals living with chronic pain.

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Greater Manchester Pain Management Workshop  Knowledge & Skills, Less Pills 24th January 2024

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VCSE Infrastructure Organisations in Greater Manchester

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VCSE Infrastructure Organisations in Greater Manchester

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Here is a link to each of the local VCSE infrastructure organisations in Greater Manchester. This is a great starting point for linking into local groups and organisations.

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What's Local Infrastructure?

Local Infrastructure Organisations (LIOs) support the third sector (voluntary, community, social enterprises, faith groups - VCSE) in their localities.

Strong local infrastructure enables communities to influence decision-making, builds partnerships and networks, and encourages volunteering opportunities. When this support is accessible locally, individuals and communities thrive.

LIOs work is diverse and different for each local area and organisation. Through research, NAVCA's have identified four broad categories that local infrastructure organisations work within - 'four Functions of Local Infrastructure'.

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Greater Manchester Medicines Optimisation Community of Practice - Health Inequalities 

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Greater Manchester Medicines Optimisation Community of Practice - Health Inequalities 

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The January community of practice focused on health inequalities.

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Greater Manchester Medicines Optimisation Community of Practice CoP 18th January 2024

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The British Pain Society is an alliance of professionals advancing the understanding and management of pain for the benefit of patients.

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The British Pain Society is the oldest and largest multidisciplinary professional organisation in the field of pain within the UK. Chronic pain is suffered by over a third of the population. It is commonly distressing and commonly highly disabling. It is devastating for individuals who suffer. Many cannot work and lose their jobs.

Treatment of pain is a fundamental human right, yet sadly there is an enormous gap between the care people require and what happens in practice. We also do not know enough about the cause and treatment of pain. Our alliance of professionals works collaboratively with patients and industry partners to advance the understanding and management of pain. We strive to reduce the suffering of people enduring daily pain.

Our multidisciplinary nature is pivotal in making The British Pain Society a uniquely relevant representative body on all matters relating to pain.

The Society was first registered as a charity on 29 November 1979 as the Intractable Pain Society of Great Britain and Ireland with a membership limited primarily to anaesthetists working in pain clinics. Over time, the membership of the Society became increasingly multidisciplinary and in 1988, the Society changed its name to the Pain Society. From this point until mid 2004, the Society's membership and activities continued to grow.

In August 2004, the Pain Society dissolved and all its assets were transferred to a new incorporated company with charitable status - The British Pain Society.

In May 2008, The British Pain Society also became a charity registered in Scotland.

Today the British Pain Society has a membership of over 800 and is a uniquely relevant representative body on all matters relating to pain.

The British Pain Society aims to promote education, training, research and development in all fields of pain. It endeavours to increase both professional and public awareness of the prevalence of pain and the facilities that are available for its management. The Society is involved in all aspects of pain and its management through the work of the Council, various Committees, Special Interest Groups and Working Parties and via its publications, Annual Scientific Meeting and educational seminars.

Memorandum & Articles of Association
Pdf of Regulations

The business of the Society is managed by an elected Council.

In September 2014, a subsidiary trading company was founded named BPS Pain Business Ltd. The British Pain Society is the sole subscriber of the Company.
BPS Pain Business Ltd is managed by a separate Board of Directors, and a Memorandum of Understanding is in place between The British Pain Society and BPS Pain Business Ltd.

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The British Pain Society is the oldest and largest multidisciplinary professional organisation in the field of pain within the UK. Chronic pain is suffered by over a third of the population. It is commonly distressing and commonly highly disabling. It is devastating for individuals who suffer. Many cannot work and lose their jobs.

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Primary Care Knowledge Boost Podcast - Chronic Pain 

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Primary Care Knowledge Boost Podcast - Chronic Pain 

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Doctors Sara and Lisa talk to Dr Mahindra Chincholkar, a consultant anaesthetist and Clinical Director Manchester and Salford Pain Centre. They take a detailed dive into the concept of pain and chronic pain, and then Mahindra explains his stepwise approach to assessing and managing chronic pain through the use of an anonymous case.

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Doctors Sara and Lisa talk to Dr Mahindra Chincholkar, a consultant anaesthetist and Clinical Director Manchester and Salford Pain Centre. They take a detailed dive into the concept of pain and chronic pain, and then Mahindra explains his stepwise approach to assessing and managing chronic pain through the use of an anonymous case. This episode is being released now to tie in with the forthcoming Greater Manchester Pain Management Resources Hub which has been co-designed with healthcare professionals and people with lived experience of pain, for use by healthcare professionals supporting people living with pain. You can complete this form to be notified once it is available: https://forms.office.com/e/qgrxwP3PTZ
You can use these podcasts as part of your CPD - we don’t do certificates but they still count :)
Useful resources: Case report about nail in the boot (original article unaccessible): Fisher et al BMJ 1995 Permission to Move Book: https://www.permissiontomove.com/books Tame the Beast: https://www.tamethebeast.org/#tame-the-beast Flippin’ Pain: https://flippinpain.co.uk/ British Pain Society: https://www.britishpainsociety.org/ Faculty of Pain Medicine: https://fpm.ac.uk/ The Pain Toolkit: https://www.paintoolkit.org/ ___
We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback
Email us at: primarycarepodcasts@gmail.com
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This podcast has been made with the support of GP Excellence and Wigan CCG. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions. The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it’s release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen.
Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk.
The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

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Get information, support and tools that have been shown to improve health outcomes.

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"I have found it so rewarding to talk to people who have cancer like me. Sometimes I feel like no one understands and people on this site are just like me. I don't know how it got started but it's the best thing that has happened to me."

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HealthUnlocked | The social network for health

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"I have found it so rewarding to talk to people who have cancer like me. Sometimes I feel like no one understands and people on this site are just like me. I don't know how it got started but it's the best thing that has happened to me."

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GM Tableau - Dependence Forming Meds Dashboard

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GM Tableau - Dependence Forming Meds Dashboard

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Dependence Forming Medications - analysing ePACT primary care prescribing of Benzodiazepines, Z Drugs, Gabapentin, Pregabalin, Oral Morphine, Oral Oxycodone & Tramadol. Plus opioid patient count indicators.

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Using ePACT2 Opioid Prescribing Comparators dashboard

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Using ePACT2 Opioid Prescribing Comparators dashboard

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Watch a demonstration on how to use the Opioid Prescribing Comparators dashboard to look at variation within the area of Opioid prescribing.

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Using the Opioid Prescribing Comparators dashboard

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"We Are Undefeatable" is a movement supporting people with a range of long term health conditions. Our purpose is to support and encourage finding ways to be active that work for you and your health condition.

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Want help with starting to move more? We're here to help. Click through for ideas and resources to help you start your journey to being active.

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Let's Live Well With Pain (LLWWP) Programme

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Let's Live Well With Pain (LLWWP) Programme

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This toolkit is designed to support healthcare providers to create a local pain management programme (the Let's Live Well With Pain Programme) that supports individuals living with chronic non-cancer pain.

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Greater Manchester Medicines Optimisation Community of Practice - Continuity of Care 

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Greater Manchester Medicines Optimisation Community of Practice - Continuity of Care 

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The October community of practice focused on continuity of care in relation to medicines management on discharge.

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Greater Manchester Medicines Optimisation Community of Practice CoP 17/10/23 Meeting Recording

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Working with our partners we have developed a range of patient information materials in different community languages to support and prepare people who have been invited for a medication review with their GP, pharmacist or other healthcare professional.

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Resources to support patients having a Structured Medication Review - The Heath Innovation Network

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Working with our partners we have developed a range of patient information materials in different community languages to support and prepare people who have been invited for a medication review with their GP, pharmacist or other healthcare professional. These materials are free to use and can be printed and used in paper format, or shared electronically

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This video highlights the difficulties in prescribing opioids to manage chronic pain and offer advice and guidance to all healthcare professionals who are responsible for administering them. Faye’s story puts these potential dangers into reality by describing, from her parent’s perspective, the sequence of events that ultimately led to her untimely death from respiratory depression.

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People living with chronic pain want you to know...

Empowering Chronic Pain Management: A Patient Advocate’s Journey with Health Innovation Manchester

Understanding Pain

Animation to support patients having a Structured Medication Review

Tame the Beast

Flippin' Pain

Live Well with Pain

Pain Concern

Pain Toolkit

We Are Undefeatable

Driving and Pain

Painkillers Don't Exist

Pain UK

NHS Fitness Studio

Mindfulness

MIND

HealthUnlocked

Ramblers Wellbeing Walks

Active Partnerships

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Primary Care Knowledge Boost Podcast - Chronic Pain

The British Pain Society

Primary Care Knowledge Boost Podcast - Polypharmacy

NO TEARS Tool

Opioid Thermometers

NICE guideline on safe prescribing and withdrawal management of medicines associated with dependence

NICE guideline on reviewing medicines associated with dependence or withdrawal symptoms

