Pain

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About this service

We are a team of specialist doctors, psychologists, physiotherapists, occupational therapists and nurses who help patients across Cornwall manage long-term pain.

Pain Management

Our integrated multidisciplinary team promotes and provides person centred specialist advice, management and rehabilitation for adults with complex long term pain.

We are a small specialist team embedded within the Pain Service at RCHT. The team is made up of Clinical/Counselling Psychologists, a Specialist Occupational Therapist and a Specialist Physiotherapist.

Nurse-led acupuncture service

We offer a nurse-led western medical acupuncture service. It consists of an initial trial of three 30-minute acupuncture sessions, which can then be extended up to a total of eight acupuncture sessions if the treatment is beneficial. The service is based at Treliske and West Cornwall Hospitals. Appointments are offered Wednesday-Friday in either a morning or afternoon clinic. Our acupuncture service only accepts internal referrals from clinicians in the outpatient pain service.

Injection Treatments

We offer targeted injections treatments to help identify where your pain is coming from as well as treat the cause of painful symptoms.

Psychology

We work with this service to help people deal with the health challenges they face by providing psychological assessment, guidance and intervention. We work alongside patients and their care teams to help reduce suffering, increase resilience and improve physical and mental health.

This includes:

• helping to make treatment, surgery or rehabilitation more effective
• helping patients adjust to, manage or recover from illness, injury or disability
• helping patients, and their care teams, make decisions about their health.

Contact information

• Telephone: 01872 252160 or 01872 252792

Where to find us

The outpatient pain service is based at the Royal Cornwall Hospital in Truro, but we also see and treat patients at Penrice, St Michael’s, and West Cornwall Hospitals. We provide telephone, video, and face-to-face consultations.

Any instructions or directions will be in your appointment letter or correspondence; please read it carefully before attending.

Information about persistent pain

Patient Information (Leaflets)

Click here for a list of our Patient Information Leaflets.

Using the link above, you can access the following patient information leaflets depending on your need:

Medication Advice

• Gabapentin (RCHT1650)
• Pregabalin (RCHT1654)
• Steroid injections (RCHT1714)
• Tricyclics (RCHT1655)

Injection Treatments

• Botox injections in the pain clinic (RCHT 511)
• Cryotherapy (RCHT 564)
• Facet Denervation (RCHT 07)
• Greater occipital nerve block (RCHT1803)
• Intravenous lidocaine infusion (RCHT1145)
• Peripheral Nerve Stimulation (PNS) RCHT1185
• Pulsed radiofrequency (RCHT 993)
• Spinal injections (RCHT1357)
• Stellate ganglion block (RCHT 490)
• Suprascapular nerve injection (RCHT1776)
• Trigger point injections (RCHT 488)

Driving Whilst Using Prescription Painkillers

• Driving and pain medications (RCHT1505)

Spinal Cord Stimulation

• Following spinal implant procedures (RCHT 1610)

Patient exercise videos

Physiotherapy for back, neck, knee, foot, shoulder and elbow pain

Click on the links below to view exercise videos for:

• patients with back pain
• patients with neck pain
• patients with knee pain
• patients with foot pain
• patients with shoulder pain
• patients with elbow pain

Yoga and Pilates for patients with chronic pain

Yoga exercise videos:

• 45-minute beginner’s yoga video class

Pilates exercise videos:

• 30-minute chair-based Pilates video
• 30-minute Pilates video class designed for patients with chronic pain
• 30-minute Pilates video class for patients with back pain
• 30-minute Pilates video class for patients with arthritis
• 30-minute Pilates video class for patients with knee pain

Tai Chi for patients with chronic pain

• Click here to view a series of videos about mindfulness movement
• Click here to view a series of videos about Tai Chi
• Click here to view video 1 for patients with shoulder and neck pain
• Click here to view video 2 for patients with shoulder and neck pain

Resources for patients with chronic pain

Psychological resources for patients with chronic pain

Meditation and sleep

• Bedtime meditation: getting a better night’s sleep. Watch this video class that takes you step by step towards a comfortable seated practice of meditation.
• Finding Peace in a Frantic World: A selection of six different meditations, taken from the book ‘Mindfulness: Finding Peace in a Frantic World’
• Finding Your Ground: Mindfulness in the Time of Coronavirus is another collection of meditations that will help you explore alternative anchors for your attention, your feet, seat or hands. There are three versions of the Finding Your Ground meditation of different lengths. If you can, try to use the ten-minute version twice a day or the twenty or thirty-minute version once a day.
• Sleepio: Sleepio is a six-week cognitive behavioural therapy sleep improvement programme, which you can enrol on for £45 and complete at home.

