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NHS England - Guide to Personalised Care

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NHS England - Guide to Personalised Care

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NHS England guide to personalised care. Personalised Care will benefit up to 2.5 million people by 2024, giving them the same choice and control over their mental and physical health that they have come to expect in every other aspect of their life. A one-size-fits-all health and care system simply cannot meet the increasing complexity of people’s needs and expectations. Personalised care is based on ‘what matters’ to people and their individual strengths and needs.

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Dr Ollie Hart, GP, Clinical Director of Heeley Plus Primary Care Network and Director of Peak Health Coaching, talks about how incorporating health coaching approaches into his consultations helped build self-management capabilities for his patients.Elaine Cross shares her experience of how this approach helped her explore a referral to a health and wellbeing coach, where [...]

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Dr Ollie Hart, GP, Clinical Director of Heeley Plus Primary Care Network and Director of Peak Health Coaching, talks about how incorporating health coaching approaches into his consultations helped build self-management capabilities for his patients.Elaine Cross shares her experience of how this approach helped her explore a referral to a health and wellbeing coach, where [...]

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NHS England - Guide to Shared Decision-Making

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NHS England - Guide to Shared Decision-Making

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NHS England guide to shared decision making. It enables:
- Increased understanding of what good shared decision-making looks like and how it ensures that we commission and provide systems and services that informed individuals want
- Commissioning of local shared decision-making initiatives and embedding them in care pathways
- Providers to have better conversations with people using services, thereby supporting them to make more informed choices based on their personal values and preferences and what is known of the risks, benefits and consequences of the options available to them.

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NHS England » Shared Decision-Making: Summary Guide

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The Shared Decision-Making Summary Guide is intended for people leading local implementation of shared decision making. It enables:

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Person-Centred Care toolkit from the Royal College of General Practitioners

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Shared decision making is a process in which clinicians and patients work together to make decisions and select tests, treatments and care plans. It places equal value on the priorities, values and preferences of the patient, and the expert knowledge of the health care professional.

It is a move away from a paternalistic approach and informed decision making.

Benefits of shared decision making include:

Increased patient involvement and engagement and

Improved adherence to treatment

Less anxiety about the care process

Increased satisfaction about treatment outcomes

Patient Decision Aids are specifically designed resources which help patients make difficult decisions about healthcare options. One example is the NHS Shared Decision App.

Resources

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person-centred care toolkit: shared decision making

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Person-Centred Care toolkit: Shared Decision Making

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Shared decision making is a process in which clinicians and patients work together to make decisions and select tests, treatments and care plans. It places equal value on the priorities, values and preferences of the patient, and the expert knowledge of the health care professional.

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HEE e-Learning for Healthcare - Shared Decision Making 

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HEE e-Learning for Healthcare - Shared Decision Making 

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This elearning resource from Health Education England Elearning for Healthcare provides guidance on what Shared Decision Making (SDM) is and how to implement it in practice. It also provides resources to help health professionals learn the required skills. The elearning sessions include films to illustrate examples of good and bad consultations and prompts, along with resources to aid health professionals with their work.

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This programme is in partnership with...

Making a good decision

SDM is not just about ensuring the patient is involved with the process, it is also about making sure the decision reached is a good decision. A good decision is one that is approached systematically, is based on reliable, evidence-based information, and with time allowed to consider all the options carefully. The examples chosen are used to help get people to think about making good decisions.

Who is this tool for?

The Shared Decision Making elearning package is suitable for all healthcare professionals, health improvement personnel and patient engagement representatives to inform and educate them on Shared Decision Making in order to embed it in day to day clinical practice. Shared Decision Making represents a cultural change in behaviour and this tool will aid and assist in changing an environment of medical paternalism to a more inclusive approach based on the 2012 Health Act 'Liberating the NHS: 'No decision about me without me'.

Patient participation in decision making

Not being properly told about their illness and the options for treatment is the most common cause of patient dissatisfaction. Most patients want more information and a greater say in decisions about how they will be treated. Shared Decision Making (SDM) is a process in which patients are encouraged to participate in selecting appropriate treatments or management options.

In Shared Decision Making, patients are involved as active partners with their health professional in clarifying acceptable medical options and choosing a preferred course of clinical care. Shared Decision Making is appropriate in any situation when there is more than one reasonable course of action and no one option is self-evidently best for everyone. This situation is very common since there are often many 'preference-sensitive' decisions. In these cases, the patient's attitude to the likely benefits and risks should be a key factor in the decision.

Sources of expertise

SDM relies on two sources of expertise:

The health professional is an expert on the effectiveness, probable benefits and potential harms of treatment options

The patient is an expert on herself, her social circumstances, attitudes to illness and risk, values and preferences

Both parties must be willing to share information and accept responsibility for joint decision-making. The clinician must provide patients with information about the diagnosis and treatment options and the patient must tell the clinician about their preferences.

Course - Talking about What Matters

Talking About What Matters is a course developed by HEE West Midlands intended to explore in greater depth the interactions between doctors and patients that help create a meaningful outcome to consultations.

The course consists of a series of patient scenarios and is designed to be applicable across primary care and not confined to medical professionals.

Access the course here: https://portal.e-lfh.org.uk/Component/Details/429363

Course - Communicating Risk - Primary Care, Perioperative Medicine, Obstetrics & Gynaecology, Ophthalmology and Plastic Surgery

The Communicating Risk course was originally commissioned by the Australian Commission on Safety and Quality in Health Care and has been licensed to the Academy of Medical Royal Colleges (AoMRC) as part of Choosing Wisely UK. It has been adapted for the UK by the Winton Centre for Risk and Evidence Communication at the University of Cambridge.

There are five versions of this course - aimed at primary care professionals, perioperative medicine professionals, obstetricians &amp; gynaecologists, ophthalmologists and plastic surgeons. Each course is designed to help clinicians from these specialties develop skills for communicating effectively with patients about the risks and benefits of treatment options. Each course consists of four sessions and will take approximately two hours to complete, with each session taking approximately 30 minutes to complete.

Health decisions often have no single 'best choice' and require choosing from multiple options, each with potential benefits, harms, trade-offs and uncertainties. For patients (and carers) to understand and have the opportunity to be actively involved in sharing decisions, clinicians need to provide relevant and clear information about the options, and the potential benefits and harms of each. This information should reflect the best available evidence and also take into account the patient's personal opinions, preferences, values and priorities. This often requires analysis and being able to convey quite complex numerical information. Yet few clinicians have any training in how to do this.

Each version of the course includes examples taken from the relevant specialty, but is suitable for any healthcare professional. It includes self-test questions and video consultation case-studies. By the end of each course, participants will be able to:

* describe why it is important for clinicians to effectively communicate benefits, harms, trade-offs and uncertainties with patients
* explain the inter-relationship between shared decision making, evidence-based medicine and patient-centred care in the context of communicating benefits and
* list key communication skills needed when talking with patients about evidence
* explain how to effectively communicate statistical information to patients
* outline the role of decision support tools, potential uses and where to locate them

Authors

* Professor Tammy Hoffmann, PhD Professor of Clinical Epidemiology, Centre for Research in Evidence-Based Practice, Bond University, Australia
* Professor Chris Del Mar, MD, FRACGP, FAFPHM Professor of Public Health and General Practitioner, Centre for Research in Evidence-Based Practice, Bond University, Australia
* Dr Raquel Newman, BVSc, MANZCVSc (Emergency and critical care), EMA. Medical Writer.
* Dr Ramai Santhirapala FRCA FFICM FHEA, Clinical Lead, Choosing Wisely UK, Academy of Medical Royal Colleges
* Dr Alexandra Freeman, Executive Director, Winton Centre for Risk and Evidence Communication

The authors were also assisted by a steering committee in risk communication and other contributors and reviewers from a range of clinical specialties.

Access the (Primary Care) course here: https://portal.e-lfh.org.uk/Component/Details/543925

Access the (Perioperative Care) course here: https://portal.e-lfh.org.uk/Component/Details/543859

Access the (Ophthalmology) course here: https://portal.e-lfh.org.uk/Component/Details/604821

Access the (Obstetrics and Gynaecology) course here: https://portal.e-lfh.org.uk/Component/Details/603796

Access the (Plastic Surgery) course here: https://portal.e-lfh.org.uk/Component/Details/608413

How to access

In order to access the Shared Decision Making programme, you will need an elfh account. If you do not have one, then you can register by selecting the Register button below.
Register >
To view the Shared Decision Making programme, select the View button below. If you already have an account with elfh, you will also be able to login and enrol on the programme from the View button.
View >
NHS healthcare staff in England

The Shared Decision Making programme is also available to NHS healthcare staff via the Electronic Staff Record (ESR). Accessing this elearning via ESR means that your completions will transfer with you throughout your NHS career.

Further details are available here.

Not an NHS organisation?

If you are not an NHS health or care organisation and therefore do not qualify for free access elfh Hub, you may be able to access the service by creating an OpenAthens account.

To check whether or not you qualify for free access via OpenAthens, you can view the eligibility criteria and register on the ' OpenAthens ' portal.

Registering large numbers of users

If you are a HR, IT or Practice Manager and would like to register and enrol large numbers of staff within your organisation for access onto the Shared Decision Makingprogramme, please contact elfh directly.

Organisations wishing to use their own LMS

For HR departments wanting to know more about gaining access to courses using an existing Learning Management System please contact elfh directly to express interest.

More information

Please select the following link for more information on how to use the elfh Hub.

elfh is a NHS England programme in partnership with the NHS and professional bodies

© elearning for healthcare 2023

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Shared Decision Making - elearning for healthcare

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This programme is in partnership with... SDM is not just about ensuring the patient is involved with the process, it is also about making sure the decision reached is a good decision. A good decision is one that is approached systematically, is based on reliable, evidence-based information, and with time allowed to consider all the options carefully.

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Pain Concern - Self-Management Navigator Tool

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Pain Concern - Self-Management Navigator Tool

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Pain Concern has developed a paper-based tool for patients to prepare themselves to bring up their concerns and worries in appointments. Designed to help patients navigate their concerns and bring the most important questions up in primary care appointments, the Navigator Tool was trialled 2017-2018 with healthcare professionals and their chronic pain patients.

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The study found that the most useful aspect of the tool was the My pain concerns form, as it identifies areas of living with pain that do not usually come up in routine consultations. We encourage people with pain, and healthcare professionals caring for people with pain, to use the form in appointments.

If you are the person with pain, download My pain concerns form to your tablet, computer or print a paper copy.

HINT: How you feel about the statements may change from day-to-day; choose agree or disagree according to what you feel is right now.

The form Questions to ask your health-care professional has some suggested questions that you might want to ask. You might also have your own questions based on the concerns you have identified.

HINT: My pain concerns form and Questions to ask your health-care professional are colour-coded to make them easier to use together.

If you are a healthcare professional you can give My pain concerns form to patients you think will benefit from talking about these issues. Simply print out the form and instructions at your practice and give them to your patient to prepare for the next appointment.

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Self-Management Navigator Tool - Pain Concern

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The study found that the most useful aspect of the tool was the My pain concerns form, as it identifies areas of living with pain that do not usually come up in routine consultations. We encourage people with pain, and healthcare professionals caring for people with pain, to use the form in appointments.

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RCGP - Top 10 Tips on Dependence Fomring Medications

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RCGP - Top 10 Tips on Dependence Fomring Medications

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Royal College of General Practitioners top ten tips on the subject of Dependence Forming Medications

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Healthwatch Derby - Chronic Pain Experiences 2022

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Healthwatch Derby - Chronic Pain Experiences 2022

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With the prevalence of those experiencing Chronic Pain being so high in numbers and the large amount of internet searches of those who are looking for help around Chronic Pain, Healthwatch Derby have designed this survey to discover what is happening in 2022 to support these patients, how they are coping with their pain on a daily basis, and whether improvements can be made.

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Chartered Society of Physiotherapy guidance webpage

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Chartered Society of Physiotherapy guidance webpage

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Physiotherapy helps people with long term (chronic) pain develop the skills they need to manage their condition, increase their activity and improve their quality of life. This webpage from the Chartered Society of Physiotherapy covers topics including what chronic pain is, how chronic pain is managed and how physiotherapy can help

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What is chronic pain?

Chronic pain is usually defined as pain that persists beyond the normal time that tissues take to heal following an injury. Most soft tissue injuries heal up within weeks, although some can take several months to completely heal.

If a pain continues longer than 3-6 months, it is usually described by pain specialists as "chronic" pain. It is helpful to understand the differences between chronic, persistent pain and acute pain.

Acute pain: short-term pains act as an alarm, telling us that something is wrong. While most minor pains are easily treated and quickly forgotten, others are a sign of something more serious that we shouldn't ignore. For example, the pain of a broken leg is helpful because it makes us rest the leg until it heals.

Chronic pain: persistent pain though often serves no useful purpose. The pain messages linked to long-term conditions such as back pain or arthritis are not helpful, and can be annoying and sometimes devastating.

Over time, the pain may affect how we function, including our ability to work and our sleep patterns. It can also have a negative effect on our family and friends.

The causes of chronic pain are not always clear but in some conditions the pain is thought to be due to the pain signals through the nerve fibres becoming confused. The brain is then unable to understand the signals properly. Chronic pain can affect any part of the body and people of any age, including children.

The nerve network associated with chronic pain is also linked to those parts of the brain concerned with emotions. So, pain can affect our emotions, and our emotions can affect our pain. If we are angry, depressed or anxious, for example, the pain often feels worse. If we are feeling positive and happy, we may experience less pain and will often be better able to cope. Pain then is never "just in the mind" or "just in the body", but a complex mix affecting our whole being.

The relationship between body and mind is complex, so it is important to seek help for any aspect of your condition that you might be struggling with, physical or mental.

How is chronic pain managed?

If your pain persists and becomes chronic then the emphasis might shift more to managing the condition and minimising its impact on your life, rather than necessarily finding a cure.

Some treatments are available which can reduce the pain intensity. For example, you might be prescribed medication, from simple pain-killers to more complex drugs. Other treatments to help reduce the pain include "hands on" treatments, massage and acupuncture, although the benefits of these treatments tend to wear off after each treatment session.

Another way of managing long-term pain is to find ways to reduce the impact of the pain on overall quality of life. This might include learning relaxation techniques, developing goal-setting skills, and learning ways of improving sleep quality.

You could be referred to a specialist pain clinic or a specific pain management programme. Some pain clinics have teams of expert healthcare professionals including doctors, psychologists and physiotherapists. However, pain clinics are not available in every area.

How can physiotherapy help?

Physiotherapists often see patients with chronic pain on an individual basis. Your physiotherapist will assess you and work with you to agree a treatment plan. A specific manual treatment such as massage or soft tissue mobilisation may be appropriate, or perhaps acupuncture. However, treatment is more likely to include advice about movement, posture and finding ways of achieving your goals.

A physiotherapist can also identify practical ways to help, such as making sure you have the correct equipment or the right shoes. Physiotherapists also see patients at a pain management clinic, working as part a specialist team. This is more likely to be a group session.

It is important to have regular reviews with your physiotherapist and ask to see them if your condition changes.

What will happen when I see a physiotherapist?

Your physiotherapist will assess your condition and difficulties, give you advice and perhaps offer you a physical treatment (see above). You might need to remove some clothes so that the physiotherapist can see your movement and muscle activity that may be contributing to your pain, so it's a good idea to dress comfortably and wear suitable underwear.

What is a pain management programme?

A pain management programme is a specialist rehabilitation approach for groups of patients run by a healthcare team which includes a physiotherapist and a psychologist, and may include an occupational therapist and a nurse.

People with chronic pain may find that it affects many areas of their lives, including how they think and feel. Pain management programmes teach people how best to cope with pain and how to live a more active life.

Referral to a pain management programme is usually through your local pain clinic.

How can I help myself?

Everyday activities such as walking, swimming, gardening and dancing can improve wellbeing for people with chronic pain. Exercise can help by:

increasing levels of chemicals known as endorphins which occur naturally in your body and act as pain killers

relieving tension and stiffness in your muscles, ligaments and joints

reducing weight gain, the risk of heart disease, osteoporosis, poor balance and falls

Relaxation techniques can help to reduce persistent pain and muscle tension, and can help to improve broken sleep. There are many types, including breathing exercises and meditation. There may be local classes available, perhaps through your local pain clinic. Ask your physiotherapist, GP or other healthcare professional for advice.

Support Groups. Pain can send you into a downward spiral of fatigue, low mood and anxiety. Talk to someone who understands what you are going through. Several organisations have helplines staffed by people living with chronic pain and they can also put you in touch with local support groups (see below). It can help to see a counsellor or psychologist. Your GP can advise you about where you can find help.

Distraction. Try distracting yourself from the pain with an activity that you enjoy. Many hobbies such as photography, sewing or knitting can be done even when your mobility is restricted.

Good night's sleep. Give yourself the best chance of a good night's sleep by going to bed at the same time each evening, getting up at the same time each morning and avoiding taking naps during the day. If sleep problems persist, speak to your physiotherapist, GP or other healthcare professional.

Friends and family. Keeping in touch with friends and family is good for your health and well-being. If getting out and about is difficult, try shorter visits, perhaps more often. If you can't get out, phone a friend, invite someone round for a coffee or have a chat with your neighbour. Aim to talk about anything other than your pain

Guidance and evidence for physiotherapy

Links and further information

Produced in association with the Physiotherapy Pain Association.

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Chronic pain is usually defined as pain that persists beyond the normal time that tissues take to heal following an injury. Most soft tissue injuries heal up within weeks, although some can take several months to completely heal. If a pain continues longer than 3-6 months, it is usually described by pain specialists as "chronic" pain.

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Moving Medicine - advice on physical activity as part of treatment pathways

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Moving Medicine - advice on physical activity as part of treatment pathways

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We provide clinicians and allied health professionals with accessible, evidence based, condition specific information to help give advice on physical activity at all stages of children, young peoples and adults treatment pathways. We also provide our toolkit for hospitals to help people be more active during and after their time in hospital The project has been developed in collaboration with experts, professional bodies and charities representing patients and healthcare professionals in each disease area.

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Moving Medicine will ensure that all health care professionals have up to date information on physical activity presented in a useable, easy to understand format, enabling them to inform their patients and motivate them to become more active.

Dr Paul Jackson, FSEM UK Immediate Past President

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NICE guideline on chronic pain (parimary and secondary) in over 16s

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NICE guideline on chronic pain (parimary and secondary) in over 16s

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NICE guideline: Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain

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This guideline covers assessing all chronic pain (chronic primary pain, chronic secondary pain, or both) and managing chronic primary pain in people aged 16 years and over. Chronic primary pain is pain with no clear underlying cause, or pain (or its impact) that is out of proportion to any observable injury or disease.

This guideline should be used alongside NICE guidelines for other chronic pain conditions, including the NICE guidelines on headaches, low back pain and sciatica, rheumatoid arthritis, osteoarthritis, spondyloarthritis, endometriosis, neuropathic pain and irritable bowel syndrome.

The recommendations in this guideline were developed before the COVID-19 pandemic.

Recommendations

This guideline includes recommendations on:

Who is it for?

Healthcare professionals

Commissioners and providers of services

People with chronic primary pain and chronic secondary pain, their families and carers

Guideline development process
How we develop NICE guidelines
This guideline was commissioned by NICE and developed in partnership with the Royal College of Physicians (RCP).

Your responsibility

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

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Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain

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This guideline covers assessing all chronic pain (chronic primary pain, chronic secondary pain, or both) and managing chronic primary pain in people aged 16 years and over. Chronic primary pain is pain with no clear underlying cause, or pain (or its impact) that is out of proportion to any observable injury or disease.

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NHS North of England Care Systems Support (NECS) have developed a prescribing data elearning programme in conjunction with the Academic Health Science Network (AHSN) for the North East and North Cumbria. The elearning is accessible free of charge to all pharmacists, technicians, GPs and other  healthcare professionals through the NECS learning site.

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Chartered Society of Physiotherapy - resources for patients on self-management exercises

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Chartered Society of Physiotherapy - resources for patients on self-management exercises

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Physiotherapy helps people with long term (chronic) pain develop the skills they need to manage their condition, increase their activity and improve their quality of life. This webpage from the Chartered Society of Physiotherapy brings together resources for patients on self-management exercises.

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There are many steps you can take at home to manage your pain.

Below are a string of resources, backed by research, that are designed to support you in taking that action and helping you to ease your pain.

The resources contain information about the nature of your condition, practical advice for managing it and simple exercises you can do in your home to aid your recovery.

The advice has been compiled by NHS England, the Chartered Society of Physiotherapy, Versus Arthritis, Public Health England and the Arthritis and Musculoskeletal Alliance (ARMA).

Resources for pain management

Turning the Volume Down on Pain information leaflet, Body Logic

Understanding pain: What to do about it in less than 5 minutes (YouTube), Australian animation

Self Management education videos (YouTube), Pain Toolkit

Gentle chair yoga (YouTube), Developed by chronic pain therapists

Gentle yoga video (YouTube), Yoga with Adriene

Information and advice leaflets, Faculty of Pain Medicine of the Royal College of Anaesthetists

Information and advice leaflets on Opioids, Faculty of Pain Medicine of the Royal College of Anaesthetists

Keele pain recorder app, Jigsaw-E

My Live Well With Pain - an exceptional website for free pain management resources developed by NHS GPs, Psychologists, Pharmacists and Physiotherapists

Pain Concern - a charity working closely with include IASP and the UK pain societies that produces useful leaflets, podcasts and magazines for people with pain

The above self-management exercises can help you to manage your condition at home. The majority of musculoskeletal conditions get better within six to eight weeks although sometimes they can persist for longer but this doesn't mean there is something seriously wrong.

However, rarely, musculoskeletal symptoms can be caused by something more serious and it is important for you to know when to seek help. If you experience any of the following you should seek the advice of you GP.

the pain you are experiencing is getting worse rather than better despite following the self-management guidance above for the condition in the time frame expected.

symptoms have not been significantly helped by a trial of medication as expected.

you feel unwell and suffer symptom such as fever, night sweats or weight loss.

you experience pain at night, possibly worse than during the day that prevents you from sleeping due to increasing pain and/or difficulty lying flat.

you experience a change in your ability to walk including balance problems or weakness/heaviness in your legs.

you develop a hot and swollen joint for no apparent reason.

early morning stiffness, lasting for longer than 30 minutes.

new on-set severe headache.

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There are many steps you can take at home to manage your pain. Below are a string of resources, backed by research, that are designed to support you in taking that action and helping you to ease your pain.

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The Pain Toolkit is a simple information booklet that could provide you with some handy tips and skills to support you along the way to manage your pain.

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British Pain Society - People living with Pain

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British Pain Society - People living with Pain

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These pages provide information that may be of use to people living with pain, including a list of UK-based patient organisations, a frequently asked questions section and a suggested reading section

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People living with Pain | British Pain Society

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For the majority of people, attending a Pain Management Programme reduces the disability and distress caused by chronic pain by teaching physical, psychological and practical techniques to improve quality of life. It differs from other treatments provided in Pain Clinics in that pain relief is not the primary goal, although improvements in pain following participation in a Pain Management Programme have been demonstrated.

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NHS guide for patients - 10 ways to reduce pain

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NHS guide for patients - 10 ways to reduce pain

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Whether your pain has just come on or you've lived with it for years, these tried-and-tested self-help steps can bring you relief.

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Whether your pain has just come on or you've lived with it for years, these tried-and-tested self-help steps can bring you relief.

Get some gentle exercise

Simple, everyday activities like walking, swimming, gardening and dancing can ease some of the pain directly by blocking pain signals to the brain.

Activity also helps lessen pain by stretching stiff and tense muscles, ligaments and joints.

It's natural to be hesitant if exercise is painful and you're worried about doing more damage. But if you become more active gradually, it's unlikely you'll cause any damage or harm. The pain you feel when you start gentle exercise is because the muscles and joints are getting fitter.

In the long term, the benefits of exercise far outweigh any increase in pain.

Read more about exercise.

Breathe right to ease pain

Concentrating on your breathing when you're in pain can help.

When the pain is intense it's very easy to start taking shallow, rapid breaths, which can make you feel dizzy, anxious or panicked. Instead, breathe slowly and deeply.

This will help you to feel more in control and keep you relaxed and prevent any muscle tension or anxiety from making your pain worse.

Read books and leaflets on pain

The Pain Toolkit is a booklet packed with simple practical advice on how to live better with long-term pain.

The British Pain Society's website also has a number of booklets and patient information leaflets about managing pain.

Counselling can help with pain

Pain can make you tired, anxious, depressed and grumpy. This can make the pain even worse, making you fall into a downward spiral. Be kind to yourself.

Living with pain is not easy and you can be your own worst enemy by being stubborn, not pacing your activities every day and not accepting your limitations.

Some people find it useful to get help from a counsellor, psychologist or hypnotherapist to discover how to deal with their emotions in relation to their pain.

You can also find out more about getting therapy or counselling.

Distract yourself

Shift your attention on to something else so the pain is not the only thing on your mind. Get stuck into an activity that you enjoy or find stimulating. Many hobbies, like photography, sewing or knitting, are possible even when your mobility is restricted.

Share your story about pain

It can help to talk to someone else who has experienced similar pain themselves and understands what you're going through.

Pain Concern, Action on Pain, Versus Arthritis and BackCare all have telephone helplines manned by people with long-term pain, who can put you in touch with local patient support groups.

The healthtalk.org website also has videos of other people's experiences of pain.

The sleep cure for pain

Many people with long-term pain find it difficult to sleep at night. But it's important to try to stick to a normal sleep routine so you've got the best chance of sleeping through the night.

Sleep deprivation can also make pain worse. Go to bed at the same time each evening, and get up at a regular time in the morning and avoid taking naps in the day. If sleep problems persist, see a GP.

Pain Concern has produced a useful leaflet on getting a good night's sleep.

Take a course

Self management courses are free NHS-based training programmes for people who live with long-term chronic conditions such as arthritis and diabetes to develop new skills to manage their condition (and any related pain) better on a day-to-day basis.

Many people who have been on a self-management course say they take fewer painkillers afterwards.

The best examples are:

Keep in touch with friends and family

Do not let pain mean that you lose contact with people.

Keeping in touch with friends and family is good for your health and can help you feel much better. Try shorter visits, maybe more often, and if you cannot get out to visit people, phone a friend, invite a family member round for a tea or have a chat with your neighbour.

Aim to talk about anything other than your pain, even if other people want to talk about it.

Relax to beat pain

Practising relaxation techniques regularly can help to reduce persistent pain.

There are many types of relaxation techniques, varying from breathing exercises to types of meditation.

Ask a GP for advice in the first instance. There may be classes available locally or at your local hospital's pain clinic.

Read about the top 10 stress busters.

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Whether your pain has just come on or you've lived with it for years, these tried-and-tested self-help steps can bring you relief. Simple, everyday activities like walking, swimming, gardening and dancing can ease some of the pain directly by blocking pain signals to the brain.

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Video demonstration - Using the ePACT2 Opioid Prescribing Comparators dashboard

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Video demonstration - Using the 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’re here for you if you need help with challenges including drugs or alcohol, trouble with housing, domestic abuse, or your mental and physical wellbeing. Our services are free and confidential, and we'll never judge you.

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We understand that everybody's experience is different. When you come to one of our services, we will personalise your care to help you achieve your goals.

If you're concerned about something and you don't know what steps to take, we have lots of advice and information that can help.

We're here to help with life's challenges, whether it's problems with drinking or drugs, or you're just looking to live a happier and healthier life.

When you come to a service for the first time, a friendly member of the team will greet you. Feel free to bring a friend or family member with you for support.

If someone was nervous to go to a service I'd say 'don't be fearful. Even if you need help for other issues like housing, the workers will do everything they can.'

Danielle works at our Bromley service

Read Danielle's story

Through volunteering, I see something in my future. I know I can still make something out of my life. I can make a difference in someone else's life.

Jose volunteers with us

Read Jose's story

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We're a national health and social care charity. We can help you with challenges including drugs and alcohol, housing, justice, health and wellbeing.

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Humankind offers services covering drugs and alcohol, clinical services, housing related support, housing, employment, training and education, health and well-being, children, young people and families, women, criminal justice and community and offender rehabilitation.

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Free, confidential support for alcohol, drugs, housing or mental health in friendly local places

How we work

We work with you on your own goals, whether that's making small changes, stopping an unwanted habit altogether or just getting some advice

Your goals

Small changes

For fair chances

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

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Free, confidential support for alcohol, drugs, housing or mental health in friendly local places Your goals Small changes For fair chances We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. By clicking "Accept", you consent to the use of ALL the cookies.

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BBC News article with several patient stories

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BBC News article with several patient stories

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An exclusive survey of over 4,000 adults aged 16-75 for BBC News, carried out by research company Ipsos, suggests that a quarter of people in the UK are living with chronic pain - an often hidden and misunderstood condition.

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Chronic pain: The ‘unbearable’ condition affecting one in four

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Specialists warn the NHS is not set up to deal with such complex conditions.

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Louise Trewern has lived with pain since childhood. She was prescribed opioid medication for back pain, which increased over a 13 year period to dangerously high levels, along with a cocktail of other drugs such as antidepressants and benzodiazepines.

With support from her local pain service Louise reduced and eventually came off her opioids and learned to self-manage her pain in other ways. She considers that this process literally ‘saved her life.’

Read more in her blog.

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Opioids - My Experience

I thought it might be helpful for others if I wrote about how the side effects of opioids adversely affected my life!

I took opioid pain medication for around 13 years to treat the debilitating pain of Fibromyalgia and Osteoarthritis and initially they were brilliant, allowing me to go about my daily life again, work as a care assistant in a 40-bed nursing home and look after my four young children and home!

When I was given MST Continus I wasn't told how addictive it was, that if I stayed on it too long I would become poorly from the side effects or that my nervous system would become sensitised so that my pain would be worse than ever! If I had been I would not have taken them!!

It was over 16 years ago now and not all the evidence was available at that time!

Over time I began to develop strange health problems and notice existing conditions gradually worsen in severity!

I would suffer sudden severe pain in my chest, it would cause me to double up in agony, and even breathing would be painful. I remember one such occasion particularly well; I was preparing to have friends over for dinner and in the middle of cooking the meal, having been perfectly fine during that day, suddenly the pain struck and almost floored me, it literally took my breath away. I was determined not to let it spoil the evening and took a couple of paracetamol and carried on with the preparations. Over the course of the evening, the pain got much worse and was seriously affecting my breathing because I couldn't expand my diaphragm without excruciating pain. My friends collectively decided to call an ambulance, they were terrified and not at all convinced by my futile attempts to reassure them it would pass! The paramedics that attended suspected a heart attack and hooked me up to do a heart trace in the ambulance. Now I was terrified! The trace didn't detect anything out of the ordinary but in every other way, I was presenting as a heart attack victim if only mildly. I was given some gas and air for the pain on the journey to hospital where I spent two whole nights while they gave me a thorough check. They couldn't understand what was going on but it definitely wasn't a heart attack! Of course, I was relieved to hear this but it was a complete mystery. One that would be repeated several times during the thirteen years on opioids.

I would also suffer from the most hideous skin problems, I had a history of mild Hidradenitis Supurativa (boils) but it had always been mild and now they were much much worse and the pain from them was totally off the scale. Antibiotics wouldn't help at all and just make me feel worse. The doctor even tried a combination of antibiotics which helped a little but never got rid of it, they would be in my groin, under my armpits, under my breasts, on my shoulder blades, behind my ears and on the insides of my thighs! It was truly hideous and made me very depressed as if my pain wasn't bad enough already! This continued on and off throughout my time on opioids!

I would also have repeated chest infections that would linger on and on despite antibiotics and steroids. If I caught a cold I would be floored for at least a week whereas my friends may have been in bed for 24/48 hours. Then the after-effects of the cold would hang about for a few weeks. Often leading to an episode of sinusitis or a nasty cough.

At some point, I was switched from MST to OxyContin a synthetic morphine derivative tablet, with Oxynorm liquid for 'breakthrough pain'.

This is when I believe I began to get worse.

One of the biggest issues I had was with hyperalgesia which is an enhanced sensitivity to pain! It became so bad I could not tolerate the cat walking across my lap because the pain was unbelievable! I put this down to my Fibromyalgia worsening. If someone nudged me it felt more like a punch, if I got cold my body would tell me I was freezing! The same if I got hot.

Mouth infections was another one! I would have repeated episodes of oral thrush which was also extremely painful! My oral health was great so I could never understand why I kept getting this?

Painfully sore gums too and most bizarrely the dentist could not seem to numb me for dental treatment and would need twice as many injections as he would need for others!

Another dental phenomenon which didn't present until the last couple of years on opioids was how I would go to the dentist with pain and he couldn't find anything obvious so he would do an X-ray only to discover that the tooth (usually the big back teeth) had rotted from the inside out! He was left with no option but to remove the tooth! I lost 3 big back teeth in total! Then I was off the opioids and my dentist has worked incredibly hard to save the rest which I'm very grateful for!

I have since discovered that this is not uncommon in long term Opioid use!

Lack of sleep was a problem, I couldn't sleep at night but would end up needing to have an afternoon nap especially during the latter years of my Opioid use! I would doze off almost every time I sat down, in waiting rooms, in front of the TV, in company, even whilst on FaceTime calls with my grandson! That upset me greatly, my family just accepted that this was how it was for me. I was diagnosed with sleep apnoea a condition that meant I would stop breathing briefly during my sleep so I was given a C-Pap machine to use at night which required me to sleep with a mask on, connected by a long tube to a machine which supplied me with air delivered at a continuous pressure. I no longer have this since coming off opioids!

I had gradually put on more and more weight until I was a touch under 25 stone, I tried everything to lose weight and I now know it was never going to happen because I wasn't sleeping, I had become almost totally inactive and I was on a carrier bag full of medications!

Something that I feel is never discussed is the effect on a person's sex life! Opioids suppress the libido in both men and women, it's called Opioid-induced Sexual Dysfunction. It's so insidious that often you don't notice it, I believed for instance that my lack of interest was because I was in pain because I was tired, etc etc and that is often accepted and never questioned by either partner because why would you expect someone in so much pain and discomfort to be interested in sex? Actually there is no reason why someone living WELL with pain shouldn't absolutely expect to have a normal sex life!

The last and worst of all was the Opioid-induced impaction.... I could NOT have a poo, to put it bluntly! It came on suddenly one Friday night, I had not been having any difficulties going to the toilet, I was taking sachets of laxative every day to prevent constipation caused by opioids. I went up to the toilet and could not go, that was it, as simple as that, by the next day I was in agony, I had tried and tried but it just wouldn't happen, I had spoken to the out of hours duty doctor who prescribed more laxatives, nothing, the pain was gradually intensifying! By the middle of Saturday night my wife called an ambulance because I was crying and writhing in agony. A paramedic came and couldn't help but called the duty doctor who came out and called the district nurse to come out and administer an enema by which time it was Sunday morning, by Sunday night I was in so much pain my wife called another ambulance and I was taken to hospital with gas and air! On Monday I was taken into theatre where at last the problem was dealt with. I'm sure you can imagine the humiliation and massive distress this caused me! My wife was also distressed because she was powerless to help.

This happened to me TWICE!!!!

The pain, the emotional distress, the embarrassment I went through just added to my depression!

The theatre staff told me that I was not unique, it happens to many people who are taking opioids!

After the second time, I needed no further incentive to get off the opioids completely!

My life couldn't get any worse!

I am so pleased to report that quite quickly after coming off opioids all the weird health issues I had collected over the 13 years started to disappear totally and the ones I had originally before opioids have returned to being mild.

I know this all sounds very scary and believe me it was but it also has a very positive ending!

If you recognise any of this in yourself or someone you know please know that there is light at the end of the tunnel, stopping or reducing opioids could be the answer for you/them too!
Opioid Pain Medication MUST not be stopped suddenly! You MUST ALWAYS seek advice from a Doctor, Pharmacist, or other Prescriber before reducing or stopping.

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Opioids - My Experience | My Live Well With Pain

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I thought it might be helpful for others if I wrote about how the side effects of opioids adversely affected my life! I took opioid pain medication for around 13 years to treat the debilitating pain of Fibromyalgia and Osteoarthritis and initially they were brilliant, allowing me to go about my daily life again, work as a care assistant in a 40-bed nursing home and look after my four young children and home!

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Mark shares how opioids have affected his life and his experience of working with his Pharmacist to reduce his pain medication.

For more information, please visit: CROP - The Campaign to Reduce Opioid Prescribing - AHSN NENC (ahsn-nenc.org.uk)

Produced by AHSN NENC (North East & North Cumbria)

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Sean, from Cornwall, describes how he has found an alternative to opiod medication to help manage his chronic pain. This video is aimed at patients who are considering alternative options to medication for pain management. Find out more at https://www.nhs.uk/live-well/healthy-...

Video produced by NHS England and NHS Improvement South West

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Wharfedale, Airedale & Craven Alliance Social Prescribing Service

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Wharfedale, Airedale & Craven Alliance Social Prescribing Service

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Social Prescribing service for people in Wharfedale, Airedale and Craven

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Social Prescribing Service - Wharfedale Airedale & Craven Alliance

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Wharfedale Airedale & Craven Alliance Ltd

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As an original pioneer of the Social Prescribing model in Bradford, HALE now have over 15 years’ experience of delivering this service through our Community Connectors service

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To view our celebrations of National Social Prescribing Day in 2021, click here:

Social Prescribing empowers individuals to improve their health, wellbeing and social welfare by connecting them to non-medical support services, groups and activities within their community.

The Social Prescribing approach recognises that people's health is affected by a range of social, economic and environmental factors and that linking people in with their community is highly effective in reducing health inequalities within a local area. Our current model enables GPs, nurses and other medical professionals to refer people for local, personal, support within their community. Local voluntary organisations seeking support for an individual can support them to request a referral for themselves via their GP/ medical practice.

As an original pioneer of the Social Prescribing model in Bradford, HALE now have over 15 years' experience of delivering this service through our Community Connectors service, with several successful evaluations undertaken by Sheffield Hallam University.

HALEs Social Prescribing Services

Our HALE Community Connectors work with GP Practices to deliver Social Prescribing in the following areas:

Saltaire and Windhill, Idle, Cliffe Avenue Medical Practices.

Affinity Partnership Practices, including Shipley, Haigh Hall, North Street, Sunnybank, Thornton, Cowgill and Denholme, Westcliffe and the Willows.

Leylands, Heaton, Wrose, Ashwell, Hollins and The Manor Medical Practices

Each area has slightly different service offer, however referrals for all services are made directly through the GP Practice.

We also provide a social prescribing service to many GP practices in the central locality areas - known as CLICS - click on the link below for more information.

Working in partnership with the CCG, and funded through the Reducing Inequalities Funding for the central Bradford Locality area (PCN4,5,6)., CLICS is a new model intrinsically linked with Social Prescribing (PCN4,5,6).

Community Connectors work closely with GPs, Advanced Practitioners and practice based staff in the Central Locality to support individuals to link into community based assets such as groups, services and centres.

This service is delivered in partnership with the CCG and other voluntary organisations, namely The VCS Alliance, The Girlington Centre, The Thornbury Centre and Trident. Many central locality practices are supported under this new service, please contact us if you require further details.

At HALE we have an excellent track record of positive client feedback. This is once again evidenced in our second 2018/2019 evaluation where 96% of clients were 'satisfied with the support received' and 97% agreed that the Community Connector 'support received was tailored to their needs'.

What are Community Connectors?

HALE Community Connectors work with adults who may need some support and encouragement to access community activities or link in with local support services.

Many of the people we work with would like to make new friends, find out about local activities or get support for all kinds of issues. We often work with people who have suffered loss, have recently had a baby, are struggling with a medical condition or have moved to a new neighbourhood. They may be facing issues that have affected their confidence. We can help them take the first steps.

Note: We also have a young people's Social Prescribing service.

Community Connectors - how does it work?

Your GP Practice can make a referral for you to have a Community Connector. Once a referral has been received a HALE Community Connector (or a Community Connector from one of our partner organisations in the CLICS service) will make contact with you to explore what kind of support you may need and which services would be helpful. They will work with you to understand how best you can access this.

The Community Connector will find out about social activities that would interest you, and talk to you about the next steps and what is available to you through your GP Practice (as this varies).

This is a personalised service- we work with the needs and pace of each individual.

All services relating to Social Prescribing are free.

How will I be referred to a Community Connector?

Your GP and other staff at your medical practice can refer you to a Community Connector and provide you with some basic information about the service.

Once we receive your referral, one of our Community Connectors will get in touch with you to introduce themselves and arrange a first appointment to talk through any issues you would like help with.

Please click below to read some of the case studies and see the real difference HALE's Community Connectors have made to people's lives

You can read the impact and the difference HALE's Community Connectors have made in other case studies

If you would like to know more please contact us

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To view our celebrations of National Social Prescribing Day in 2021, click here: Social Prescribing empowers individuals to improve their health, wellbeing and social welfare by connecting them to non-medical support services, groups and activities within their community.

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Opportunities for arts and creativity, physical activity, healthy eating,  volunteering, mutual aid, befriending and self-help.
Support with, for example, employment, benefits, housing, debt, legal advice, or parenting problems; learning and education, for example English as a Second Language, literacy and numeracy, computing/ICT, skills for work; recovery and health condition management & self-management for example for people with substance misuse histories, enduring physical and mental health problems (e.g. diabetes, cardio vascular & respiratory conditions, mobility, depression, stress and anxiety); and bespoke support for specific groups e.g. female asylum seekers & refugees, homeless/at risk men

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Bevan Wellbeing Centre

We provide a wide range of additional non-medical services for our patients to help improve their health, wellbeing and to lead more fulfilled lives. The centre will serve as a local, community-based venue for Bevan and a range of partner organisations to engage and support people facing multiple and complex economic and social barriers in their lives.

Please take a look at the Services page to see what is currently on offer at the centre!

SERVICES

We provide a wide range of additional non-medical services for our patients to help improve their health, wellbeing and to lead more fulfilled lives.

VOLUNTEERING

Volunteers are important to Bevan Healthcare. Volunteering gives you an opportunity to make a difference to people's lives here in Bradford.

BEVAN HOUSE - BRADFORD

OPENING HOURS

Monday08:00 - 18:00

Tuesday08:00 - 18:00

Wednesday08:00 - 18:00 Closed - 1.30pm - 3.30pm

Thursday08:00 - 18:00

Friday08:00 - 18:00

SaturdayClosed

SundayClosed

BEVAN HOUSE - 01274 322400

YORK STREET - LEEDS

OPENING HOURS

Monday08:00 - 18:00

Tuesday08:00 - 18:00 Closed - 13:00 - 15:00

Wednesday08:00 - 18:00

Thursday08:00 - 18:00

Friday08:00 - 18:00

SaturdayClosed

SundayClosed

YORK STREET - 0113 295 4840

Monday09:00 - 16:30

Tuesday09:00 - 16:30

Wednesday09:00 - 13:30

Thursday09:00 - 18:00

Friday09:00 - 18:00

SaturdayClosed

SundayClosed

WELLBEING CENTRE - 01274 905323

Translate into Your Language >>

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Bevan Wellbeing Centre We provide a wide range of additional non-medical services for our patients to help improve their health, wellbeing and to lead more fulfilled lives. The centre will serve as a local, community-based venue for Bevan and a range of partner organisations to engage and support people facing multiple and complex economic and social barriers in their lives.

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Linking Leeds is an integrated, free city-wide Social Prescribing service for people in Leeds

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To make this video large, please click 'Watch on youtube'. You can also view subtitles by doing this. Please note this is taking you to a third party site that may contain adverts

Social Prescribing really works.

Social prescribing helps people to address concerns in their life that are having a negative effect on their physical and mental wellbeing. It could be debt problems, housing issues, loneliness.... or anything else. It's tailored to the individual and connects them to services that help them feel better and live healthier lives. Social isolation, emotional issues or wellbeing concerns can cause all sorts of conditions including anxiety, depression, stress and many more conditions.

By supporting people it can stop them even needing to visit a GP or go to A&E. This is great for the person and for the NHS!

We are funded by the NHS Leeds Clinical Commissioning Group which is dedicated to supporting the health of local people in Leeds. We work closely with our NHS partners and all the GP surgeries in Leeds.

Who Can Use Our Services?

Any resident of Leeds over 16, who is registered with a GP in the city.

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Linking Leeds - Social prescribing for practical or emotional problems

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To make this video large, please click 'Watch on youtube'. You can also view subtitles by doing this. Please note this is taking you to a third party site that may contain adverts Social prescribing helps people to address concerns in their life that are having a negative effect on their physical and mental wellbeing.

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One You Leeds is a free local healthy living service designed to support Leeds residents to start and maintain a healthy lifestyle

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When you stop smoking, good things start to happen

It's never too late to quit - stopping smoking brings immediate benefits to your physical and mental health.
Why not join Stoptober this year?
Research has shown that if you quit for 28 days, you're five times more likely to quit for good.

Get Started

We will help you succeed

There are two main ways to try quitting smoking.

One way is to stop completely. You set a quit date and stop altogether on this date.

The other way is to cut down. You set your quit date and then reduce the amount you smoke gradually until this date, and then you stop completely. Or you might reduce now and set a quit date when you feel more ready.

Whatever option you choose, we can help you. Here's how...

Stop completely with a Health Coach

We are up to three times more likely to succeed with specialist support.

You can join six sessions with an expert Health Coach in Leeds. They will use the latest, evidenced-based behavioural change support and medication to help you.

Your six sessions can be one-to-one or as part of a group of other people working towards the same goal.

As well as your support sessions, our service includes:

Carbon Monoxide (CO) breath tests to track the progress you are making

A course of free e-cigarette supplies

A course of free Nicotine Replacement Therapy (NRT) supplies

Access to support communities and regular check-ins to keep you going

Get Started

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Now is the best time to quit. Stop smoking is one of the best things we can do to improve our health. It's never too late to quit. Leeds Stop Smoking Services is helping people to succeed.

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Online directory of services, activities, opportunities & events across Wakefield District

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Community Wakefield

Find services, activities, opportunities & events across Wakefield District.

Find what you're looking for.

Together, for a happier, healthier Wakefield District.

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Community Wakefield Find services, activities, opportunities & events across Wakefield District. Find what you're looking for.

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Supporting healthy living for the people of Wakefield

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Supporting healthy living for the people of Wakefield

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UK wide searchable social prescribing directory

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"This is an excellent website. I am a Social Worker in a CMHT and tell everybody I work with about it."

"This site is wonderful - simple to use and full of great information, I wish there was one in every area!"

"Loving this app and look forward to using it and spreading to word to all my friends!"

"As a nurse its a brilliant guide for social prescribing"

"I thought this site was very useful, will definitely be sharing this with my team members."

"This has proved to be an valuable and useful resource for my tablet/smartphone learners around the Keighley District"

"I love the treacle site, cheerful as well as informative"

"This is an excellent website. I am a Social Worker in a CMHT and tell everybody I work with about it."

"This site is wonderful - simple to use and full of great information, I wish there was one in every area!"

"Loving this app and look forward to using it and spreading to word to all my friends!"

"As a nurse its a brilliant guide for social prescribing"

"I thought this site was very useful, will definitely be sharing this with my team members."

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"This is an excellent website. I am a Social Worker in a CMHT and tell everybody I work with about it." "This site is wonderful - simple to use and full of great information, I wish there was one in every area!"

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A structured approach to opioid prescribing

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A structured approach to opioid prescribing

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Online guides covering:
- Patient assessment
- Type of pain & timing of therapy
- The opioid trial
- Long term prescribing
- Tapering & stopping
- Dose equivalents & changing opioids
- Checklist for prescribers

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A structured approach to opioid prescribing

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Opioids Aware: A structured approach to opioids prescribing

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Patient assessment questions and considerations

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Patient assessment questions and considerations

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The experience of pain is complex and influenced by the degree of tissue injury, current mood, previous experience of pain and understanding of the cause and significance of pain. This outlines questions and considerations for effective conversations with patients about their pain.

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The experience of pain is complex and influenced by the degree of tissue injury, current mood, previous experience of pain and understanding of the cause and significance of pain. Previous unpleasant thoughts, emotions and experiences can also contribute to the current perception of pain and if unresolved, can act as a barrier to treatment. A full pain history should therefore include:

Description of pain

Where is the pain?

Does it radiate elsewhere?

What does the pain feel like (eg, aching, burning, stabbing)?

Does it vary in intensity?

What makes it worse?

What makes it better?

What is the effect on sleep?

What is the effect on mood?

What is the effect on physical function?

What is the effect on vocational/social function?

Current medications and response to drugs (it may be appropriate to continue non-opioid therapies which have been previously effective)

response to previous medications and other interventions including self-management strategies and alternative therapies (If opioids have previously been ineffective it is unlikely that offering an alternative opioid preparation will be helpful.)

physical health including operations and illnesses. NB some comorbidities such as renal or hepatic impairment and sleep apnoea, will influence the choice of drug, dose and safety of therapy

mental health including emotional trauma, previous and current mood, contact with mental health circumstances. Mental health comorbidities and a history of significant emotional trauma are not a contraindication to opioid therapy but:

- are a risk factor for opioid therapy becoming prolonged and for high doses to be used
- patients may use opioids to blunt unpleasant thoughts and experiences: this may make opioids difficult to stop
- are a risk factor for addiction to prescribed opioids
- will be contributory to the current pain experience soneed to be identified and managed separately

current or previous history of addiction to drugs or alcohol. Patients with a current or past history of addiction will need careful management and support in collaboration with specialists with expertise in addiction (for more information click here)

patient circumstances and context (employment, family responsibilities, sources of support). Patients with a family/household member with addiction will need additional support and counselling about risks of diversion of controlled drugs

patient's understanding of pain and expectations of outcome

pain assessment tools eg, VAS, Brief Pain Inventory, Leeds Neuropathic Pain Scale

relevant physical examination including observation of patient mobility, distress

imaging and other diagnostics (x-rays, scans, blood tests and electrophysiology)

Further Reading

Faculty of Pain Medicine. Conducting Quality Consultations in Pain Medicine. 2015.

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The experience of pain is complex and influenced by the degree of tissue injury, current mood, previous experience of pain and understanding of the cause and significance of pain. Previous unpleasant thoughts, emotions and experiences can also contribute to the current perception of pain and if unresolved, can act as a barrier to treatment.

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Downloadable resources from the Painkillers Don't Exist campaign including materials such as:
- Painkillers newsletter
- Leaflets (Physio, GP, Pharmacy)
- Animated social media graphics
- Posters (A3 & A4)
- Social media graphics
- Email footer
- GP plasma screen
- Ideas for social media posts
- Website title and banner

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Campaign resources - Painkillers Don't Exist

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There are FOUR main types of pain medication: paracetamol, non-steroidal anti-inflammatory drugs (NSAIDS) like ibuprofen, opioids that range in strength from codeine through to high dose examples like tramadol and morphine and other medicines such as anti-depressants and anti-epileptics. Each works in a different way.

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Live Well With Pain - Professional Tools

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Live Well With Pain - Professional Tools

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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.

These tried and tested techniques, developed and practised by health care professionals, will help you shift the conversation towards self care and guide the person you are supporting, to become a confident self manager of their pain.

Access all tools and resources completely free when you sign up.

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Professional tools - Live Well with Pain

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Live Well With Pain - 10 Footsteps programme

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Live Well With Pain - 10 Footsteps programme

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Ten Footsteps to Living Well with Pain is a step-by-step online guide to living well despite your persistent pain. It’s available – completely free – on the Live Well with Pain website.

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Ten Footsteps programme - Live Well with Pain

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Live Well With Pain - Self Management Skills

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Live Well With Pain - Self Management Skills

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Resources for patients covering pain self management skills including:
- Sleep
- Understanding pain
- Acceptance
- Getting active
- Pain medicines
- Relaxation

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Self management skills - Live Well with Pain

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Important information regarding the NHSBSA One Drug Database
The NHSBSA have combined their data sources into a One Drug Database (ODD). Please read this notice before using our data or visualisations.
Important changes to data

Introducing data and analysis

Using our visual analytics with hints and tips

Reporting timescales
Updates to our data work.
Read more >
Related

Data change log
Always current, a log which details changes, enhancements and changes made to the data.
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Tell us what you think
We're always looking for new ways to make our reports and systems shine. Whilst we try our best to validate our data to a high level, if you have any comments regarding any content below, please contact us with your feedback.

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Important information regarding the NHSBSA One Drug Database The NHSBSA have combined their data sources into a One Drug Database (ODD). Please read this notice before using our data or visualisations. Important changes to data Introducing data and analysis Using our visual analytics with hints and tips Reporting timescales Updates to our data work.

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University of Westminster - Making sense of Social Prescribing

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University of Westminster - Making sense of Social Prescribing

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Comprehensive but easy-to-read guide to Social Prescribing

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Royal College of GPs - eLearning module - Chronic pain in adults

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Royal College of GPs - eLearning module - Chronic pain in adults

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This e-learning module aims to educate GPs and other healthcare professionals (HCPs) about the physiology of pain, and how pain can become persistent.  It summarises the 2021 NICE guideline on chronic pain and gives practical advice about how the guideline can be applied to patient care

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Skip Intended for UK Health Care Professionals Only

Search results: 8

Time to complete this course:
30 minutes

Date of publication:
Jan 2022

This module aims to educate GPs and other healthcare professionals (HCPs) about the physiology of pain, and how pain can become persistent. It summarises the 2021 NICE guideline on chronic pain and gives practical advice about how the guideline can be applied to patient care.

An educational grant was received from Boston Scientific for the production of the course. Editorial and content decisions were made solely by the RCGP.