GMMMG Opioid Resource Pack

Live Well with Pain - Tools for HCP

Group Education Sessions for ongoing non-cancer pain

Faculty of Pain Medicine - Opioids Aware

Me & My Medicines Guide

Me & My Medicines Materials

GMMMG Communication Standards for Opioid Medicines Prescribed at Discharge

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Greater Manchester Pain Services

Map of Social Prescribing in Greater Manchester

VCSE Infrastructure Organisations in Greater Manchester

NHS Talking Therapy Service

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GM Tableau - Dependence Forming Meds Dashboard

ePACT2 Overview

Registering for ePACT2

Using ePACT2 Opioid Prescribing Comparators dashboard Demonstration

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Patrick's Story - Social Prescribing

Lisa's Story -Social Prescribing

Blog: Caroline Lindsay, The Benefits of Social Prescribing

Blog: Charlotte Leonhardsen, The importance of supporting people living with pain with 'more than medicine'

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Hub User Guide

Greater Manchester Pain Management Workshop: Techniques and the Benefits of Reducing Harm from Opioids Workshop

Greater Manchester Pain Management Workshop: Knowledge & Skills, Less Pills

Pain Management for Social Prescribers

Greater Manchester Optimisation Community of Practice - Social Prescribing

Greater Manchester Optimisation Community of Practice - Continuity of Care

Greater Manchester Optimisation Community of Practice - Health Inequalities

Let's Live Well With Pain (LLWWP) Programme

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Lisa's Story

Sean's Story

Faye's Story

Live Well with Pain - True Stories

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The problem with Opioids

Structured Medication Review Guidance

Opioid Patient Scenario: Chronic Pain

Opioid Patient Scenario: Seeking Stronger Opioids

Myths and Facts about Pain Medication

Pain Self-Management Strategies

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Animation to support patients having a Structured Medication Review

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Animation to support patients having a Structured Medication Review

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This animation has been created to help patients think about their medicines and to prepare for a Structured Medication Review.

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NICE guideline on reviewing medicines associated with dependence or withdrawal symptoms 

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NICE guideline on reviewing medicines associated with dependence or withdrawal symptoms 

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We provide advice and support to empower anyone experiencing a mental health problem. We campaign to improve services, raise awareness and promote understanding.

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We’re Mind, the mental health charity | Mind

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We're Mind, the mental health charity. We're here to make sure no one has to face a mental health problem alone.

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Paying more attention to the present moment – to your own thoughts and feelings, and to the world around you – can improve your mental wellbeing.

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It can be easy to rush through life without stopping to notice much.
Paying more attention to the present moment - to your own thoughts and feelings, and to the world around you - can improve your mental wellbeing.

Some people call this awareness "mindfulness". Mindfulness can help us enjoy life more and understand ourselves better. You can take steps to develop it in your own life.

What is mindfulness?

Mindfulness involves paying attention to what is going on inside and outside ourselves, moment by moment.

It's easy to stop noticing the world around us. It's also easy to lose touch with the way our bodies are feeling and to end up living "in our heads" - caught up in our thoughts without stopping to notice how those thoughts are driving our emotions and behaviour.

An important part of mindfulness is reconnecting with our bodies and the sensations they experience. This means paying attention to the sights, sounds, smells and tastes of the present moment. That might be something as simple as the feel of a banister as we walk upstairs.

Another important part of mindfulness is an awareness of our thoughts and feelings as they happen moment to moment.

How mindfulness helps mental wellbeing

Becoming more aware of the present moment can help us enjoy the world around us more and understand ourselves better.

When we become more aware of the present moment, we begin to experience afresh things that we have been taking for granted.

Mindfulness also allows us to become more aware of the stream of thoughts and feelings that we experience, and to see how we can become entangled in that stream in ways that are not helpful.

This lets us stand back from our thoughts and start to see their patterns. Gradually, we can train ourselves to notice when our thoughts are taking over and realise that thoughts are simply "mental events" that do not have to control us.

Mindfulness can help us deal with issues more productively. We can ask: "Is trying to solve this by brooding about it helpful, or am I just getting caught up in my thoughts?"

Awareness of this kind may also help us notice signs of stress or anxiety earlier and deal with them better.

Mindfulness-based therapies are recommended by the National Institute for Health and Care Excellence (NICE) as a way to treat less severe depression.

NICE also recommends that employers make mindfulness available to all employees, to support mental wellbeing at work.

How to be more mindful

Reminding yourself to take notice of your thoughts, feelings, body sensations and the world around you is the first step to mindfulness.

