Lancashire Teaching Hospitals Services

Acute Pain

Acute pain is short-term and tends to be more associated with damage or possible damage to your body. For example, if you sprain your ankle it is likely you will feel pain associated with the bruising and swelling. This is acute pain. Usually it will settle as your body heals because the affected part no longer needs protecting. Healing usually takes less than three months, even for quite severe injuries.

Inpatient Acute Pain service

Our inpatient Pain Team service has daily rounds. The team includes pain consultants and specialist nurses in pain management. We routinely review patient post operative, major trauma and acute on chronic pain.

Common areas that require our support are critical care, major trauma gynae, surgical wards and A+E.

We also link with Pain Psychologists and Pain Physiotherapists when the clinical reason arises.

The pain management service

As a unit, we are able to offer a whole range of pain management strategies from pain management programmes to complex interventions like radiofrequency ablation, coeliac plexus block, splanchnic plexus block, lumbar sympathetic block, interventions for cancer patients, interventions for trigeminal neuralgia, and spinal cord stimulation for back pain, leg pain, neck and arm pain and complex regional pain syndrome.

We have an inpatient pain team which includes four specialist nurses and is led by a consultant with a special interest in acute pain. There is a daily ward round which is led by our nurses and is supported by three consultant led ward rounds per week. We usually have about 600 epidurals per year (excluding obstetrics).

Our pain centre has active ongoing research opportunities, and our pain team has a weekly education and research meeting with breakfast provided to focus on these opportunities. We have a collaborative research programme with the University of Central Lancashire which enables us to progress research opportunities. There are currently two industry funded studies going on and we are being looked at for participation in phase 1b studies too. We have excellent support from our NIHR Lancashire Clinical Research Facility; which is based at Preston Hospital to undertake these studies.

In 2014, our hospital was registered as a provisional endometriosis centre with the British Society for Gynaecology (BSGE). This means we provide multidisciplinary pain management for patients with endometriosis.

In 2018, we became one of the first hospitals to start a Rapid Access Pain Service (RAPS) to prevent hospital admissions of acute on chronic pain patients presenting to our emergency departments.

There is extensive cross-over and co-operation between our inpatient and outpatient pain teams. We have recently appointed a band 8 nurse lead to take both our inpatient and outpatient services forward. We also work closely with our colleagues in prosthetics, neurorehabilitation, oncology and palliative care. Preston Hospital hosts centres for major trauma, vascular surgery, cancer and neurosurgery, which gives us a wide, diverse caseload. We enjoy excellent relationships with our local general practitioners and CCGs and are very well supported in our work.

About the Team

We are a diverse and friendly team who are fully supportive of career development and flexible working patterns to ensure that our colleagues are happy at work.

Our team comprises a large, but friendly and inclusive team of individuals who have a wide range of subspecialist interests and are committed to providing the best care for our patients. We encourage our team members to develop an interest in fields of their choice so that they can develop their own career pathways and make the most of their opportunities.

We are also a forward looking team and are committed to research and service development.

Consultants

Click on a consultant to see more information.

Dr Emma Baird

Consultant Anaesthetist and Clinical Lead for Inpatient Pain

Dr Parag Desai

Deputy Clinical Director and Consultant in Anaesthesia and Pain Medicine

Dr Nicholas Hacking

Consultant Anaesthetist and Lead for Pain Medicine

Dr Arumugam Pitchiah

Consultant Anaesthetist and Clinical Lead for Governance and Risk

Professor Shiva Tripathi

Consultant Anaesthetist and Consultant in Pain Medicine

Dr Rajesh Kumar

Associate Consultant for Pain Medicine

Dr Kaushal Mishra

Consultant Anaesthetist, Consultant in Pain Medicine and Clinical Director for The Pain Management Service

Our Team

Pain Management Team photo wide

Lancashire Teaching Hospitals NHS Foundation Trust is celebrating an incredible 40 years of pain services with a day of celebratory and informative events.

Pain services have now been in existence for 40 years across both Royal Preston Hospital and Chorley District Hospital and see up to 2000 new patients annually. As the regional pain unit, Lancashire Teaching Hospitals deliver more consultant-led clinical sessions in pain medicine than any other hospital in the North West region.

The pain service at Lancashire Teaching Hospitals was started by Dr Ray Consiglio who ran the whole service on his own at the time. The first labour epidural was done in the hospitals in 1981. The service and the team have now developed and grown to include eight consultants, three chronic pain nurse specialists, four inpatient nurse specialists, two psychologists, two physiotherapists, two healthcare assistants, and six secretaries making up the team.

