When you are first referred to a pain management clinic, you may be concerned about what exactly will happen there. Don’t worry, we’ve got you covered. This guide will take you through all the details, to ease your worries and set you up to make the most of your appointments.

What is a pain management clinic?

Why you’ve been referred

If you have chronic pain, meaning pain that has lasted for over three months, your doctor may refer you to a pain clinic. If your pain is significantly affecting your life and daily functioning, you are more likely to be referred. You may be referred with or without a diagnosis for your chronic pain.

Depending on where you live and the services available, you may be placed on a waiting list to attend a pain management clinic. For some people, seeking out pain management clinics privately may be a feasible option.

The goals of a pain management clinic

Before you attend

Once you’ve been referred to the pain clinic it’s a great idea to start monitoring your symptoms and writing them down. This can help the medical professionals at the pain clinic to get a clear idea on how your pain affects you and therefore how to help you.

Try to write down everything that you can think of about your pain in short, easy-to-read, bullet points. Keeping a pain diary can help you start to notice any patterns.

Sometimes it can be a little bit nerve-wracking when you’re attending a medical appointment in a new place with new people. Writing down things that you want to ask to ensure you don’t forget can be a good idea. You may be able to take someone with you for emotional support; it’s a good idea to double check this before you go.

You will get a letter to inform you of where you are going and what to take with you. Take any current medications with you, even if they’re over the counter, so that the doctors can get as clear a view as possible of your situation.

While they may already have your medical records, it’s a good idea to take any scans or medical letters you have along with you.

Planning out how you are going to get there, whether someone is taking you, if you’re driving or taking public transport for example, can ease nerves and ensure that you are there in plenty of time.

If you’re going to an inpatient programme, you will be provided with a list of items you need to take with you and details on how long you will be there.

Initial consultation

From there you may be given a series of tests, particularly if you don’t already have a diagnosis. This could involve blood tests, Xray’s, MRIs, ultrasounds and so on, according to your symptoms. Depending on the clinic, these tests may be done at the first appointment, or you may be given an appointment at a later date to attend a hospital or separate medical facility to get the tests.

During your first consultation it’s important that you are open and honest with the doctor or nurse, so that they can get as full and accurate a picture of your pain as possible. If you’re worried about anything, remember that they are human just like you. Ask them questions and talk to them about how you are feeling.

What happens next?

After your first appointment and the results of any tests, the team of medical professionals at the pain management clinic will consult with each other. They may call you or send out a letter to give you your next appointment.

At your next appointment you may be given a diagnosis if you do not already have one; this is often a preliminary or working diagnosis. This simply means it’s what they think your diagnosis is but they will continue to monitor you and update it if needed.

From there they will discuss a treatment plan with you. Your treatment will be individual to you, to tackle your symptoms, help you manage your pain and increase your daily functioning.

You will usually go on to attend the pain clinic for a set number of weeks, agreed upon by you and your doctor. You will be guided throughout your treatment plan, seeing the appropriate specialists and being given exercises to practice at home.

A range of medical professionals

Potential treatments

Remember to always ask questions about any medication you are prescribed. Many have side effects and it’s important that you consider all of these before adding any new medication to your daily routine.

If you are still unsure after leaving the pain clinic, you can always do more research on medications online. Ensuring you are making the best choices for you is important.

Pain relief injections

Some clinics may offer various types of pain injections which block the pain messages from the nerves, or which provide painkillers in a more concentrated way in a specific painful area. This can sound scary, but some people can find it very effective. Always speak up if you are worried

Transcutaneous Electrical Nerve Stimulation (TENS)

You may be offered a TENS machine and shown how to use it. Usually you will be allowed to take this home with you. It can sound a bit worrying but it’s just a small machine with sticky pads that you place on certain areas of your body.

The machine releases a small electric current to interrupt pain messages. You are in charge of the strength of the signals and the intensity of the pulses the machine sends out, so you can do what is comfortable for you. It doesn’t feel painful; it tends to feel like a pulsing or tingling sensation.

Therapeutic Neuroscience Education (TNE)

You may have individual or group sessions of pain education. These sessions will teach you the science behind what causes pain, both acute and chronic, including how the body processes pain. By learning about pain science, you can understand what is going on within your body, replacing uncertainty with knowledge and fear with confidence.

This study explains how big a difference TNE can make for pain patients, having a positive influence by, “easing pain, decreasing disability and pain catastrophization, increasing physical movements and increasing adherence to therapeutic treatments such as exercise.”

Group talking therapy

Group therapies usually involve you sitting around in a circle or in a classroom setting. You may be asked to talk about your feelings, being there to support and guide one another. Sometimes finding support from others who understand what you are going through can be valuable.

The doctor or nurse who leads the session may ask you to engage in group activities to help you learn more about your pain and learn management strategies you can utilize at home. Sometimes a pain expert will provide a lecture on pain science and the latest management techniques.

Physiotherapy

Deconditioning through avoidance of movement is common within those with chronic pain, which can lead to muscles being weakened and pain increasing. Sessions with a physiotherapist will involve them guiding you through exercises to strengthen your body and teach you how to move your body with confidence without making your symptoms flare.

Exercise

Often pain patients become fearful of exercise, worrying that it is going to worsen their pain; this can become fear avoidance, and is detrimental to patients. During a pain clinic, exercise may be engaged in in various forms. It may be incorporated into other therapies; it may be done in a group setting or individually. There may be exercise classes such as yoga and stretching which teach you how to exercise safely with support from medical professionals. You can then use these tools at home to start exercising more regularly.

Cognitive Behavioural Therapy (CBT)

CBT will be delivered by a psychologist or psychotherapist, either in a group or individual setting. CBT focuses on replacing negative thoughts and the associated unhealthy behaviours, with positive thoughts and behaviours that will lessen pain. This study concluded that CBT, “reduces patients’ pain, distress, and pain behavior, and improves their daily functioning.”

Acceptance and Commitment Therapy (ACT)

ACT focuses on accepting your pain and your present situation, as well as learning that negative thoughts do not need to lead to unhelpful behaviours. ACT teaches you to commit to changing pain-creating behaviours and in turn, managing your pain more effectively. This study found that participants who engaged in ACT showed, “significant improvements in physical disability, psychosocial disability, and depression”

Mindfulness

Stress is proven to worsen chronic pain and fuel it as this study explains, “Ultimately, a prolonged or exaggerated stress response may perpetuate cortisol dysfunction, widespread inflammation, and pain”. Mindfulness can reduce stress and therefore pain.

During a pain clinic, mindfulness may be integrated into other therapies or may be done as separate classes. You may be led in guided meditations, yoga or breathing exercises for example. The skills you learn will enable you to incorporate mindfulness into your daily life, even with things like getting dressed or taking a bath.

Mindfulness based stress reduction (MBSR) is commonly used, which combines meditation and mindfulness exercises with stress reduction techniques to break the stress and pain cycle. This study explains that, “Participation in an MBSR program is likely to result in coping better with symptoms, improved overall well-being and quality of life, and enhanced health outcomes.”

References