Notice the everyday

As we go about our daily lives, we can notice the sensations of things, the food we eat, the air moving past the body as we walk.

Keep it regular

It can be helpful to pick a regular time, such as a morning journey to work or a walk at lunchtime, during which you decide to be aware of the sensations created by the world around you.

Try something new

Trying new things, such as sitting in a different seat in meetings or going somewhere new for lunch, can also help you notice the world in a new way.

Watch your thoughts

Some people find it very difficult to practise mindfulness. As soon as they stop what they're doing, lots of thoughts and worries crowd in.

It might be useful to remember that mindfulness isn't about making these thoughts go away, but rather about seeing them as mental events that come and go. This can be very hard at first, but with gentle persistence it is possible.

Some people find that it is easier to cope with an over-busy mind if they are doing gentle yoga or walking.

Name thoughts and feelings

To develop an awareness of thoughts and feelings, some people find it helpful to silently name them: "Here's the thought that I might fail that exam" or: "This is anxiety".

Free yourself from the past and future

You can practise mindfulness anywhere, but it can be especially helpful to take a mindful approach if you realise that, for several minutes, you have been trapped in reliving past problems or pre-living future worries.

Different mindfulness practices

As well as practising mindfulness in daily life, it can be helpful to set aside time for a more formal mindfulness practice.

Mindfulness meditation involves sitting silently and paying attention to thoughts, sounds, the sensations of breathing or parts of the body, bringing your attention back whenever the mind starts to wander.

Yoga and tai-chi can also help with developing awareness of your breathing.

Is mindfulness helpful for everyone?

Studies show that mindfulness can help with stress, anxiety and depression. More research is needed to show whether it helps with other mental health conditions.

Many people find mindfulness helpful, but it's not right for everyone. Some people find that it does not help them, or that it can make them feel worse.

More tips for wellbeing

There are other steps we can all take to improve our mental wellbeing. Learn more about the 5 steps to mental wellbeing.

You can also get your free Mind Plan on the Every Mind Matters website for personalised mental wellbeing tips and advice to your email inbox.

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Awareness of ourselves and the world around us - sometimes called mindfulness - can improve our mental wellbeing.

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Talking therapy is for anyone who's going through a bad time or has emotional problems they need help with.

For many adults it may be the same or more effective than medicine.

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Talking therapies can help all sorts of people in lots of different situations. You may also hear them referred to as counselling, talking treatments or psychological therapies.
Talking therapy is for anyone who's going through a bad time or has emotional problems they need help with.

For many adults it may be the same or more effective than medicine.

Can you get talking therapies on the NHS?

You can get talking therapies like cognitive behavioural therapy (CBT) on the NHS.

You can refer yourself directly to an NHS talking therapies service without a referral from a GP.

Or you can get a referral from a GP if you prefer.

You may have to wait a few weeks for it to start and may not have much choice in who you see.

If you're under 18, or want to get help for someone under 18, find out how to get mental health support for children and young people.

Read about talking therapies on the NHS
How a talking therapy can help

Sometimes it's easier to talk to a stranger than to relatives or friends.

During talking therapy, a trained counsellor or therapist listens to you and helps you find your own answers to problems, without judging you.

The therapist will give you time to talk, cry, shout or just think. It's an opportunity to look at your problems in a different way with someone who'll respect you and your opinions.

Usually, you'll talk one-to-one with the therapist. Sometimes talking treatments are held in groups or couples, such as relationship counselling.

They'll usually be done face-to-face, but you might be able to have talking therapy over the phone, via email or on Skype.

Although there are lots of different types of talking therapy, they all have a similar aim: to help you feel better.

Some people say that talking therapies do not make their problems go away, but they find it easier to cope with them and feel happier.

Talking therapy for mental health problems

Talking therapies can be helpful for lots of things, including:

They're often used if you have been diagnosed with a serious mental health condition, such as schizophrenia or bipolar disorder.

Talking therapies are commonly used alongside medicines.

Talking therapy after difficult life events

If you're going through a sad and upsetting time, talking therapies can help you deal with it.

This could be after a relative or friend has died, after finding out you have a serious illness, if you're struggling with infertility, or if you have lost your job.

Physical illness and talking therapy

People with long-term health conditions are more vulnerable to depression, and talking therapies have been proven to help.

Talking therapies may improve your quality of life if you have:

Talking therapy for the over-65s

Older people, especially those with depression, are as likely to benefit from talking therapies as everyone else.

