Centre of Pain Education (COPE)

"Chronic pain is pain that either persists beyond the point at which healing would be expected to be complete, or that occurs in disease processes in which healing does not take place. (...) It can be experienced by those who do not have evidence of tissue damage"
Clinical Standards Advisory Group, 2000

Some types of pain last a long time and, as yet, have no cure. We call these pains long-term or persistent. Unfortunately medical treatments for persistent pain do not always work as well as we would like. People are then left with a difficult problem of continuing pain and all the negative effects pain can have on every part of life, including work, relationships, social life, mobility, mood and sleep. Attending a pain management programme can help people cope with the challenges and difficulties that living with persistent pain brings.

If you have pain, which has continued more than six months it would be defined as chronic pain.

Patients referred to COPE will be invited to attend the introductory pain education programme. The two and a half hour long education session, includes:

• Understanding persistent or chronic pain
• Strategies for coping with pain
• Information about the eight week pain management programme and other COPE services.

The introductory programme is held every five weeks and is limited to 20 participants. It is delivered by at least two members of the COPE clinical team, which includes a clinical physiotherapist specialist, a clinical nurse specialist and a clinical psychologist.

Why is it important?

As medical treatments for persistent pain do not always work as hoped, people are often left with continuing pain which begins to impact on other parts of their life, such as work, family, social life, sleep and mood.

The aim of the programme is to help you to understand how chronic pain works and introduce you to a range of skills for managing your pain. We hope that this will help you to improve your quality of life and cope with the challenges that persistent pain can present.

The session will also give you the opportunity to find out more about our eight week pain management programme and decide if you would like to be considered for this.

What you can expect

The session lasts for two and a half hours and includes a refreshment break. Pillows and mats are available for those who need to take time out to rest during the session. For those people for whom sitting time is restricted we will encourage you to move about whenever you need to.

What happens after the introductory programme?

If you wish to attend the pain management programme or discuss what other help may be available you will be invited to make an appointment for multidisciplinary assessment at COPE.

If you do not contact us within three weeks of completing the introductory programme we will assume you do not want or feel that you need further help from COPE and you will be discharged back to your GP or the original referrer.

Please note: this is not a support group and no one will be asked to share information of a personal or sensitive nature. Anything which you do disclose will be kept confidential by the COPE team, and although we will ask other participants to respect your confidentiality, we cannot guarantee this. You will have the opportunity to discuss any personal issues confidentially at the multidisciplinary assessment if you choose to opt in to this.

Our pain management programme is an eight-week course designed to teach people a range of skills so that they can improve their physical function and quality of life, and reduce emotional distress.

The programme is run by a physiotherapist, nurse and clinical psychologist who are all experienced in the management of chronic pain.

The course involves eight weekly sessions timetabled from 9.30am to 12.15pm, with three further follow-up appointments over the course of the year. During the sessions there are talks, discussions and practical sessions. The programme is limited to 10 participants.

On joining the programme we ask you to commit to attend all sessions, to do the homework and to make changes! You must also agree not to seek other medical treatments in the month prior to the course starting, up to the first follow-up appointment.

The programme includes:

• Explaining pain by teaching about pain mechanisms
• Graded exercise programme
• Relaxation programme and stress reduction advice
• Help to use medication effectively
• Improving sleep
• Managing your emotions
• Identification of valued activities and goal setting
• Family and friends session
• Management of flare ups/ setbacks
• Help to tailor programme to individual needs.

Who is the programme suitable for?

If you can answer 'yes' to several of the following questions the pain management programme may be suitable for you:

• Have you had pain for most of the time for more than six months?
• Have you stopped doing many activities because of your pain?
• Does your pain make you feel irritable, anxious or depressed?
• Are you afraid that exercise and movement will make your pain worse?
• Are you worried about the painkilling medication you are taking but do not know how else to cope?
• Are you not sleeping because of your pain?
• Are the people closest to you affected by your pain?
• Have you lost confidence because of your pain?
• Do you feel that you are not coping?
• Is the struggle to control your pain dominating your life?

The programme will give you help to put into practice the ideas we have introduced during the sessions. It is based on principles and practices which have been proved to help many people with chronic pain to improve their quality of life.

What are the requirements to attend a programme?

To benefit from the programme people need to be able to speak English and be able to take part in a group. They need to be able to manage their self-care independently during course sessions. There is support available for people with mild hearing difficulties, visual impairments or literacy difficulties to help them to access the programme.
 
For people who are unable to access the group, there is a small facility for appointments to be arranged on an individual basis with the specialist nurse, physiotherapist and clinical psychologists.

Q. Does it work?

A. Research has shown that attending a pain management programme can help reduce the disability and distress associated with chronic pain. A pain management programme will not cure pain, but can help people to manage the difficulties that living with persistent pain can bring.

We routinely measure clinical outcomes which show that people who attend the programme improve their physical abilities, are less depressed and anxious, have less pain overall, and are more confident in their ability to cope with ongoing pain.

Q. What do I do if I think the eight week programme is for me?

A. If you would like to be considered for the programme, you will need to ask your doctor to refer you to COPE. We will then invite you to the introductory pain education programme. After this, you will need to telephone COPE and arrange a multidisciplinary assessment appointment with the team.

Q. What does the assessment involve?

A. You will attend a two hour multidisciplinary assessment, with a psychologist, nurse and physiotherapist. If the programme is considered suitable for you, a choice of possible course dates will then be offered. Alternatively, if the programme does not appear to best suit your needs a member of the team will contact you to discuss what other services may be appropriate.

Q. What happens after the programme?

A. It is expected that you will take away pain management strategies and continue to practise your pain management after the programme. There are three follow-up appointments over the next year to support you with this. At times people have setbacks, or need some further advice to get back on track and therefore there is ongoing telephone support available.

Referral forms

• SWL Pain Clinic Referral Form (Nov 2023)

Leaflets

• Information for referrers [pdf] 348KB
• General patient information leaflet [pdf] 402KB

Books

• Nicholas, M., Molloy, A., Tonikin, L., Beeston, L., (2003): Manage Your Pain
  Souvenir Press, London ISBN 0-28563-679-0
• Cole, F., Macdonald, H., Carus, C., Howden-Leach, H., (2005): Overcoming Chronic Pain: a self-help guide using CBT
  Robinson Publishing, London ISBN 1-84119-970-2

CDs

• Berry, N., (2001): Living with Chronic Pain
  A CD or cassette tape produced by consultant clinical psychologist Neil Berry.
  To order, please send a postal order or cheque made out to "Pain CD" for £5 to PO Box 84, Blackburn, BB2 7GH. Please indicate whether you require a CD or cassette.
• Oxford Cognitive Therapy Centre, (1997): How to Relax 
  A CD or cassette
  To order, please send a cheque made out to OCTC for £2.50 indicating if you require a CD or cassette to: Booklets Secretary, OCTC, Warneford Hospital, Oxford OX3 7JX. Tel: (01865) 223986, Fax: (01865) 226331, E-mail: octc@obmh.nhs.uk, Web: www.octc.co.uk (opens in a new window). Please note that orders cannot be accepted without payment.

Websites

• British Pain Society: www.britishpainsociety.org (opens in a new window).