Anxiety and mindfulness

• The SAM App: The Self-help App for the Mind (SAM) is free to download and will help you to understand what causes your anxiety, monitor your anxious thoughts and behaviour over time and manage your anxiety through self-help exercises and private reflection.
• Be mindful: Be Mindful is an online course for reducing stress, depression and anxiety based upon mindfulness-based cognitive therapy.
• Mindfulness Cornwall: Mindfulness Cornwall is a charity which aims to help people learn about and use mindfulness in their everyday lives. They offer 8-week courses and individual appointments.

Other NHS resources

• Living with chronic pain (listen online – audio CD): Living with chronic pain is a free to access site which has 10 audio tracks covering a variety of topics including living with chronic pain, how to improve your fitness sleep and diet as well as a step-by-step approach to goal setting, how to use “Relaxation” to get a better night’s sleep.
• ESCAPE-pain: ESCAPE-pain is an online structured program for people with knee, hip and back pain. It integrates educational videos with an exercise program. The resource is free.
• Healthy Cornwall: The Make A Change Physical Activity page contains links to a variety of local walking, running, swimming and other sports activities. There is something for everyone no matter your age or ability.
• The Expert Patient Programme: The expert patient programme is open to all patients in Cornwall and run by a team of trained volunteers. As part of the course, you attend six weekly sessions, which last two and a half hours, where you will learn how to manage your condition and meet other people who share similar experiences. The registration form and contact details are at the bottom of the page.
• Reconnect2life: Reconnect2life is an interactive webpage where you can click through a series of information pages at home about understanding pain, improving your fitness and how you think about pain and how pain effects your mood. The health and fitness section also includes a step-by-step how to do it guides and videos on Tai Chi and Body conditioning.
• Body reprogramming: Body reprogramming is a course for people who have Chronic Primary Pain, such as fibromyalgia. It provides an understanding of the condition and explores ways to help you reduce your symptoms. The course is composed of 6 sessions, each about 2 hours long.
  If you would like to take part please contact your GP because they must refer you directly for this.

External pain management resources

• The Pain Management Plan: The Pain management Plan book, is a self-directed cognitive behavioural therapy learning programme, which can be purchased from Amazon and worked through at home.
• painTRAINER: painTRAINER is an interactive, free, online program that teaches you effective strategies to manage your pain. The painTRAINER program is made up of 8 sessions, each lasting about 30-45 minutes.
• Pathway through pain: Pathway through pain is an online pain management program which you can enrol on for £40 and complete at home.

Resources for patients with pelvic pain

Information about pelvic muscle pain

Your pelvis and pelvic muscles

Your pelvis is made up of several structures including the bones and muscles of your skeleton, your pelvic floor muscles, as well as your reproductive and urinary organs, rectum, and perineum (the skin around your anus and genitals).

Your pelvic muscles move things by contracting and then relaxing. All muscles work in tandem with other nearby muscles, with them all coordinating various stages of contraction and relaxation to achieve organised movement. Some of this movement is conscious, for example when you choose to cross your legs, and some of it is involuntary, for example when your bladder relaxes and expands so that it can fill with urine.

Your pelvic floor muscles are a specialised set of muscles, positioned at the base of your pelvis, which help keep your pelvic organs in the correct place and control your bladder, bowel, and sexual functions.

Pelvic muscle overactivity

Like all muscles, your pelvic muscles can become hypertonic (overactive), which means the muscle may become painful, weaker, less responsive and move out of time with other nearby structures, leading to a loss of the coordinated movement described above.

You won’t necessarily “feel” pelvic muscle overactivity because some of the muscles, such as those in your pelvic floor, are involuntary so you are not conscious of whether they are contracting, relaxing or hypertonic.

Symptoms of pelvic muscle overactivity

As well as pain, the loss of the coordinated movement may cause changes in your bladder and bowel habit and have an effect on your sex life. Symptoms of overactive pelvic muscles include:

Changes in your bladder habit such as:

• Needing to go to the toilet a lot
• Needing to rush to the toilet and finding it difficult to “hold on”
• Difficulty passing urine
• Only passing small amounts of urine
• Feeling like you cannot empty your bladder

Changes in your bowel habit such as:

• Feeling bloated
• Constipation
• Needing to go to the toilet a lot
• Needing to rush to the toilet and finding it difficult to “hold on”
• Difficulty passing stool and needing to strain

Changes in your sex life such as:

• Loss of libido
• Pain before during and/or after sexual intercourse
• Erectile dysfunction

Understandably, any and all of these symptoms are very stressful and can be very distressing, which may lead to thoughts, feelings and behaviours that themselves can cause pelvic muscle overactivity, and so make things worse.

Further information

Click here to view a booklet entitled: “An introduction to pelvic pain” (PDF only, 2.2 MB) produced by the Pelvic Pain Foundation of Australia. This short guide contains lots of information about different types of pelvic pain, advice about how to reduce your symptoms and is aimed girls, women, men, and families.

Pelvic muscle relaxation and physiotherapy

The mainstay of treatment for pelvic muscle overactivity is targeted relaxation and physiotherapy.

While all of us have been told to “relax” at some point in our lives, many of us don’t know how to do this properly, and especially how to target specific muscle groups like your pelvic floor muscles.

We would like you to spend about a week learning: 1) How to relax properly; 2) How to relax your pelvic floor muscles; 3) Stretch your pelvic skeletal muscles.

Then we would like you combine all of these activities into a single exercise regimen and build this into your daily routine.

We hope you will quickly notice that your symptoms improve with these changes, and that you will learn over time how much, when and what exercises you need to do to control and manage your symptoms.

Step 1: How to relax properly

Start by reading this handout entitled “The Mitchell Method of Physiological Relaxation” (PDF only, 927 KB) produced by the Pelvic, Obstetric and Gynaecological Physiotherapy Network. This guide describes how to relax.

Try to practice this for 5-10 minutes, once per day, every day, for one week or until you become comfortable with the process and can develop a pleasant feeling of comfort through your whole body.

Once you have done this, move onto the next step.

Step 2: How to relax your pelvic floor muscles

Click here to reach the Pelvic Physiotherapy website, which aims to help patients with pelvic pain and other disorders.

The webpage describes a series of exercises to help relax your pelvic floor called “Sniff, flop and drop”. Try to familiarise yourself with these exercises and practice them for 5-10 minutes, once per day, every day, for one week or until you become comfortable with them.

Now try to combine the two, by first using the “Mitchell” relaxation routine to relax your whole body, before then working though the “Sniff, flop and drop” exercises from the website.

Once you feel settled with this, move onto the next step.

Step 3: How to stretch your pelvic skeletal muscles

Click here to view a handout entitled: “Easy Stretches to Relax the Pelvis” produced by the Pelvic Pain Foundation of Australia. These exercises are suitable for both men and women.

Try to familiarise yourself with these exercises and practice them for 5-10 minutes, once per day, every day, for one week or until you become comfortable with them.

Now try to combine all three exercises, by first using the “Mitchell” relaxation routine to relax your whole body, then work though the “Sniff, flop and drop” to relax your pelvic floor and then finishing with the easy stretches to relax your pelvis.

Is there anything else that I can do to help?

Specialist pelvic floor physiotherapist

If you find it difficult to understand or perform these self-directed exercises, or would simply prefer to be seen in person, you may benefit from seeing a specialist pelvic floor physiotherapist. Please contact your GP about it. You may need to arrange this privately depending on what services are available in your area.

Pelvic floor injection therapy

If your pelvic floor muscles are so painful that you cannot complete any physiotherapy, you may benefit from seeing a gynaecologist with a specialist interest in this area, who may be able to perform injection to relax some of the overactive muscles in your pelvis. Please contact your GP about it. You may need to arrange this privately depending on what services are available in your area.

Resources for patients prescribed opioid medication

Information about opioid medication

Opioids are very good analgesics for acute pain and for pain at the end of life, but there is little evidence that they are helpful for long term pain.

A small proportion of people may obtain good pain relief with opioids long-term if the dose can be kept low, and especially if their use is intermittent.

The risk of harm increases substantially at doses above an oral morphine equivalent of 120 mg/day.

If a patient has pain that remains severe despite opioid treatment it means they are not working and should be stopped, even if no other treatment is available.

Further information can be found on the Opioids Aware website resource which has been produced for patients and healthcare professionals and aims to support safe prescribing of opioid medicines.

Video resources for patients

Here are two patient videos, produced by NHS England, that describe the potential harms of using strong opioid drugs to treat chronic pain:

• Click here to view Faye’s story, which describes, from her parent’s perspective, the sequence of events that ultimately led to her untimely death from respiratory depression.
• Click here to view Sean’s story, which describes the devastating impact strong opioid prescribing had on his life, and how he has engaged with more effective non-drug therapy that has been life-changing.