Persistent pain is complicated and we don’t fully understand why some people develop persistent long term pain and others do not.

Persistent pain is often due to a combination of factors, these include:

• A chronic condition, such as osteoarthritis
• An initial injury – most injuries heal after three months.
• Increased sensitivity of the nervous system. The nervous system becomes so sensitive that it reacts quicker and needs fewer stimuli to generate a painful response.  Pain often extends beyond the initial injury or site of pain because joining nerves also become stimulated and don’t turn off. Normal movement can become painful
• Pain often causes a change in activity level and how we move –  this often leads to stiffer and more painful joints and muscles, which can contribute to pain.
• Pain can causes low mood, anxiety, anger, stress, weight gain, lack of sleep, all of these factors then increase pain, increase the sensitivity of the nervous system and affect our ability to cope with the pain.

Persistent pain management involves looking at all of the factors that contribute to your pain.

Constantly trying to fight or ‘push through’ the pain and  delaying things until the pain subsides leads to reduced activity and increased frustration.

Find out more by accessing The Pain Toolkit or looking at this guidance from the Institute for Chronic Pain.

Taking more control often involves changing behaviour and attitudes. Trying to identify what needs to be changed and where to start can be difficult. The Leeds Community Pain Service can support you, and this may involve the steps below:

• Deciding what you want to change – you will choose what you need to change with our support and guidance
• Identifying the benefits and barriers to change
• Planning how you will make the change.
• Maintaining the change

 Atomic Habits by James Clear Video

People who have pain will often reduce their levels of exercise but we know that inactivity actually leads to increased weakness, tiredness and muscle pain. For most people, getting fitter and moving more can improve the quality of their life.

It is important to know how to get active effectively. Some people can get stuck in a pattern of pushing through the pain, doing too much and then having to rest for too long. This often leads to increased flare ups of pain and an overall reduction in activity levels.

Getting the right balance can be difficult especially if you have a family and work commitments.

We will work with you to identify your usual activity level and how this can be managed.

Useful links for moving more and getting healthier

• NHS fitness studio 
• One You Leeds stop smoking
• Advice on specific musculoskeletal (MSK) conditions such as frozen shoulder, tennis elbow and arthritis of hip and knee
• NHS Couch to 5k
• NHS strength and flex exercise 5 week plan
• Linking Leeds to find local activities

Strong emotions like low mood, depression, negative thoughts and anxiety can make the sensation of pain worse. Negative thoughts can lead to:

• Constantly thinking about your pain
• Escalating fear of the cause of your pain
• Reduced ability to cope with your pain
• Increased sensitivity of the nervous system
• A spiral of negative thoughts
• Feelings of hopelessness
• Increased pain

Managing mood is an essential part of pain management.

Useful Links for managing your mood

Anxiety management

Online courses on anxiety and stress can be accessed via the Leeds Mental Wellbeing Service website

Anxiety

Social Anxiety

Stress management

Online courses on stress management can be accessed via the Leeds Mental Wellbeing Service website

Stress

Stress – Every Mind Matters

Leeds MindWell stress information

Depression and low mood

Online courses on low mood and depression can be accessed via the Leeds Mental Wellbeing Service website

Depression and low mood

Leeds MindWell information and resources for managing depression

Panic attacks links

Panic Attacks

Online courses on panic attacks can be accessed on the Leeds Mental Wellbeing Service website 

Bereavement 

Bereavement

Online video courses on bereavement can be accessed through the Leeds Mental Wellbeing Service

Self harm 

Self Harm

Suicidal thoughts

Leeds MindWell information on self-harm

Battle Scars self-harm support group

Anger

Controlling Anger

Problems getting to sleep, staying asleep and waking early in the morning are very common for people living with persistent pain. Not having enough sleep can increase your pain, reduce your ability to cope with your pain, affect your mood and motivation. There are many factors that can contribute to your lack of sleep, it is important to identify all factors that could be relevant to you and put these in your pain management plan.