Depression in later life, especially over the age of 65, is often dismissed as a normal part of ageing.

But this is not the case, and talking therapy can improve your enjoyment of life if you're feeling low.

Talking therapies may also help people with dementia and people looking after them.

Talking therapy and past abuse

If you've been physically or sexually abused, or have experienced discrimination or racism, you may feel able to cope with life better after a course of talking therapy.

Talking therapy for relationship problems

Couples therapy can save a relationship that's in trouble or help you through separation and divorce.

Ideally, a couple should go to counselling together, but if your partner refuses to join you, counselling can help you sort out lots of things on your own.
Find out more about relationship counselling from the Relate website.

Talking therapy for families

Family therapy is talking therapy that involves the whole family. It can be especially helpful for children and young people with depression or a behavioural problem, or whose parents are splitting up.

It can also help families where someone has an eating disorder, mental health condition, or addiction.

Talking therapy for anger

Talking therapy can help people who find it difficult to keep their anger under control.
Find out how to manage anger

Children's talking therapy

Talking therapy works as well for children as it does for adults.

The National Institute for Health and Care Excellence (NICE) recommends talking therapy rather than medicines for children who are depressed.

See the NICE guidelines on depression in children and young people.

It can also help children with anxiety or attention deficit hyperactivity disorder (ADHD), or who are in physical pain much of the time.

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Find out about counselling and talking therapies and the problems they can help, including depression, anxiety, phobias, addiction and relationship problems.

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Try instructor-led exercise videos, including aerobic exercises, strength and resistance training, pilates and yoga.

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NHS Fitness Studio: free online fitness videos, aerobics videos, strength and resistance videos, pilates and yoga videos and more.

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Pain UK is an umbrella organisation providing a voice for people in pain.

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We were founded in November 2011. Since then, our membership base has grown rapidly and we now support charities dealing with all manner of painful conditions, from head to toe. You can see more about...

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Have you been on pain medication for more than 3 months? If so, this is a good indication that it’s time to get a pain review appointment with your Pharmacist or GP at your practice.

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About pain medication

The term 'painkiller' is misleading - it implies that medicine will kill the pain completely. Although they can play a part in managing persistent pain they do not work for everyone, and even if you get some benefit, after 3 months they're probably not working and addiction becomes a serious issue.

There are four main types of pain medication: 1) Paracetamol. 2) Non-steroidal anti-inflammatory drugs (NSAIDS) like ibuprofen. 3) Opioids, that range in strength from codeine through to high dose examples like tramadol and morphine. 4) Other medicines such as anti-depressants and anti-epileptics. Each works in a different way. Most people only need to take pain medication for a few days or weeks.

About painkillers

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An NHS Sunderland and County Durham campaign to raise awareness of the dangerous effects of long-term high-dose pain medication.

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Here you can access the websites of Greater Manchester Specialist Pain Services.

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Improvements to our registration process We’ve streamlined our user onboarding journey by providing comprehensive definitions of our account types, downloadable registration forms, and step-by-step directions.

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ePACT2 gives authorised users access to prescription data and allows you to:

access easy to use interactive reports and dashboards

look at high level data summaries down to individual prescription item and patient level detail

build bespoke analysis

export data from reports and dashboards

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A range of training materials are available for ePACT2. These are tailored to our different types of users and include written and video guides.

You can also book ePACT2 training webinars with the training team.

You can also sign up to our ePACT2 user forum where you can get useful advice, updates on ePACT2 improvements and discuss ideas with other ePACT2 users. Go to the NHS Futures platform to request access to our forum.

If you have any queries or need support to use ePACT2, contact our support team by:

Email: DataServicesSupport@nhsbsa.nhs.uk

If you would prefer a response through a Microsoft Teams chat or phone call, state this at the beginning of your message.

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ePACT2 gives authorised users access to prescription data and allows you to: access easy to use interactive reports and dashboards look at high level data summaries down to individual prescription item and patient level detail build bespoke analysis export data from reports and dashboards Log in to ePACT2 We recommend you use Google Chrome or Mozilla Firefox to access ePACT2.

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Here you can find some useful pain self-management strategies to consider.

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A guide to adopting NHSE approved patient behaviour change materials that can support better and more meaningful conversations during a medication review.

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Map of Social Prescribing in Greater Manchester

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Map of Social Prescribing in Greater Manchester

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This map provides an overview of all the social prescribers operating in Greater Manchester.

