Pain and Opioid Management Resources

The AHSN NENC have collated several resources to help support the management of pain and reduce opioid prescribing.

Back to Rehab – Regional Backcare

This was an invite-only event organised by The Academic Health Science Network North East North Cumbria and the Applied Research Collaboration North East and North Cumbria Integrating Physical, Mental and Social Care theme. For post-event materials and meeting recordings click on the link below:

Regional Backcare programme ‘Back to Rehab’

Feeling the Pain Event

The AHSN NENC recently held an event to present the problems and potential solutions of pain, its management and the subsequent issues of opioid prescribing for non-cancer pain.

This event also hosted the launch of the new North East and North Cumbria Integrated Care System Chronic Pain Clinical Network.

National and regional speakers presented an overview of the opioid problem in the North-East and North Cumbria; its impact on public health, personal experiences of opioid prescribing and novel ways of managing pain and its sequelae.

Feeling the Pain Event Resources – Speaker presentations, posters and many more resources can be found here:

Feeling the pain resources

Further resources are in development and will be uploaded here in the near future.

Changing the Conversation

Dr Dave Tomson FRCP is a GP and Clinical Director of the North Shields PCN with a special interest in communicating with people who experience persistent pain.

Watch Dr Tomson’s Persistent Pain Management workshop. The aim of this video is to help reduce opioid prescriptions and arm frontline clinicians with the skills required to help patients with persistent pain manage their condition.

Changing the Conversation Resources:

6 Self Care Questions for People Living with Persistent Pain

10 footsteps – Your Journey to Living Well with Pain

Health and Wellbeing Check

Pain and the Brain

Pain Puzzles – Understanding that Pain is Complex

Persistent Pain – Iceberg Poster

The Great Opioid Side Effect Lottery

The Pain Cycle

Using Medicines for Persistent Pain

Further Resources

Live Well with Pain

Live Well with Pain offers a range of knowledge, skills, tools and resources to use by clinicians in brief patient contact time.

My Live Well with Pain is a collection of resources that are designed to help the patient to learn the skills they need to become an effective self-manager of their pain.

Home – Live Well With Pain

This project brings together a diverse group of pain livers and refugees, who have connected with a creative arts company. This opportunity has presented innovative ways to understand themselves, their relationship with their body and their pain, exploring new ways to express their experiences.

Unmasking Pain – The Documentary – YouTube

The Live Well with Pain team presented a 35 minute webinar for the NENC Pain Community of Practice in September 2023, succinctly explaining what Live Well with Pain is, and how it supports the management of persistent pain.

Live well with Pain Webinar

Painkillers Don’t Exist

Painkillers Don’t Exist is an NHS campaign that aims to raise awareness of the dangerous effects of long-term high-dose pain medication and empower people living with pain to make informed decisions about their health.

Painkillers Don’t Exist

The Pain Toolkit

A toolkit helping people to self-manage persistent pain. Pain self-management is about the patient learning new and using old, skills – trying them out and to see what works for them.

 The Pain Toolkit – Pain Self Management by Pete Moore

Flippin Pain – linked via Live well with pain

Flippin’ Pain™ is a public health campaign with a clear goal:

To change the way we think about, talk about and treat persistent pain

Flippin’  your understanding of pain could change the lives of you and your loved ones forever.

Flippin’ Pain

Redburn Park Medical Centre – Codeine Reduction Resource

A GP practice team in North Tyneside have undertaken a codeine reduction project within their practice. Patients were invited to reduce their opioids using a patient letter. The example letter along with associated supporting resources are below.

 

Example Codeine Reduction Letter

Oxford University FT Opioid Leaflet

Example Patient Criteria for Opioid Reduction

Practice Controlled Substance Practice Policy

Patient Treatment Agreement

Potential issues related to enforced tapering of opioids

International Stakeholder Community of Pain Experts and Leaders Call for an Urgent Action on Forced Opioid Tapering

Clinical and neuroscience evidence supports the critical importance of patient expectations and agency in opioid tapering

Patient-Centered Prescription Opioid Tapering in Community Outpatients With Chronic Pain

The British Pain Society

This leaflet explains what patients can do to prepare for going home after surgery and to help their recovery. It describes the medicines used to reduce pain, and how to use them safely while the patient recovers.