The pain service has gone from strength to strength during this time; helping patients to recover from and manage their pain. In 1990, the acute pain service was introduced to provide additional support for patients during their time in the hospitals. Subsequently a pain management programme was developed to help people to live with chronic pain by helping them to learn ways of dealing with the effects of their pain. Multi-disciplinary team clinics were then introduced to provide additional support to patient dealing with pain from an array of specialties including psychologists and physiotherapists. The team are also now getting more and more involved in research and clinical trials to improve outcomes for pain patients in the future.

The pain department has got an active research programme. There are number of academic and industry sponsored studies going on currently. Lancashire Teaching Hospitals are the first in Lancashire to participate in a phase 1, industry sponsored, lower back pain study. The hospitals have also been selected as the only site in the UK to start a first in human (FIH) study into lower back pain.

Additionally, in 2014, Lancashire Teaching Hospitals was registered as a provisional endometriosis centre by the British Society for Gynaecology (BSGE), providing multidisciplinary pain management for patients with endometriosis, which can affect areas such as the ovaries and fallopian tube, and can be a difficult condition to live with.

In 2018, Lancashire Teaching Hospitals also became one of the first hospitals to start a Rapid Access Pain Service (RAPS) to prevent hospital admissions of acute on chronic pain patients presenting to the emergency departments, and making sure they received the best treatment and care for them.

The pain team at Lancashire Teaching Hospitals are continuously striving to establish excellent working relationships with partners in the community, surrounding hospitals and the clinical commissioning groups (CCGs). The team has also got excellent links with the GPs in and around Preston and Chorley.

To celebrate these achievements and how much the pain service has developed and grown over the past 40 years, a celebratory day will be held at Preston Hospital. The celebratory day will take place on Friday 7^th June with staff from the pain department and the executive team at Lancashire Teaching Hospitals, and professionals from across the pain industry in attendance. The day will include a range of presentations on the evolution of pain services over the last 40 years, the use of apps and digital technology in pain management, and the future of pain medicine. This will culminate in a celebratory dinner for all of the staff who have made the pain service what it is today at Lancashire Teaching Hospitals.

The multi-disciplinary pain management team members

Pain Consultants in Pain Medicine

Pain Consultants in Pain Medicine who take overall responsibility for your care and treatment plan.

Clinical Psychologist

Clinical Psychologists specialise in the psychological and social aspects of pain management. Their aim is to support people to develop ways of living well with and alongside their pain symptoms, using a range of therapy models and techniques

Clinical Nurse Specialist

Clinical Nurses Specialist who specialise in the assessment and treatment of inpatient and persistent pain patients.

Specialist Physiotherapists

Specialist Physiotherapists who specialise in movement and managing the impact of persistent pain. Our physiotherapists specialise in analysing movement and helping patients function better physically

Pain Management Admin Team

Our Pain Management Secretaries are responsible for managing the waiting lists, booking outpatient appointments, intervention clinics (pain management procedures) where injections take place and writing letters and organising the service.

Operational Team

Business managers are responsible for planning and supporting service delivery including budget management working closely stakeholders and primary care

The Patient Management Service Philosophy

Our Pain Management Service supports people living with persistent long-term pain. Our philosophy is help you to ‘live your best life’, even though this may be in the presence of pain. For the majority of our patients pain is an ongoing condition which they are gradually coming to terms with.

Unfortunately we are rarely able to cure pain, but we hope to reduce its impact on peoples’ lives and we hope to help make the reduce the impact the pain has on your quality of life.

At Lancashire Teaching Hospitals we provide both outpatient and inpatient pain management services.

Our Inpatient Pain Services comprises of daily ward rounds. Reviewing patient patients who have been admitted to both Royal Preston Hospital and Chorley District Hospital with acute pain management needs following surgery or a trauma or an acute flare of their persistent pain.

Persistent or Chronic Pain

Many of us have experienced pain from time to time. This usually goes away on its own or gets better with time and this is known as acute pain (short term). However, sometimes pain can become long standing and this is known as persistent pain or chronic pain.

Pain is considered persistent when it has lasted for more than three months or has lasted beyond the expected healing time. Sometimes pain nerves can start to send pain signals to the brain even when there is no injury, damage, danger or inflammation. The brain then continues to send signals that trigger the real feeling of pain.

Musculoskeletal pain affects bones, joints, ligaments, tendons or muscles. An injury such as a fracture may cause sudden, severe pain. A persistent condition like arthritis may also cause pain.

How to access our OPD service

Referrals

Patients are referred via their GP / Primary Care Providers

Patients may be referred from other consultant specialities

Initial assessment:

Patients who are referred to our service by GP or other consultant will be offered an appointment after completing a number of questionnaires (electronically or by post)

You will received questionnaires which will ask questions about your pain, previous treatment that you have received and how your pain affects you on a daily basis. This information is vital to help our team get an overall picture about you, your pain and how this impacts on your lifestyle.