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Greater Manchester Pain Management Workshop: Techniques and the Benefits of Reducing Harm from Opioids Workshop

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Greater Manchester Pain Management Workshop: Techniques and the Benefits of Reducing Harm from Opioids Workshop

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Focusing on pain management techniques and the benefits of reducing harm from opioids, this virtual workshop for health and care professionals was a key opportunity to come together, learn, share experiences, challenges and best practice.

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NICE guideline on safe prescribing and withdrawal management of medicines associated with dependence 

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NICE guideline on safe prescribing and withdrawal management of medicines associated with dependence 

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Clinicians often find pain consultations difficult. This is due to limited understanding of the biopsychosocial model of pain and unhelpful beliefs held by patients. Tackling these unhelpful beliefs and helping patients engage with self-management are key to a productive consultation.

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Opioid Patient Scenario: Seeking Stronger Opioids 

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Opioid Patient Scenario: Seeking Stronger Opioids 

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Clinicians often find pain consultations difficult. This is due to limited understanding of the biopsychosocial model of pain and unhelpful beliefs held by patients. Tackling these unhelpful beliefs and helping patients engage with self-management are key to a productive consultation.

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Opioid Patient Scenario - Seeking Stronger Opioids

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Group Education Sessions for ongoing non-cancer pain

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Group Education Sessions for ongoing non-cancer pain

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This guide has been developed to support GP practices to implement Group Education Sessions (GES) for patients with ongoing non-cancer pain, lasting more than 3 months.

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Greater Manchester is working together to better support our people and communities. We know that where we live, our work, our money and the social connections we make, most affect our health and wellbeing. That’s why GPs, nurses and social workers across Greater Manchester are prescribing local support and activities. Improving health and wellbeing and the lives of our residents.

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Greater Manchester Integrated Care Partnership 

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Social Prescription in Greater Manchester

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A resource developed by the Salford Pain Team to support social prescribers to gain a better understanding of pain and self-management strategies for patients.

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Blog: Charlotte Leonhardsen, The importance of supporting people living with pain with ‘more than medicine'

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Blog: Charlotte Leonhardsen, The importance of supporting people living with pain with ‘more than medicine'

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Charlotte Leonhardsen, Social Prescribing lead for NHS Greater Manchester Integrated Care, highlights the importance of supporting people living with pain with ‘more than medicine'.

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I was very fortunate to be able to talk about Social Prescribing at the Greater Manchester Medicines Optimisation Community of Practice event on the 12 th July 2023. Being in a (virtual) room with a variety of people, all with the same aim- to improve the quality of life for people despite them living with pain and/or on multiple prescriptions - was really energising.

Social Prescribing is a person-centered approach that looks at "What is strong with you" not, what is wrong with you. Social Prescribing Link Workers know their communities very well, and the local information, support, and activities on offer. They are experts at connecting people to the things that make them feel better.

Acknowledging that people can be supported with 'more than medicine', recognises that people living with pain might not be able to work full time, for example, or work at all and therefore feel financial strain. It also acknowledges that it is hard to find the energy to get out to see friends or participate in activities, and if you do, you might pay a high price in the days that follow.

Having to prioritise where you spend energy, and how much pain you are willing to accept, means it can be easy to become defined by a condition and what it allows you to do.

But, people are so much more than their health condition....

A Social Prescribing Link Worker gives people time and space to explore what matters to them and will support people to identify activities and services that can support them to live a more satisfying life, with them in the driver's seat.

It could be that finding a way to move more, without causing further pain and discomfort, is a priority, or support getting access to financial advice to ease money stresses, or transport to maintain a social life. Social Prescribing Link Workers can support those who have become isolated to find like-minded people to connect with. They will give as much or as little support as needed, to get people to where they want to be. This could be from just sharing information about a community group to going together if that feels right.

As Akeela, who was supported by a Social Prescribing Link Worker in Bolton said:
"I lost my job as a healthcare assistant because of back pain and was also trying to look after relatives. I was so stressed and depressed. My link worker helped me get a volunteer role at a charity. I'm very happy now. I've got my confidence back and feel like I'm part of the community."

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Greater Manchester Medicines Optimisation Community of Practice Focusing on Social Prescribing - Health Innovation Manchester

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I was very fortunate to be able to talk about Social Prescribing at the Greater Manchester Medicines Optimisation Community of Practice event on the 12 th July 2023. Being in a (virtual) room with a variety of people, all with the same aim- to improve the quality of life for people despite them living with pain and/or on multiple prescriptions - was really energising.