Managing Pain After Surgery

The North Cumbria Opioid Workstream has been led by Helena Gregory (NENC ICB) in collaboration with partners. The team identified a higher volume of opioid prescribing for people in north Cumbria and associated risks to people, particularly those taking higher doses or combinations. The collaboration has come together around a common problem in a safe space, keeping the patient at the heart, and valuing all members of the team equally. During this time, the number of people taking opioids in north Cumbria has decreased by 20%. With credit to CLIC (Cumbria Learning and Improvement Collaborative)

The North Cumbria Opioid Workstream

This report is a rapid insight into the services available to patients across North East and North Cumbria to manage chronic (non-cancer) pain. It also includes drivers for the historic high rates of opioid prescriptions to manage pain and the development of interventions to support patients to manage their pain better and reduce use of inappropriate medication

Rapid Insight Report

 

A selection of books recently published that shed light on the opioid overprescribing issue and describe new understanding of pain.

Empire of Pain: The Secret History of the Sackler Dynasty

The Sackler’s are one of the richest families in the world, known for their generous donations to the arts and sciences. The source of the family fortune was vague, however, it has emerged that the Sackler’s were responsible for making and marketing OxyContin, a blockbuster painkiller that was a catalyst for the opioid crisis.

The Meaning of Pain: What it is, why we feel it, and how to overcome it

In The Meaning of Pain, renowned osteopath Nick Potter draws on insights from biology, evolution and social behaviour to present a radical new understanding of pain and why we feel it.

Back to Life: How to unlock your pathway to recovery (when back pain persists)

Back pain is very hard (often impossible) to diagnose and to specify, hence heavy painkillers are thrown at people. But the only way to beat the pain is to understand it. Based on cutting-edge research into back pain and the psychology of pain itself, David Rogers and Grahame Brown have set up the Functional Restoration Service at the Royal Orthopaedic Hospital in Birmingham.

The Pain-Free Mindset: 7 Steps to Taking Control and Overcoming Chronic Pain

NHS pain consultant Dr Ravindran brings his 20 years of experience to offer an effective set of techniques that will help take back control and overcome pain.

The Painful Truth: The new science of why we hurt and how we can heal

Exploring cutting-edge research that encompasses everything from phantom aches to persistent pain, as well as interviews with survivors of torture and those who have never felt pain, Dr Lyman not only provides hope for reducing and managing pain but takes us to a deeper understanding of what it means to be human.

Dr Deepak Ravindran

Dr Deepak Ravindran is an NHS consultant in pain medicine and what he describes as an ‘upstreamist’ with a trauma informed approach to pain practice. He takes a truly holistic, trauma informed and integrated approach to pain management, and has a deep appreciation for the role of lifestyle, nutrition and the overlap between pain.

Pain Speak: Pain Speak Special – The Painful Truth with Dr Monty Lyman

Dr Ravindran speaks to Oxford based junior doctor and academic scholar Dr Monty Lyman about his new book The Painful Truth.

In recent years our understanding of pain has altered so radically it’s fair to say that everything we thought we knew about pain is wrong. As Dr Monty Lyman reveals, we misunderstand pain – with harmful consequences. In his book, The Painful Truth, Dr Lyman explores and presents cutting-edge research, encompassing phantom aches to persistent pain, and interviews survivors of torture as well as those who have never felt pain.

The Doctor’s Kitchen Podcast #124: Fix your Pain

Here Doctor’s Kitchen, Dr Rupy Aujla speaks with Dr Deepak Ravindran about his book, THE PAIN-FREE MINDSET. Pain is a silent epidemic affecting over 25 million people in the UK alone.

Dr Deepak Ravindran has over 20 years of experience in Pain Management and is Clinical Lead in Pain Medicine at the Royal Berkshire Hospital in Reading, Berkshire, UK. He is also one of the very few consultants in the UK who holds triple certification in musculoskeletal, pain and lifestyle medicine.

Dr Gabor Maté

Gabor Maté is a Hungarian-Canadian physician and author. He has a background in family practice and a special interest in childhood development, trauma and potential lifelong impacts on physical and mental health including autoimmune disease, cancer, attention deficit hyperactivity disorder (ADHD), addictions and a wide range of other conditions.

He has written four books exploring topics including ADHD, stress, developmental psychology, and addiction.

What follows is a series of Podcasts in which Dr Maté has been interviewed in which he shared his experiences and insights.

Trauma, Illness and Healing in a Toxic Culture

Dr. Rangan Chatterjee speaks with Dr Gabor Maté about his book The Myth of Normal: Trauma, Illness and Healing in a Toxic Culture. It connects two of the most important factors in modern health – individual trauma and the pressures of modern-day living.

During this conversation, the prevalence and nature of addiction is discussed. The question what ‘normal’ means these days when it comes to health. And why it is that success rarely equates with contentment.

How Our Childhood Shapes Every Aspect of Our Health with Dr. Gabor Maté

In this podcast from 2018, Dr. Rangan Chatterjee speaks to Dr. Gabor Maté in which he calls for a compassionate approach toward addiction, whether in ourselves or in others. Dr Maté believes addiction is not a choice, neither is it all about drugs and illicit substances. Instead, he believes that addiction affects most of us – whether it be to alcohol, nicotine, sugar, work or exercise…the list is endless. According to Dr Maté, the source of addiction is not to be found in our genes but in our early childhood.

Dr. Gabor Maté On How Trauma Fuels Disease

In this podcast from 2022, Rich Roll speaks with Dr Maté about his latest book The Myth of Normal, a ground-breaking extrapolation of his addiction thesis that investigates the true causes of illness, the many ways in which our society breeds disease, and the pathway to health and well-being.

Elliot Krane: The mystery of chronic pain

We think of pain as a symptom, but there are cases where the nervous system develops feedback loops and pain becomes a terrifying disease in itself. Starting with the story of a girl whose sprained wrist turned into a nightmare, Elliot Krane talks about the complex mystery of chronic pain, and reviews the facts we’re just learning about how it works and how to treat it.

Karen D. Davis: How does your brain respond to pain?

Everyone experiences pain — but why do some people react to the same painful stimulus in different ways? And what exactly is pain, anyway? Karen D. Davis walks you through your brain on pain, illuminating why the “pain experience” differs from person to person. [Directed by Brett Underhill, narrated by Addison Anderson].

Sheetal DeCaria: The bias behind your undiagnosed chronic pain

While doctors take an oath to do no harm, there’s a good chance their unconscious biases can seep into how seriously they take your pain. Physician Sheetal DeCaria explains how perception impacts medical care and treatment — and calls for health care professionals to check in with how they do their patient checkups.

Lorimar Mosely: Why we feel pain

 

Lorimar Mosely describes the neurobiology of pain through a personal anecdote.

Here are links to several Community of Practices that have been set up to support the issue of pain management and reducing harm caused by opioids:

Pain Community of Practice

Community of Practice supporting pain management.

Pain Community of Practice North East and North Cumbria

The North East and North Cumbria Pharmacy Network

Community of Practice for Primary Care Network Pharmacy Professionals within NENC Integrated Care System.

Community of Practice for Primary Care Network Pharmacy Professionals

North East and North Cumbria (NENC) Polypharmacy Community of Practice (CoP)

A community of practice that supports local systems and primary care to identify patients at potential risk of harm and support better conversations about medicines by promoting shared decision making.

North East and North Cumbria Polypharmacy Community of Practice

BestMSK Health Collaborative

The BestMSK Health Collaborative is to recover and rebuild high quality high value personalised MSK provision, integrated across primary, community and secondary care and with mental health, social services and the third sector organisations.

BestMSK Health Collaborative

PCNs and Practices Support Hub

Support hub to focus on the most up to date national information, guidance, support and resources that PCNs and Practices need to deliver care for their patients.

https://future.nhs.uk/P_C_N

Shared Decision Making

Decision support tools, also called patient decision aids, support shared decision making by making treatment, care and support options explicit. They provide evidence-based information about the associated benefits/harms and help patients to consider what matters most to them in relation to the possible outcomes, including doing nothing.

NHS Decision making tool

NHS England Decision support tools

The Personalised Care Institute

The personalised Care Institute are equipping health and care professionals with the knowledge, skills and confidence to help patients get more involved in decisions about their care. Evidence shows this leads to better health outcomes and increased patient and clinician satisfaction.

Personalised Care Institute

Faculty of Pain Management

The Faculty of Pain Medicine is the professional body responsible for the training, assessment, practice and continuing professional development of the specialist medical practitioners in the management of pain in the UK. They support a multi-disciplinary approach to pain management informed by evidence-based practice and research.

Faculty of Pain Medicine

International Association of the Study of Pain

The International Association on the Study of Pain (IASP) is the leading global organization supporting the study and practice of pain and pain relief. IASP brings together scientists, clinicians, health care providers, and policymakers from around the world in pursuit of their mission to bring relief to those who are in pain.

International Association of the Study of Pain

Moving Medicine

Moving Medicine provide clinicians and allied health professionals with accessible, evidence based, condition specific information to help give advice on physical activity at all stages of children, young peoples and adults treatment pathways. We also provide our toolkit for hospitals to help people be more active during and after their time in hospital The project has been developed in collaboration with experts, professional bodies and charities representing patients and healthcare professionals in each disease area. We are working on new resources including children and have also developed our online course, Active Conversations.

Moving Medicine