The link for this is not yet ready - Link to completing Medicus questionnaire – video

First appointment what to accept

The team will offer you the most appropriate first appointment. This will be either with the MDT or with a consultant in pain medicine. At this appointment you will be assessed and treatment options will be discussed

What treatments our outpatient (OPD) service provides

Medication review:

You may be prescribed different tablets or a combination of tablets. Some of these are conventional analgesics that will reduce pain and some are from other groups of medicines that can reduce pain in certain conditions or make conventional analgesics work more efficiently. We have Consultant and Clinical Nurse Specialist led clinics where your medication may be reviewed and managed safely.

Multi Disciplinary Clinics (MDT)

MDT Clinics are undertaken by different members of the pain management team including one of our Pain Consultants, Clinical Nurse Specialist, Clinical Psychologists and Specialist Physiotherapist.

Transcutaneous Electrical Nerve Stimulator (TENS)

A TENS is a small battery powered nerve stimulator which can reduce some pains and help control symptoms. If this is recommended for you we will offer you the opportunity to attend a nurse lead clinic and offered a trial.

Injections

Certain pain conditions respond well to specific injections. These are generally performed in the pain procedure room to reduce risk of infections.

Radio Frequency

If appropriate Radio Frequency facet joint nerve ablation may be offered and this involves heating up the small nerves that supply facet joints of the vertebrae. Similar procedures can be also carried out close to other specific nerves.

Self Acupuncture

Self acupuncture may a suitable treatment option for you and if appropriate this will be discussed with you.

What we provide

Neuromodulation (spinal cord stimulation)

Neuromodulation can be useful for some patients and is similar to an internal TENS machine. This is also called a ‘Spinal cord stimulator’ or sometimes a ‘Dorsal Column stimulator’.

If you are suitable you would undergo a trial to determine if this would be helpful and if successful you would be referred to the neurosurgeons who would insert a permanent implant to treat persistent pain. Electrodes can be implanted next to nerves or the spinal cord so pain pathways can be stimulated.

Specialist pain physiotherapy

Our Physiotherapist are specialist in movement and together with you will aim to improve your confidence and ability to be active. The cycle of pain and inactivity can lead to reduced fitness levels and have implications on your general health and wellbeing.

Specialist pain psychology

Persistent pain can have a major impact on your quality of life and like many people you may find it difficult to cope at times. Coping with persistent pain is stressful and can increase physical and mental tension. Unfortunately this extra stress can aggravate your pain and increase muscle tension and cause unhelpful reactions that make dealing with pain and other life problems more difficult. Their aim is to support people to develop ways of living well with and alongside their pain symptoms, using a range of therapy models and techniques.

Pain Management Programme: PMP.

The group pain management programme we offer is called IMPACT. This is 8 week course which aims to help you learn new ways of managing every day activities through pain management skills. The delivered by a team of clinical psychologist and physiotherapist. IMPACT gives the confidence to manage and skills to manage your pain yourself. Currently we run a fact to face and virtual courses.

What can I do?

There are a lot of things you can do to help yourself and have a better life even with chronic pain. Often simple changes can often make a big difference to the amount of disability and suffering you can experience. This is called pain management.

To help manage your pain, you might want to consider:

Planning your day - Make a plan of things to do and places to be to help you keep on top of your pain
Pacing yourself - Don’t push through the pain, stop before it gets worse then go back to whatever you were doing later
Learning to relax - Relaxing can be hard when you have pain but finding something which relaxes you will reduce the stress of pain.
Taking regular enjoyable exercise - Even a small amount of exercise will make you feel better and ease your pain. It will also keep your muscles and joints strong.
Taking pain medicine - Pain medicines work better alongside a plan. Patients often say their pain medicines don’t seem to work very well.
Talking to others - Tell your friends and family about chronic pain and why you need to do things differently.
Enjoyment - Doing things you enjoy boosts your own natural painkillers. Think about what you enjoyed before the pain and introduce it back into your routine.

Managing flare-ups

People with persistent pain often have times when their pain has increased significantly and they are able to do less. This is often called a flare up and can last up to few hours or possibly last a few days. Flare-ups are a difficult but normal part of living with persistent pain.

There are many reasons why a flare up will occur such as overdoing things, being generally unwell, stress or changes in medications.

There are many strategies to help you cope with flare ups including relaxation and mindfulness.

Other strategies include moving regularly which is good for our joints and muscles and can reduce or prevent stiffness to joints and muscles.

Using a TENS Machine

Other simple tools to help such as heat or cold.

Take your medications as prescribed.

Back pain red flags

Any combination or a number of the following warning signs could be a symptoms of cauda equina syndrome. In this case you need to seek urgent medical review.

If you have problems with back pain please be aware of the following. If you develop any of the following symptoms you should go to Urgent Care / A&E immediately: