Humber NHS Foundation Trust
Humber Community Pain Service
Humber Community Pain Service
Humber Community Pain Service is a new community based service that treats patients with moderate impact pain including people living with back pain and those experiencing anxiety and depression associated with their pain. Its highly skilled multi-professional core team undertake assessments and deliver individual care management plans with the client. The service welcomes <referrals> from GPs in Hull and the East Riding and Hullâ&#x20AC;&#x2122;s community musculoskeletal service PhysioHull.
Humber NHS Foundation Trust
Effective self-control and pain management
Specialist physiotherapists, occupational therapists and psychologists in pain management
Direct referral links to secondary care
Step down care
Community based
Links with employment support services
Partnership approach
Individual care management plans
Humber Community Pain Service
Our experience Humber NHS Foundation Trust has continuing experience of piloting and consolidating community pain services within the East Riding. The Trust provides a community pain service in Bridlington with a multi-professional team consisting of occupational therapists, nurse practitioners, pain management physiotherapists, psychologists and medical specialists. Members of our clinical team there have ongoing clinical input into the Centre for Pain Medicine at Castle Hill Hospital and work closely with secondary care providers. Patient feedback suggests the Bridlington clients are highly satisfied with the group pain programme and that it has led to clinical improvements in self-efficacy.
The Service Humber Community Pain Serviceâ&#x20AC;&#x2122;s highly skilled multi-professional core team undertake assessments and deliver individual care management plans with the client. Each client will have a key worker who stays with them throughout the care pathway, this is usually the team member whose professional remit most closely matches the patientâ&#x20AC;&#x2122;s needs. The team also run a number of group work programmes. To support patients fully with a truly holistic service, we will work with internal and external service providers and utilise local and national resources that will help our clients achieve their goals. Our aim is to support clients to manage their own pain through knowledge, empowerment, ownership, change and action. Contact with local and national resources will be encouraged as part of a clientâ&#x20AC;&#x2122;s agreed package of care and the resource information made available to clients during the course of their initial assessment interview.
Pain rehabilitation group work programme The pain rehabilitation group work programme is a pivotal part of the service that focuses on the provision of information for self-care. It is is based on cognitive behavioural principles to support and empower patients to self-manage their condition. The patient joins a group of patients with similar problems who work together in a supportive, empathetic and encouraging environment. This helps them develop appropriate skills in goal setting, pacing, movement and exercise, relaxation skills and challenging negative thinking processes.
Humber NHS Foundation Trust
Pain Management Plan The pain management plan is a supported, home-based programme based on cognitive behavioural principles for patients unable to access the group programme. The patient will be supported by their key worker in setting goals, keeping weekly plans and recording progress. The plan contains an easy to use workbook and relaxation CD. This plan is already being used successfully within the Bridlington Community Pain Service.
Humber Community Pain Service
Care Pathway Tier 1 mild impact pain that can be managed in primary care and the support and intervention carried out by other community services such as PhysioHull and East Riding MSK services.
Tier 2 moderate impact pain â&#x20AC;&#x201C; these are the patients ideally suited for the Humber Community Pain Service.
Tier 3 severe impact pain â&#x20AC;&#x201C; interventions that could be delivered in secondary care specialist services such as rheumatology and neurology.
Humber NHS Foundation Trust
Humber Community Pain Service
Humber NHS Foundation Trust
Tier 3 Severe Impact Pain
Patient with emerging long term pain condition. pain > 3/12
Tier 2 Moderate Impact Pain
Tier 1 Mild Impact Pain
Other Services GP, other clinicians, PT/ OT, Physio Direct
Single Point of Access to Community Pain Service admin and clinical triage
• • • •
Review by key worker
Patient to complete preassessment paperwork
Self reporting Health Needs assessment baseline questionnaire The Pain Self- Efficacy Questionnaire (Nicholas 2006) The Hospital Anxiety and Depression Scale The Pain Disability Questionnaire (Anagnostis et al 2004)
Secondary Care Services Specialist Pain Service Neurology
Other community or MH services: IAPT / Health Trainers / NCT / MSK / Chronic fatigue service
Key Worker Allocation Community Pain Service. MDT Assessment by a member of the team within 4 weeks of referral.
As Required: 1:1 Intervention by appropriate Team member
Referral outward bound with review as necessary by key worker at any point in the pathway
Group session intervention offered to all patients led by members of the core team and a health trainer. 5 Sessions of 1 hrs duration or Pain Management Programme with key worker
Access to other self care options: gym and leisure centres e.g. exercise on prescription, expert patient programmes, health trainers, smoking cessation, the benefits agency, job centre, social services, library resources, local patient support groups, alternative therapies
Discharge with plan Maintenance programme review by key worker
Humber Community Pain Service
Humber NHS Foundation Trust
Client outcomes: • • • • •
Quantifiable improvements in patient’s perception of their pain Taking effective self-control of their condition A reduction in the use of medication More use of effective use of medication Self-reported levels of functional gain
Our core team of pain management specialists Patients can access one to one interventions with members of the whole team that includes:
Specialist physiotherapist in pain management
Specialist psychologist in pain management
For joint mobilisation, periarticular and intraarticular corticosteroid injection of the peripheral joints (not spinal), TENS, trigger point acupuncture, core stability exercise programme, postural advice and management.
In-depth assessment of issues requiring specialist psychological intervention. Signposting towards services providing intervention and/or support i.e. Single Point of Access, MIND and other support networks. Providing short-term psychological intervention including training in self-hypnosis, cognitive behavioural and mindfulness approaches and individual evidence-based brief therapy approaches including health coaching. Support with personal self-care management programme. Support with personal pain management plan.
Specialist occupational therapist in pain management For assessment and provision of aids and adaptations, support and signposting to relevant benefits, employment agencies, training opportunities and introduction of one off relaxation techniques. Support with personal self-care management programme. Facilitation on the group pain management programmes and one to one pain management plan.
Humber Community Pain Service
Humber NHS Foundation Trust
Other members of our team involved in management and treatment include: Medical Clinician
When and where are patients seen?
Mentor for the core team, review diagnosis, medicine management, trigger point injections and assessment of further specialist intervention as required.
Patients are seen at one of our clinics across Hull and the East Riding of Yorkshire and can choose the clinic nearest to them.
Pharmacist For review of medicine management and adherence to non-specialist analgesia algorithm in a cost effective way. Recommending and/or prescribing medicines.
Health Trainer To provide personal support and motivation to clients to help them lead a healthier lifestyle. Put clients in touch with local services, community groups, support and self-help groups.
Humber Community Pain Service
Our pain service is available at clinics across Hull and the East Riding of Yorkshire
Humber NHS Foundation Trust
Refer to Community Pain Service Hull: GPs and PhysioHull can refer into the service
East Riding: GPs can refer into the service Choose & Book, SystmOne or paper/fax referral.
All referrals go through administrative and then clinical triage. Patients invited for an appointment will receive a pain management information pack which includes a number of pre-assessment questionnaires and information on pain and pain management.
Hull
Humber Community Pain Service Central Booking Office East Riding Community Hospital Swinemoor Lane Beverley HU17 0FA Tel. 01482 478886 or 0800 7314483 Fax. 01482 478887