Factors that can affect sleep:

• Pain
• Medication – some analgesics and antidepressants can affect getting to sleep and deep sleep
• No bed time routine
• Not enough physical activity
• Lack of exposure to natural light and being outside
• Worry or anxiety or unable to switch off
• Certain medical conditions – sleep apnoea, depression, menopause
• Worry about not sleeping
• Restless legs
• Bereavement
• Environment – noise, temperature etc
• Diet
• Needing to go to the toilet during the night
• Caring for young children/ dependents during the night
• Age – sleep quality changes with age, people tend to experience more frequent waking
• Alcohol – this might help you to get to sleep but can also affect the quality of sleep
• Lack of exposure to natural light
• Inability to switch off

Useful Links for managing your sleep

• MindWell information on sleep
• Live well with pain, sleep information
• How to get to sleep
• Trouble sleeping?

Pacing and goal setting

To be able to make a Pain Management Plan you will need to develop skills in pacing and goal setting.

Pacing – involves looking at the activities you find difficult / want to change/ want to improve and breaking them down into more manageable chunks or setting limits to reduce the incidence of pain flare ups so that you avoid ‘boom and bust’ (doing too much on good days and then having to rest for too long to recover because over time this pattern leads to reduced activity). Here’s an example of pacing:

Goal setting

You need to set realistic goals to give you the best chance of success. These are known as SMART goals:

• Specific – the goal should state what, when, where and how you will change
• Measureable – so you can monitor your progress and stay motivated to continue
• Achievable – the goal must be realistic and specific to you. If you make the goal too difficult it will make it less likely that you will achieve it and you will be demotivated.
• Relevant – the goal must be important for you
• Timed – a goal should have a time limit, when you will start and finish the goal

Useful Links

Goal setting from the Pain Toolkit

Goal setting from Live Well with Pain

Pacing leaflet from live well with pain

Pacing information from the Pain Toolkit 

First decide what you want to change, and then follow the example below

We will support and guide you through the process of developing your SMART goals.

The following treatments don’t cure pain, but they can help some people manage their pain better. Some treatments like acupuncture or massage might only provide short term pain relief (a few hours or days) but they can also help to reduce stress and anxiety. These treatments are not provided by Leeds Community Pain Service but are available privately and through some charities.

Medication can help, but we only expect a 10-40% reduction in pain from analgesia (pain relief medication). Some people get no effect because analgesics become less effective when used regularly. Many people cannot tolerate the side effects of analgesia – for example constipation and drowsiness.

Here’s more information on available treatments:

• Acupuncture 
• Complementary therapy (Osteopathy, Chiropractor)
• Tens
• Strong opioids – for example Tramadol, Morphine
• Amitriptyline
• Gabapentin
• Pregabalin
• Duloxetine
• Spinal cord stimulator
• Injections (look for facet joint medial branch blocks) 

The meaning of relaxation and how it is achieved is different for everyone. We know that persistent pain increases muscle tension, stress and anxiety so creating periods of time where pain is reduced can help to:

• Reduce tension, headaches, neck and shoulder pain
• Reduce stress, improve concentration and memory
• Reduce anxiety, anger and frustration
• Aid sleep
• Increase calmness and sense of being more in control

We recommend building daily relaxation into your pain management plan. This might include:

• Reading a book
• Listening to music
• Having a warm bath
• Massage
• Progressive muscle relaxation
• Mindfulness
• Breathing exercises
• Yoga or Pilates
• Getting creative
• Exercise

Useful links on mindfulness

• • Online course from Leeds Mental Wellbeing Service
  • The pain CD
  • Leeds MindWell – this link includes diaphragmatic breathing and relaxation audio
  • Information on mindfulness

Lifestyle factors can affect your physical and mental health, which can increase your pain, for example if you are isolated, this may make you feel sad, lonely, depressed and unable to go outside for exercise and to meet people. There are a number of positive small lifestyle changes you can explore to help manage your pain, these need to be added to your pain management plan.

Please see the links below for more information and support:

Healthy eating

• NHS Live Well Eat Well
• NHS Eat Well Guide

Weight management

• The NHS Digital Weight Management Programme

Tackling isolation

• Leeds Age UK
• Increasing your support network

Money worries

• Leeds welfare rights
• Leeds Citizen’s advice

• Money Buddies

Finding local activities and facilities

• Linking Leeds 

Housing

• Contact Leeds Housing
• Leeds Homes Website

Information on equipment and adaptations in the home

• The William Merritt centre
• The disabled living foundation
• Leeds Adult social care can be contacted for advice on a range of equipment and adaptation.  For assessment telephone:  0113 2224401