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?
A pain clinic is a clinic staffed by multiple medical professionals who specialise in diagnosing, treating and helping patients to manage their pain. You may attend an outpatient or inpatient programme.
- Outpatient pain management clinics
Rather than staying in hospital, you will attend the clinic regularly, perhaps once a week for a set number of weeks. You may stay at the clinic for a whole day or for several hours depending on the clinic. These are more commonly used than inpatient clinics.
- Inpatient pain management clinics: If you are referred to an inpatient clinic you will stay in a hospital setting for three to four weeks for a more intensive pain management programme.
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
While what is offered at pain management clinics can vary depending on where you live, they all share the same goals:
- Providing pain science education
- Giving you the tools to better manage your pain
- Helping you to increase your level of functioning
- Reducing pain symptoms
- Increasing confidence
- Giving you more control of your life and your condition
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.
When you first attend the pain clinic, you will have an initial consultation with a doctor. They will chat to you about your pain to establish things like:
- How long the pain has been affecting you
- Which areas of your body are painful
- How the pain affects your functioning
- How you’re sleeping, eating and exercising
- What support you have at home
- Whether you already have a diagnosis for your pain
- How you cope with your pain currently
- If you’re on any medications
- If you have any other health issues
You may be given a physical examination by the doctor. This usually entails them using their hands to put gentle pressure on specific areas of the body, or moving specific parts of your body. They will ask you how the pain feels and how severe it is while they do, while also looking for swelling and other symptoms.
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
Typically, there will be a wide range of medical professionals at the clinic including:
- Doctors/ Primary Care Physicians (PCPs)
- Occupational Therapists (OTs)
- Psychical Therapists (PTs)
- Nurse practitioners (NPs)
- Psychologists/ psychotherapists
There are a wide range of potential treatments you may engage in as part of your pain management treatment plan. For some people it may be trial and error to find the treatments that work for them. For others they may see results more quickly from one approach.
It’s all about figuring out what helps each individual, treating them as a whole person rather than just focusing on one specific part of their body. It’s likely you will be engaging in more than one treatment and seeing more than one specialist within the clinic.
Doctors or nurses will discuss with you any current medications and potential medications that you could take to relieve your symptoms. They will typically talk to you about the side effects of each option and how you can take them safely. Medications that may be discussed include:
- Pain killers: these can range from over the counter options like paracetamol to stronger prescribed medications.
- Anti inflammatories: these provide relief from inflammation as well as reducing pain. Some may be over the counter while others may be prescribed. They may be non-steroidal anti inflammatories (NSAIDS) or corticosteroids.
- Anti-convulsants: thought to block pain messages, anti-convulsants may be prescribed to try and control your pain.
- Anti-depressants: as well as dealing with the mental health problems that often accompany chronic pain, anti-depressants are understood to interrupt pain messages
- Muscle relaxants: these are sometimes prescribed to ease tense muscles and provide some relief.
Topical medication: creams or gels which interrupt pain messages for a short period of time when applied to the affected area can be used. Patches which you stick onto your skin and which release a steady dose of medication, such as a lidocaine patch, can bring some relief as explained here.
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.
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.
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”
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.”
An occupational therapist will talk to you about your daily routine and your environment both at home and if you are working, in the workplace. They will help you to find ways that you can make day to day tasks easier for yourself, in order to reduce the chance of flaring and increase your level of functioning.
You may see a dietitian or nutritionist who will advise you on how to form healthy eating habits. A healthy diet helps your immune system to function, aids in general physical and mental health, and helps you maintain your weight.
Depending on the clinic, sometimes other treatments like massage therapy, acupuncture, hydrotherapy and chiropractic treatment may be offered.
- Massage therapy: a professional masseur will talk to you about which areas of your body are painful and provide a massage to loosen tense muscles and provide some pain relief.
- Acupuncture: very fine needles are inserted into specific areas of the body to stimulate the body’s natural pain-relieving chemicals to be released.
- Hydrotherapy: exercising in a pool of warm water can take weight off your joints and make exercising less painful Working against the water during movement can also help to build muscle strength.
- Chiropractic treatment: A chiropractor will use their hands to manipulate specific areas of the body to release muscle tension and relieve pain.
While attending a pain management clinic can feel worrying at first, the reality is that these clinics are safe places filled with medical professionals who can give you the skills and tools you need to get your life back! You might also like to check out our pain therapy app (download links below). It can be used alone, or in conjunction with your treatment at a pain clinic.
- Merkes M, (2010), “Mindfulness-based stress reduction for people with chronic diseases.”
- Physical Therapy, Volume 94, Issue 12, Pages 1816–1825, Kara E. Hannibal, Mark D. Bishop (2014), “Chronic Stress, Cortisol Dysfunction, and Pain: A Psychoneuroendocrine Rationale for Stress Management in Pain Rehabilitation “
- Spine: Volume 27, Issue 22, p 2564-2573, McCracken, Lance M., PhD; Turk, Dennis C., PhD, (2002), “Behavioral and Cognitive–Behavioral Treatment for Chronic Pain: Outcome, Predictors of Outcome, and Treatment Process”
- Pain Medicine, Volume 13, Issue 7, Pages 861–867, Lance M. McCracken, PhD, Rosie Jones, BSc (2012), “Treatment for Chronic Pain for Adults in the Seventh and Eighth Decades of Life: A Preliminary Study of Acceptance and Commitment Therapy (ACT)”
- International Journal of Health Sciences, Vol. 2, No. 3, pp. 33-45,Adriaan Louw, Emilio J Puentedura, (2014), “Therapeutic Neuroscience Education, Pain, Physiotherapy and the Pain Neuromatrix”
- NHS (2017), “Chiropractic”
- NHS, (2019), “Acupuncture”
- Versus Arthritis, (2018), “Hydrotherapy”
- Practical Pain Management, Volume 11, Issue 6, Forest Tennant, MD, DrPH, (2012), “A Diet for Patients With Chronic Pain”
- Practical Pain Management, Elizabeth Michaelson Monaghan, (2019), “Your First Visit to a Pain Clinic”
- Practical Pain Management, Forest Tennant, MD, DrPH, (2019), “Medications for Chronic Pain”
Please note: This article is made available for educational purposes only, not to provide personal medical advice.