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Blog: Caroline Lindsay, The Benefits of Social Prescribing

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Blog: Caroline Lindsay, The Benefits of Social Prescribing

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In this blog, Caroline Lindsay from the Wellbeing Matters Programme tells us more about her role as a Community Connector and the benefits of Social Prescribing.

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I am employed by what's known as an anchor organisation within the VCSE sector and feel incredibly lucky to be situated within this type of community setting.

The community centre I work in is a fantastic location to meet individuals and share what's happening within the centre including exercise sessions, social groups, food clubs, and advice and information sessions.

I am aware of the barriers that local people face with regards to health and wellbeing which can stop them from leading happy and fulfilled lives.

There are areas of Salford where individuals may lack motivation, have low self-esteem, and feel they don't have the skills or training to contribute meaningfully to their community. There are also individuals who may not have the time or resources to exercise or meet socially leading to a feeling of isolation.

I have an in-depth understanding and knowledge of the neighbourhood in relation to services, groups, and activities. Each of these help to support people in improving wellbeing and can provide space for an individual to discuss what matters to them, help them to feel more connected to their community, help to increase confidence and feel less socially isolated, by linking them into local groups and services.

The goal of this is for an individual to be better equipped to manage their own health and wellbeing. Some of the benefits of this can be found below:

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Caroline Lindsay: The Benefits of Social Prescribing - Health Innovation Manchester

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In this blog, Caroline Lindsay from the Wellbeing Matters Programme tells us more about her role as a Community Connector and the benefits of Social Prescribing.

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A pain consultation can be frustrating both for clinicians and patients as patients feel they are not getting the right treatments and clinicians feel they are unable to help.  Some clinicians may feel obliged to escalate pain medications which is unhelpful.  Opioids can help in chronic pain but regular use results in tolerance.

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In persistent pain, using opioid painkillers, such as codeine, tramadol and morphine for more than a few months, has not been shown to be helpful. The higher your dose, the greater your risk of problems. This handy ‘thermometer’ helps you work out whether your dose is too high.

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Live Well with Pain has developed a rich collection of self management tools and techniques for use by clinicians and other practitioners working with people with pain.

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Professional tools - Live Well with Pain

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Here we look at some common myths and give you the facts about opioid pain medication.

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This is a short guidance document that summarises what you should cover in a Structured Medication Review.

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Lisa talks about how social prescribing helps her pain management.

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GM Medicines Optimisation Community of Practice - Social Prescribing

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GM Medicines Optimisation Community of Practice - Social Prescribing

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The July community of practice focused on social prescribing.

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Sean describes how he has found an alternative to opioid medication to help manage his chronic pain. This video is aimed at patients who are considering alternative options to medication for pain management.

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Faculty of Pain Medicine - Opioids Aware

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Faculty of Pain Medicine - Opioids Aware

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This resource, developed by UK healthcare professionals and policymakers, provides the information to support a safe and effective prescribing decision.

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A resource for patients and healthcare professionals to support prescribing of opioid medicines for pain

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A useful video to help you understand pain in less than 5 minutes.

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Live Active Chiropractic (Live Active Clinic)

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Understanding Pain in less than 5 minutes, and what to do about it!

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Lisa, a patient representative, shares her experiences of living with pain through most of her life. Hearing from Lisa and others who live with long-term pain helps us understand more about the issues that are important from the perspective of patients, and how we can learn from lived experiences and develop solutions together.

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Useful 5 minute video to help understand pain.

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Read the transcript >

Once upon a time, all the lands were fraught with persistent pain. So widespread was this affliction that one in four people experienced it. The pain lasted more than 3 months. It shadowed their daily lives... held them back from everyday activities ... and the interventions they tried proved useless...

Hey, pain! Go away! We've tried it all But still you stay! Moving less, Taking pills, Knives and needles

Hey, pain! Go away! We've tried it all But still you stay!

But the pain remains like a loyal companion.

The peoples' hopes faded and they became resigned to living with the pain - only now, the pain was a beast! Then, along came a group of researchers, of which I am one. "Back off, big fella!" I'm Professor Lorimer Moseley and I'm a pain scientist.

Pain scientists are starting to think differently about pain and its causes. And we're making exciting discoveries...

Like how the way you think about your pain can change the way it feels. Over the next few minutes, I'll help you to understand your pain. Understanding is important because it can change how much things hurt and how much your body can do... And can help you to tame the beast.

First, trust me about this... Pain is not an accurate measure of tissue health. Pain is a protector. By making unpleasant feelings, your brain changes your behaviour - so you can avoid injury or your tissues can heal. Sometimes pain is not helpful - like phantom limb pain. You don't expect a missing limb to ache. But it does and the pain is very real.

