Education sessions lead to reduction in waiting lists for people with long-term pain

Waiting lists for people living with long-term pain have been reduced thanks to innovative pain education sessions implemented by the Persistent Pain Service (PPS).

Persistent pain, which is often incurable, affects approximately 20% of people in the country, according to the Welsh Government.

Already long lists for PPS initial assessments and Pain Management Programmes (PMPs) were exacerbated during the COVID-19 pandemic, as the service remained open to new referrals despite the majority of PPS staff being redeployed to other roles.

The PPS, working with Medicines Management (MM) and with the support of GPs, has developed an education session in which persistent pain self-management strategies are shared, and support available from the PPS, including one-to-one therapies, medication reviews, injection interventions and PMPs are offered.

This approach has contributed to a reduction in the PPS waiting times for first appointment, from 63 weeks to 33 over a 12-month period.

Clinical Psychologist Nick Brace said: “In many circumstances, mechanisms of persistent pain are very different from our general understanding of how pain works. Contemporary evidence base for the management of persistent pain conditions emphasises the importance of people being able to live well with their condition, much as they would be encouraged to live well with things like diabetes. Holistic support from a range of professions including medical staff, psychologists, physiotherapists, pharmacists, occupational therapists and nurses can help people who are understandably finding their situation challenging.

“Key to improving care has been the development of co-produced pain management plans, which means we improve the fit between what people want from the service and what can reasonably be offered. The requirement for face-to-face contact after the pandemic has also become clear in consultation with a range of stakeholders.

"A well thought-out pain management plan, developed together, helps people better understand how the PPS can support them to self-manage their pain. In the first instance, people are helped to make an informed decision regarding which part of the service they wish to access first.

“Having developed the initial education session, we have found significant reduction on PPS waiting times, improvements in efficiency of staff time, reduction of non-attenders to follow-up appointments, and better informed and shared decision making with people who have persistent pain.”

The sessions, an alternative to waiting for 1:1 initial appointment, are provided by PPS staff in individual primary care clusters, bringing care closer to home, in line with Welsh Government and Health Board strategy.

Occupational Therapist Portia Barry said: “Persistent pain can affect all aspects of someone’s life. Often activities that people may have once taken for granted can become more difficult to manage.

“As a service our focus is on supporting people to live well with the challenges of persistent pain rather than the elimination of the pain itself.

“During the cluster information sessions we explain pain and talk about how a supported self-management approach can help. We provide some initial advice, for example ways of managing daily activities without exacerbating pain and how to exercise safely. 

People are often unaware of the options available, so we explain that the service offers support in a number of ways, be that individual therapy including psychology, physiotherapy, occupational therapy or attendance at a group Pain Management Programme.

Having attended the session, of the options available, people are invited to decide with which healthcare professional or part of the service they would like to have an appointment.

“A benefit of these information sessions is that it introduces the idea of self-management and when people are waiting for their next appointment they can start to put into practice some of the ideas discussed during the session."

Despite improved relationships with primary care leading to an increase in referrals to the service from an average of 200 to 250 referrals per month, waiting lists for a first appointment continue to reduce.

Portia added: “The session has an informal feel and is two hours long, although we are available afterwards as well if people want to speak to us.

“The decision-making is shared but it is led by the patient. It is multi-disciplinary working,  and the structure of the session has changed following feedback. 

“It has been working well. People tell us they are surprised they have been seen so quickly, and most importantly they feel more confident about how they can move forward in managing their pain.”

Pictured: Some of the Persistent Pain team at the Living Our Values Awards