Barnsley Pain Management Service Review 2023/24

Many people struggle with long-term pain but help from the NHS and other pain services can help to lessen the pain, improve independence, and help cope in general.

You may have a painful diagnosed condition such as arthritis or diabetes nerve pain or you may have a painful condition that medical science doesn't fully understand, such as long-term back pain.

There are two main types of pain.

• Acute pain, also known as short-term pain, is pain that has started recently.
• Chronic, or long-term pain, is pain that has lasted for three months or more.

If you have short-term (acute) pain, your GP will try to make a diagnosis and treat the pain.

If you have chronic/long-term pain it might be as a result of a diagnosed medical condition, a painful condition that is not yet fully understood or no underlying condition at all. This doesn't mean you don't have pain, but it does mean that a different approach to managing that pain might be helpful such as a referral to a pain management clinic/ service. (Information courtesy of NHS online).

Most people in Barnsley access pain management clinics at a number of places, including local hospitals (including Sheffield and Doncaster) or a community-based service, although some patients do travel further afield, and some also access services online. 

At all of these places, the pain management service will have teams of staff from different medical areas, including occupational therapists, psychologists, doctors, nurses, and physiotherapists. They all work together to help people with pain.

Pain clinic treatments vary but usually offer a variety of treatments aimed at relieving long term pain, such as painkilling drugs; injections; Acupuncture and Cognitive Behavioural Therapy (CBT).

Patients can be referred to a pain clinic by their GP or some other NHS professionals.

We want to make sure the treatments provided to Barnsley people are up to date with current clinical and national guidance. To do this, we are required to regularly review services offered in Barnsley.

Key to this review was for us to gain views and feedback from the people who are accessing these types of services as well as the people who both deliver and refer into them. The more examples and feedback we can get, the better we can ensure that future services meet the needs of the local people accessing them.

During July and August 2023, two separate surveys were used to gather the thoughts and experiences of patients, carers and the professionals who deliver and refer into local pain managements services. These were made available online and also as paper copies. We also conducted telephone interviews with individuals and arranged an online focus group with the aim to gain views and feedback from people living with chronic pain in Barnsley.

The patient/ carer survey was primarily shared via the Connect Health Pain Management Service in Barnsley with their current Barnsley patients (approx. 50 people), and this was also shared via local partners via the following routes.

• Via the Barnsley Involvement and Equality Leads Group
• Via the Barnsley GP Practice Bulletin
• Via local service leads
• Via a South Yorkshire Suicide Prevention, Long Term Conditions, and Chronic Pain Workshop held on 21 July.
• Via a dedicated pain management workshop session for healthcare professionals held on 3 August

Partners were asked to share the information regarding the review along with both survey links with their relevant internal and external networks. 

Connect Health also kindly obtained the consent and contact details from seven patients who agreed for us to contact them to carry out a 1:1 interview over the telephone and we also had three people sign up to attend an online focus session held on Thursday 3 August via MS Teams.  Unfortunately, due to unforeseen circumstances only one person was able to join the focus session on the day and therefore this was changed to a 1:1 interview instead. 

Additional to the above, a dedicated pain management workshop session for healthcare professionals was held on 3 August.  This was held in person at Hillder House, Barnsley and colleagues were also given the option to link into this session virtually.

In total we received feedback from twelve individuals from a patient perspective.  We had nine completed patient surveys (five of the survey responses included feedback collected via dedicated 1:1 telephone interviews) and feedback from a further three people has been collated separately but themed alongside the completed survey responses.

In relation to the professional’s survey, a total of twenty-five completed surveys were filled in and returned to us online. Ten colleagues attended the workshop session held at Hillder House on 3 August and five colleagues linked into this virtually.  

A 1:1 online feedback session was also offered and conducted by the commissioning lead for this review with the appropriate local service leads and provider colleagues to enable them to feedback where they were unable to attend the workshop session.

In summary, the findings from the engagement with patient and professionals identified the following key themes:

1. ​​​The patients we heard feedback from felt if a dedicated pain management service was not an option, their GPs would not be able to support them effectively and that they did not think that there would be an effective service to support them if the pain management service did not exist in some form.
2. The people we heard from wanted it to be made clear about the need for wider healthcare professionals to better understand and acknowledge the complexities for people living with chronic pain and the importance for them of coming to terms with and finding collective solutions alongside professionals for them to be able to deal with and manage both the physical and mental health impacts of living with long term chronic pain more effectively. 
3. Patients felt services need to be better integrated than they are currently as they seem very disjointed making it difficult to navigate and know what is available. People want to know what services/support is available to them and how, where and when this can be accessed.
4. People want to be listened to and feel ‘heard’ by clinicians and that services are connected and effectively communicate with one other to avoid them having to repeat their story over and over again.    
5. A significant number of the patients we heard feedback from did not want to go down a medication route wherever possible due to the potential harm caused by various further debilitating side effects. They would prefer wherever possible to explore a more holistic route to their pain management with a discharge plan in place to wider support services available.
6. Psychological support was essential in order to enable the person to come to terms with their condition, the nature of this and how this would impact their life. Being given the tools to help them manage this to ensure they could live their best life possible was seen as being vital as was the ongoing support. 
7. Many of the people we spoke with described the sense of grief they had felt about ‘their old life’ before living with chronic pain and the impact that this had on their relationships and lives and the need for effective support to help them to come to terms with their new normal.  A number of people had lost their jobs as a result of their condition or had been forced into early retirement and the people who were in this position highlighted how difficult this had been to come to terms with and the impact that this had on their mental and emotional health. 
8. A number of people praised the team from the current service provider for helping them come to terms with this aspect of living with chronic pain and almost ‘giving them the permission they needed to grieve their life before living with chronic pain’
9. People want access to self-help groups and a range of different types of support as there is not a one size fits all approach.  Self-help digital and face to face groups are helping people and whilst some people preferred 1:1 support other people preferred group/ peer support sessions and the ability to attend in person but also virtually.
10. There is currently no integrated chronic pain management pathway and services are mostly working in silo.  
11. There is a culture that people’s needs are too complex for current services to manage or are not suitable for their services. 
12. The expectation from some patients is often that medication will help to resolve the pain and managing this narrative needs to be changed.
13. Some people were unaware of the commissioned specialist pain management service, and some did not gain the outcome they expected if they do attend.  
14. Some existing services e.g., Talking therapies, additional roles within primary care; Working Win etc could potentially provide additional help to manage people’s needs if specialist training was provided for handling chronic pain.