So how do we explain this? Pain is a warning signal from your brain that depends on credible evidence to say your body needs protecting. Sometimes it's too protective and you get unnecessary warning signals. Pain scientists now understand that there are many ways our nervous system ends up producing unnecessary warning signals. Take conditioning for example.

Think of Pavlov's dog... Every time food was offered, Pavlov rang a bell. Of course, the dog would salivate seeing the food. This went on for a while. Eventually the dog was conditioned to salivate for the bell alone. Conditioning is just one of the ways your body learns pain. And the longer your nervous system produces pain, the better it gets at producing it. Your body learns pain

So what feeds this beast? Let's look at how pain works... In your body's tissues, there are specific neurones, which normally only respond to harmful stimuli. - whether mechanical, chemical or thermal. When they are activated, they send a warning signal to your spinal cord, which can in turn send a signal to your brain. This activity in neurones is called 'nociception' and it's happening all the time. But it only sometimes results in pain. Most of the time, the brain protects you with other things like movement. Once the warning signal reaches the brain, the brain makes sense of it based on the information arriving and the vast amount already stored. If there's reason to think protection is required, then your brain makes pain.

One of our amazing discoveries is that you can have pain without any physical stimuli. Thoughts and places might activate the warning signals. And the pain feels exactly the same. But it's not just your brain - your spinal cord also learns how to generate unnecessary warning signals.

So how do you know when your nervous system is learning pain? You may notice your pain spreads or comes on without warning. Your body feels odd and it's hard to move properly. Your pain changes quickly with your mood and small annoyances can set it off. Old injuries start to hurt again. You're more sensitive to stimuli. And the longer the pain goes on, the more all of this occurs.

The old way we understood pain left many sufferers feeling like no one believed it was real. Or that for it to hurt so bad, there must be a tissue problem. But we now know how persistent pain happens.

So how can you tame the beast?

Pain is a very personal thing. There's no one size fits all solution. And while you probably have well thought out coping strategies, it's time to take a new approach to dealing with and reducing your pain - one that focuses on retraining your pain system. This might mean testing yourself physically and moving more than you normally would. Being honest about your current attitudes and beliefs can also help. As can asking your health professional new questions.

How do I know if my pain system is being over protective? How can I retrain my pain system to be less protective? How do I know if I'm safe to move?

So be brave and have hope! Because - it is possible to tame the beast!

Visit our website for more information and questions to ask your health professional. tamethebeast.org

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Once upon a time, all the lands were fraught with persistent pain. So widespread was this affliction that one in four people experienced it. The pain lasted more than 3 months. It shadowed their daily lives... held them back from everyday activities ... and the interventions they tried proved useless...

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Flippin’ Pain™ is a public health campaign with a clear goal: To change the way we think about, talk about and treat persistent pain. Flippin’ your understanding of pain could change the lives of you and your loved ones forever.

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Persistent pain affects 30-50% of us

Its impact is significant, negatively affecting our physical and mental health, our social and home lives and our ability to stay in work.

There are a lot of misconceptions about persistent pain

Common public understanding is significantly out of step with current scientific thinking.

Understanding pain is important

How you think about your pain can change the way it feels and how you respond to it.

Healthcare design and delivery doesn't always reflect the best scientific understanding

It often fails to fully embrace the complicated biological, psychological and social nature of pain.

Change is needed

Where better place to start than raising awareness, facilitating a better understanding and empowering people to take back control?

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Flippin' Pain™ is a public health campaign with a clear goal:To change the way we think about, talk about and treat persistent pain.

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Charity for people with pain that includes educational podcasts.

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We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. By clicking "Accept All", you consent to the use of cookies. Read More...

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Find information and resources to help manage your pain. We work to improve the lives of people living with pain and those who care for them.

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Pain self management advice including opioid reduction information.

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Welcome to Live Well with Pain. The website for people who are living with persistent pain and those who support them. More than a third of the population live with persistent pain. It is a long term condition and cannot be 'fixed or cured'. Traditional medical treatments such as pain medicines are now recognised as ...

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Pain self-management advice.

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Pete Moore, Pain Toolkit - info@paintoolkit.org

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Pain Self Management by Pete Moore | Pain Toolkit

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Is pain self management your first choice, or last resort? The Pain Toolkit by author Pete Moore, helps people all over the world self manage persistent pain.

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Guidance for patients on driving while on pain medication.