Reflection on working with the Pain Management Service in Ayrshire and Arran

My name is Lynsey Wilson. I am a static MSK physiotherapist working in the MSK physiotherapy department at Ayr Hospital. I was involved in a development opportunity working alongside the pain management specialist physiotherapists within the Pain Service at Crosshouse Hospital. I was interested in this opportunity as I felt this was an area I wanted to develop my knowledge and skills in the assessment and management of patients who have persistent pain. A large percentage of my caseload in MSK out-patients includes patients who have persistent pain so I felt this would be an excellent opportunity to improve my ability to support these patients in the management of their condition to allow them to have an improved quality of life. As the service includes multi-disciplinary team working I also thought it would be interesting to find out about the roles of the other team members and how the service is run.

Reflection on working with the Pain Management Service in Ayrshire and Arran

I spent seven weeks working within the Pain Management Service alongside the multidisciplinary team including physiotherapists, consultant anaesthetists, the pharmacist and psychologists. I attended the weekly MDT meetings. I was able to spend time shadowing the consultants in theatre carrying out spinal injections and also in the clinic carrying out one to one assessments and reviews with patients. I also got to spend time with the physiotherapist and shadow their clinic. In addition, the pain management specialist physiotherapist carried out various tutorials with me to improve my knowledge of treating patients with persistent pain. I also had a workbook of competencies to work through and research relevant information on the assessment and management of patients attending the pain service. I also had my own caseload of patients to assess and treat which I was able to discuss with the specialist pain management physiotherapist and gain feedback on my assessment and treatment of my patients.

Being able to shadow the other members in the team and work alongside the team allowed me to gain a good insight into: how the service runs, the patients who are appropriate to be referred into the service and which patients are inappropriate for referral into the service.

I feel this experience has been invaluable in improving my knowledge and skills in the assessment and management of patients with persistent pain. Managing patient expectations with persistent pain can be challenging as it is not always possible to achieve what the patients would ultimately strive for; which is often to be pain-free. Prior to spending time working in the pain management service I always found this was a difficult conversation and conveying this to patients was challenging. I now have a better understanding of the importance of explaining pain to these patients and how crucial it is to ensure they have a good understanding of this prior to engaging in their rehab and management. I realise it is essential to explain to patients how we can support them with the difficulties which arise as a result of their persistent pain and what they can hope to gain with physiotherapy which is an improved quality of life, despite still having pain, and that this will be different for each patient. I feel this experience has given me more confidence to explore this with patients and provide better explanations on understanding pain and how patients can manage their pain better.

Initially treating patients felt a bit overwhelming as the patients were all very complex in that they had various issues including: multiple areas of pain, various co-morbidities, yellow flags and a varying degree of psychological issues. I felt worried that I did not have the knowledge and skills to support and treat patients with complex pain problems and related psychological issues and distress. I now realise that as a physiotherapist working with patients with persistent pain my role is related to helping patients to see where they are; what their realistic options are and help them to set realistic goals based on their own values. I think having a better awareness of this then allows me to support patients better and take this into consideration when planning our joint treatment goals. If I felt further support was required I would now have the confidence to refer on to a more appropriate service or get another service involved alongside treating the patient within physiotherapy. I also found that although I may not be able to fully address all of their anxieties and stresses, by treating and working on certain goals with patients, it had a positive impact on their mood and overall well-being. This made me realise just how important it is to treat these patients holistically and look at the wider picture and not just focus solely on their physical problems as poor mental health can be a big issue within patients who have persistent pain.

In conclusion, I feel the experience of working in the pain service was hugely beneficial for me and would welcome spending more time working there again in the future. Despite the challenging nature of the role it is very rewarding being able to help patients both physically and mentally to have a positive impact on improving their quality of life.

Had I had more time to spend working in the service I would have liked to have spent time shadowing the pain specialist psychologist, as I feel this is an area where patient’s would really benefit in their overall management . I feel further training for myself would be useful in supporting people with mental health/ psychological issues in relation to their pain as the mind and body are so interlinked that a holistic approach in the management of pain is essential.

I feel this experience would be beneficial for anyone working within musculoskeletal physiotherapy as patients with persistent pain are not only seen within pain management services. Patients with persistent pain are seen on a daily basis as part of the MSK physiotherapy caseload and until we are able to help these patients self manage better, we will continue to see them returning to the MSK service on a number of occasions. This may be when they have a flare up, when other aspects of their life become a burden and increased stress increases their pain, due to overall deconditioning as a result of their pain or for some other reason; be it physical or mental, that causes a deterioration in their symptoms. However, having the knowledge and skills to support patients with persistent pain self manage their long term condition; we could hopefully reduce the recurrence and frequency of returns to MSK physiotherapy services and allow patients to lead the best quality of life possible.

Links to Additional Learning

Ayrshire and Arran Pain Management Website

e-PAIN: online modules which people can register for free and do different pain topics

Arthritis Action

LearnPro and NES modules are available on: