Group Pain Consultations

GROUP PAIN CONSULTATIONS at CENTRAL SURGERY

The next meetings are Thursday 27th February 2020, then Thursdays 5th, 12th, 19th and 26th March 2020.

You can book by contacting our Pain Administrator Dorothy Mulvain at the surgery – phone 01914554621 or email centralsurgery.enquiries@nhs.net. Book promptly!

WHO IS THIS FOR?

This is a group meeting to help and support people with chronic or persistent pain.

Chronic or persistent pain is as defined as “pain lasting more than 3 months that does not respond well to medication.”

Most people with chronic or persistent pain are on or have tried opiate medication such as codeine, tramadol, morphine or oxycodone and ‘nerve pain modifiers such as gabapentin or pregabalin.

WHO WILL THE GROUP DO?

Chronic pain is a long-term condition where education, building networks, teaching practical skills and building care plans can make a difference; that has been our experience from running two preliminary pain groups at three different GP practices.

  • It is a group of 15-18 patients with chronic or persistent pain led by a facilitator and lasting about an hour and a half to two hours.
  • The group leader will introduce the group which will look at a video about ‘What chronic pain is and what you can do about it,’ then the leader will help the group to set an agenda or list of questions that they want to look at. This may be about alternative ways of managing pain, reducing medication and pain-related issues.
  • The group leader, a pharmacist or a GP will answer group questions, present information and describe approaches that help self-care, making lifestyle changes and reducing medication.
  • At the end of the meeting, the pharmacist or GP prescriber will visit the group to make  a ‘pit-stop’– for those patients who want to alter their treatment on the day.
  • All patients will sign a confidentiality agreement as people’s personal medical histories may be discussed in the meeting.
  • This is NOT a normal GP, pharmacist or nurse appointment; if you want to talk at length about your pain or treatment then you will need to make a separate pharmacist or GP appointment.
  • These consultation ‘pit-stops’ will be managed by the group leader or an admin person from the practice.

DOES IT WORK?

This is a new venture for us, but the evidence is that this type of group work helps people to manage their pain better. The agenda will be set by you but we also have useful information to share. Many of those that attended a previous group have reduced, stopped or changed their pain medication or taken up new ways of managing their pain.

This is not a ‘magic bullet’ for managing your chronic pain but it could help you to feel more in control of your pain and make a big difference to your life.

Quick Resource Guide

The practice pain site is at painnet.org.

There is some brilliant stuff here about pain and links to several helping sources or organisations.

  • LEAFLETS and a lot more on this site http://my.livewellwithpain.co.
  • ESCAPE-PAIN: A programme for people who it’s knee and hip pain (Over 55). More details 0191 4566903.
  • BLISSABILITY: A programme (any age) that helps people with chronic illness and pain. Ring: 0191 4271666
  • LIFECYCLE – Talking therapy: helps with anxiety, stress, depression and coping with pain. Tel: 0191 2832937
  • PHYSIOTHERAPY: Can be helpful in managing musculoskeletal pain and pain management. Tel 0191 6531072

Central Surgery, South Shields NE34 7QD.

Tel: 0191 455 4621. Web:centralsurgerysouthshields.nhs.uk

 

Why do I have persistent pain?

Pain is complicated. It’s partly due to damage in nerves, muscles and other tissues, but pain can continue even when the damage repairs. We think that the mind has a big part to play and learns to continue the pain, rather like the ‘phantom’ pain someone has after an amputated leg; the leg has gone but the mind still registers the pain. We also know those other things that ‘prey on our mind,’ such as family pressures, illness, anxiety, depression, past experiences of injury and poor sleep ‘dial-up’ our pain rather than ‘dial it down. Understanding this helps to look at other things to reduce chronic or persistent pain.

Have a look at the brilliant video about persistent pain on our patient site PAINNET.ORG

 

Information leaflets

Information leaflets

These leaflets are used by Central Surgery. The first is about opiates such as high dose codeine (30mg), tramadol, morphine, oxycodone and fentanyl. The second is about ‘nerve-pain’ modifiers such as amitriptyline, gabapentin, pregabalin, fluoxetine and carbamazepine.

Opiate medication information leaflet

PATIENT INFORMATION: OPIATE MEDICATION

What is an opiate?

An opiate is a medicine related to morphine. These include weaker opiates such as codeine 15mg and stronger opiates such as Codeine 30mg, Tramadol, Morphine sulphate (Zomorph), Oxycodone (Oxynorm) and Fentanyl. This leaflet is about ‘stronger’ opiates.

What’s the problem with opiates?

They only work in about 20 % of people with non-cancer pain – 80% of people do not benefit.

Your GP will only prescribe an opiate  as a trial of 2 weeks.  If not working it will stop.

You might also want to look at other ‘non-drug treatments. For example, you might want to join one of the GP Practice run pain management or reduction groups – ask the receptionist about these.

What are the side effects?

Side effects are common.

Common:Dry mouth (50% of people), constipation (20-40%), sweating (35%), confusion or sleepiness (14-29%), weight gain (29%), sleep problems (26%), reduced sex drive (25%) and memory loss (24%).

Less common:Risk of falls and fracture, mood changes, emotional ‘flatness,’ increased pain and immune and heart and lung systems affected. The death rate for people on high dose opiates (over 120mg of morphine or 60mg of oxycodone) is 5 x that of someone not on an opiate.

Other consequences: Tolerance – your body gets used to it so it loses its effect. Dependence – withdrawal symptoms when doses missed (shaking, sweats, tummy pains). Drug seeking behaviour – overusing and asking for more. Ask your GP for help if you feel you are dependant and want to reduce your opiates.

What conditions areapproved for having a trial of an opiate?

  • Cancer or palliative (end of life) pain
  • Pre or post operative surgery pain – limited to 2-8 weeks’ maximum
  • Severe back or joint pain – short term but for no more than 1-4 wks. Repeat long term prescribing is unlikely to be continued. 

What conditions are NOT approved for having a trial of an opiate?

  • Fibromyalgia
  • Simple back or other muscle, joint or bone pain
  • Sciatica – there are approved other better medicines
  • Neurological pain – ‘nerve’ pain
  • Pain of unknown origin

Assessment for a trial of an opiate will cover;

  • Your risks of being dependant
  • Potentials side effects and interactions with other medications
  • Agree when you return to review it’s impact
  • They will agree a stop date if not working
  • You will sign a contract which talks about length of prescription, review and stopping
  • They will continue as part of plan that includes what else you can do to reduce your pain.

What else can I do to reduce my pain and increase my mobility

  • VIDEO AND LINKS: on our website PAINNET.ORG
  • LEAFLETS and a lot lot more on this brilliant site http://my.livewellwithpain.co.
  • ESCAPE-PAIN: A programme for people who it’s knee and hip pain (Over 55). More details 0191 4566903.
  • BLISSABILITY: A programme (any age) that helps people with chronic illness and pain. Ring: 0191 4271666
  • LIFECYCLE – Talking therapy: helps with anxiety, stress, depression and coping with pain. Tel: 0191 2832937
  • PHYSIOTHERAPY: Can be helpful in managing musculoskeletal pain and pain management. Tel 0191 6531072
  • PAIN GROUP: If you would like to attend one of our pain groups talk to a receptionist

Rules about regular opiate prescriptions

  • Do not ask for a repeat of your opiate medication unless that has been agreed as part of your management plan
  • Opiate prescriptions – there are controlled drugs and only issue in monthly amounts
  • The maximum about of morphine that we now prescribe (total daily dose) is 120mg, for oxycodone it is 60mg.

Written by Central Surgery’s ‘Pain Team:’ Dr Gallagher, Dr Tose and Mr. Urwin (pharmacist)    10.12.18

‘Nerve-pain’ modifier patient information leaflet

PATIENT INFORMATION: ‘NERVE PAIN’- MODIFIERS’

What is a ‘nerve pain’-modifier?

A ‘nerve pain’-modifieris a medicine that can help ‘nerve pain.’ This includes amitriptyline, gabapentin, pregabalin, duloxetine and carbamazepine.

What’s the problem with these medicines?

They only work in about 20-30 % of people – 70-80% of people do not benefit.

Your GP will only prescribe as a trial of up to 4 weeks.  If it is not working it will stop.

You might also want to look at other ‘non-drug treatments. For example, you might want to join one of the GP Practice run pain management or reduction groups – ask the receptionist about these.

What are the side effects?

Side effects are common.

Amitriptyline:Nausea or vomiting, Drowsiness or tiredness, Nightmares, Excessive sweating, Weakness, Headaches, Dry mouth, Constipation. More details – https://www.drugs.com/sfx/amitriptyline-side-effects.html

Gabapentin and Pregabalin:Common:headaches, feeling sleepy, tired or dizzy, diarrhoea, mood changes, feeling sick, swollen hands, arms, legs and feet, blurred vision, for men, difficulties with getting an erection, weight gain, memory problems More details – https://www.drugs.com/sfx/pregabalin-side-effects.html

Rare but serious: thoughts of harming or killing yourself – a small number of people taking pregabalin have had suicidal thoughts that can happen after only a week of treatment, difficulties breathing, severe dizziness or you pass out, hallucinations (seeing or hearing things that aren’t real) problems going to the toilet, including blood in your pee, needing to pee more often, constipation.

Duloxetine: Common: Nausea, Dry mouth, Sleepiness, Fatigue, Constipation, Loss of appetite, Sweating.

Rare but serious: thoughts of harming or killing yourself – a small number of people taking pregabalin have had suicidal thoughts that can happen after only a week of treatment, aggression, irritability, panic attacks, turning ‘yellow’ (jaundice), lip swelling, rashes, dependence – we are not sure how this happens but a withdrawal symptoms can happen (sweats, irritability, tummy pains)

What conditions areapproved for having a trial of ‘nerve-pain’ modifer?

  • Diabetes – all meds except carbamazepine
  • Sciatica – there is debate about using gabapentin here
  • Neurological nerve pain e.g. MS
  • Shingles pain – amitriptyline first
  • Trigeminal neuralgia – the best choice is carbamazepine which is rarely used 

What conditions MAY NOT benefit from having a trial of a ‘nerve pain’-modifier?

  • Fibromyalgia – only 10% of people get a reduction in pain with gabapentin and pregabalin – amitriptyline can help sleep
  • Simple back or other muscle, joint or bone pain
  • Pain of unknown origin

Assessment for a trial of an opiate will cover;

  • Your risks of being dependant
  • Potentials side effects and interactions with other medications – some of these medicines have lots of interactions especially duloxetine
  • Agree when you return to review it’s impact
  • They will agree a stop date if not working
  • They may continue as part of plan that includes what else you can do to reduce your pain.

What else can I do to reduce my pain and increase my mobility

  • VIDEO AND LINKS: on our website PAINNET.ORG
  • LEAFLETS and a lot lot more on this brilliant site http://my.livewellwithpain.co.
  • ESCAPE-PAIN: A programme for people who it’s knee and hip pain (Over 55). More details 0191 4566903.
  • BLISSABILITY: A programme (any age) that helps people with chronic illness and pain. Ring: 0191 4271666
  • LIFECYCLE – Talking therapy: helps with anxiety, stress, depression and coping with pain. Tel: 0191 2832937
  • PHYSIOTHERAPY: Can be helpful in managing musculoskeletal pain and pain management. Tel 0191 6531072
  • PAIN GROUP: If you would like to attend one of our pain groups talk to a receptionist

Rules about regular prescriptions

  • Do not ask for a repeat of nerve-pain medication unless that has been agreed as part of your management plan
  • Gabapentin and Pregabalin: from 1stApril 2019 these are controlled drugs and only issued in monthly amounts
  • Gabapentin and Pregabalin: If you are on this long-term you will need a yearly review. Often at this stage the dose can be reduced.

Written by Central Surgery’s ‘Pain Team:’ Dr Gallagher, Dr Tose and Mr. Urwin (pharmacist)    10.12.18

 

 

 

Self help resources for patients

Self help resources for patients

One of the best sources of help for patients and professionals is at ‘Live well with Pain.

The website and resources were developed in North Tyneside and my patients have found these to be extremely helpful in thinking about what ‘Persistent Pain’ is and how we can ‘dial down’ the impact it is having on our lives.

I would suggest that you explore the site and some of the links on it. You might want to print out something that applies to you that you can discuss with your GP.

One of the problems is that some GPs are not good about talking about persistent pain, but we are working with them to try and improve their knowledge and skills.

 

Dr Morris Gallagher

PS: Look at the short video on pain on the front page of this blog for a quick summary of the latest thinking – and action – that can help you live better with persistent pain. 

WELCOME

WELCOME

This is a trial site. It is intended for people living and working in South Tyneside, but is is publicly viewable.

The purpose of the site is to equip people with resources to help manage persistent pain. In the future it may host a forum for people with pain.

If you are interested in contributing to this site email me .

Dr Morris Gallagher

Central Surgery, Sough Shields