A fifty item online applied knowledge test, with questions sourced from the major updates, briefings and reference material found within Essential Knowledge Update 14, on topics including:

Vitamin D: Multiple Health Outcomes & Risk of Cause Specific Death

Prostate Cancer: Diagnosis & Treatment

Peripheral Arterial Disease

Management of Chronic Pain in Adults

A fifty item online applied knowledge test, with questions sourced from the major updates, briefings and reference material found within Essential Knowledge Update 15, on topics including:

Female Genital Mutilation

Atrial fibrillation & New Oral Anticoagulants in Patients with Atrial Fibrillation

Dyspepsia & Gastro‑oesophageal Reflux Disease

Asthma, COPD & Asthma-COPD Overlap Syndrome

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royal college of general practitioners - online learning environment : search results

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Royal College of General Practitioners - Online Learning Environment : Search results

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Skip Intended for UK Health Care Professionals Only Time to complete this course: 30 minutes Date of publication: Jan 2022 This module aims to educate GPs and other healthcare professionals (HCPs) about the physiology of pain, and how pain can become persistent.

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Faculty of Pain Medicine - Online guides to the clinical use of Opioids

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Faculty of Pain Medicine - Online guides to the clinical use of Opioids

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Online guides covering:
- Opioids & acute pain management
- Opioids for pain management in palliative care
- Opioids for long term pain
- Side effects of opioids
- Long term harms of opioids
- Current UK data on opioid misuse

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Faculty of Pain Medicine - Online guides to understanding pain

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Faculty of Pain Medicine - Online guides to understanding pain

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Online guides covering:
- About pain
- Challenges of long term pain management
- Assessment of long term pain
- The role of medications in pain management
- A stepped approach to pain prescribing
- Patient context

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About pain, challenges of long term pain management, assessment of long term pain, the role of medications in pain management, a stepped approach to pain prescribing, patient context

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Understanding Pain and Medicines for Pain

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About pain, challenges of long term pain management, assessment of long term pain, the role of medications in pain management, a stepped approach to pain prescribing, patient context

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Video - Understanding Pain: Brainman stops his opioids

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Video - Understanding Pain: Brainman stops his opioids

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2 minute video on the risks of opioids for chronic non-cancer pain

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Understanding Pain: Brainman stops his opioids

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Faculty of Pain Medicine - Patient Leaflet - Taking Opioids for Pain

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Faculty of Pain Medicine - Patient Leaflet - Taking Opioids for Pain

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Faculty of Pain Medicine - Patient Leaflet - Thinking about Opioid Treatment for Pain

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Faculty of Pain Medicine - Patient Leaflet - Thinking about Opioid Treatment for Pain

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Patient information leaflet covering considerations prior to starting opioids

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Faculty of Pain Medicine - Patient Leaflet - About Pain

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Faculty of Pain Medicine - Patient Leaflet - About Pain

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Patient information leaflet covering:
- Types of pain
- Treatments for different types of pain

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NHS Elect Guide to Measurement for Improvement

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NHS Elect Guide to Measurement for Improvement

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Measurement and analysis before, during and after any quality improvement project is essential. This guide connects measurement for improvement to the model for improvement and provides an overview on ‘how to’ measure to support quality improvement projects in health and care systems.

Includes:
- Patient flow: the context for your project
- About measurement for improvement
- Using the seven steps to measurement for improvement
- Run chart and statistical process control chart rules in practice
- Tools: further information and resources

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Groundswell chronic pain guide for people experiencing homelessness

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Groundswell chronic pain guide for people experiencing homelessness

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Chronic pain affects over half of all people experiencing homelessness. Physical pain can have a big effect on your life, but it can be managed. If you are experiencing physical pain, this guide is to help you think about your pain. You can write your answers to the questions in the boxes to help you focus on what makes a difference and then take steps to limit the impact.

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Painkillers Don’t Exist is an NHS campaign that aims to raise awareness of the dangerous effects of pain medication and empower people living with pain to make informed decisions about their health.

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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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Live Well with Pain was created by a small group of health care professionals in England working in pain management, using a self management approach with their patients. Seeing how successful it could be, they wanted to share their approach with more people.

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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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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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There are actually many ways to retrain your pain system, but they all begin with understanding your pain. In fact, understanding that pain is much more complex than a signal from damaged tissues is one of the best things you can do to start your journey to recovery - many people say that their pain began to reduce as soon as they understood it better.

The goal is to re-train your pain system back to providing protection when you need it, but not when you don't.

Start by developing an accurate understanding of your pain system and how it can become overly protective. This overly responsive pain system is the result of the amazing ability of all of our body systems to adapt. Sometimes when injured tissues heal, they don't look the same as they did before your injury - think of a scar from an old cut - but they can still adapt to being stronger and fitter and less painful.

Understanding is very important when it comes to pain because pain depends on what it means to you. If you can change the meaning of your pain, then you can change your pain!

Knowledge is power and really knowing that your system is overprotective, and really understanding that pain is affected by thoughts, feelings, moods, sayings - the list of things is just way too long - pain can be turned up by anything that can trigger a protection response and turned down by anything that makes your system feel safe. You might find that with understanding comes a renewed confidence to move - even when it hurts - and to nudge your system little by little.

Find a good coach. A good coach will help you understand your pain better and to identify the things that make your pain worse and things that make it better. A great coach, with training in pain science (you can ask your physio, OT, doctor or nurse if they have this), will teach you how to plan your recovery, one week at a time, and encourage you to persevere and 'train smart'. Remember your coach can guide you, but this is a journey that you have to take.

You can start without a coach too - moving just a little more than you normally would and doing something that lifts your heart rate - little by little - is actually the best way to train your system to be less protective. You might have to be patient - sometimes it is slow going and you can have set-backs - but remember pain is protecting you, not telling you that you have damaged yourself.

Being creative in managing your journey is likely to help. Our brains love to get new information or to be reminded of situations or activities that are full of safety messages.

Never forget that your brain is always looking out for you. Even thoughts and feelings, social interactions, and life's day-to-day events can powerfully influence your pain. Remember too, the trick is not to avoid all life's challenges but to retrain your system to cope with them.

Sounds challenging right? Well it is, which is why you might need some coaching. Take a long-term approach - this is a journey. You might have to teach your nearest and dearest about pain too - they might not realise it, but the way other people understand your pain, can affect your pain

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There are actually many ways to retrain your pain system, but they all begin with understanding your pain. In fact, understanding that pain is much more complex than a signal from damaged tissues is one of the best things you can do to start your journey to recovery - many people say that their pain began to reduce as soon as they understood it better.

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This document created by Dr Liz Mooney, GP based in St Helens, is designed to aid patients to make an informed decision regarding taking Opioid Medications. Includes info on:
- What are opioids?
- Why stop opioids?
- Side effects to opioids
- Driving and opioids
- Stopping opioids

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Every month, the NHS in England publishes anonymised data about the drugs prescribed by GPs. But the raw data files are large and unwieldy, with more than 700 million rows. OpenPrescribing makes it easier for GPs, managers and everyone to explore - supporting safer, more efficient prescribing.

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Every month, the NHS in England publishes anonymised data about the drugs prescribed by GPs. But the raw data files are large and unwieldy, with more than 700 million rows. We’re making it easier for GPs, managers and everyone to explore - supporting safer, more efficient prescribing.

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A free webinar training service to all ePACT2 users. You can book onto these sessions as many times as you need. Webinar sessions are 1 hour long and 5 different types of sessions are offered:
- Dashboards and Reports
- Building Analysis
- GP Practice User
- PCN User
- Hospital Trust User

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ePACT2 webinars We offer a free webinar training service to all ePACT2 users. You can book onto these sessions as many times as you need. Our webinar sessions are 1 hour long and we offer 5 different types of sessions. Use the booking form to select the session, date and time that suits you:

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Groups of guides to aid you in getting the most from ePACT2 depending on the type of organisation you are registered under

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ePACT2 online learning

This page features training guides and videos covering a range of ePACT2 topics.

Guides by organisation type

Groups of guides to aid you in getting the most from ePACT2 depending on the type of organisation you are registered under. Additional organisation groups will be added soon.

Functionality Guides

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ePACT2 online learning This page features training guides and videos covering a range of ePACT2 topics. Guides by organisation type Groups of guides to aid you in getting the most from ePACT2 depending on the type of organisation you are registered under. Additional organisation groups will be ad…

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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.