The treatment of chronic pain includes various different aspects and modalities (multi-modal approach) and often involves different healthcare professionals (multi-disciplinary approach).

More complex patients are often given an appointment in the pain clinic where they are usually reviewed by a pain consultant. Rheumatologists, Physiotherapists, Neurologists, Psychologists and Psychiatrists are also seeing chronic pain patients in the out-patients departments of hospitals. A referral by the GP is necessary.

Available treatment options are:

• Education, Information and Reassurance of patients, Management of patient expectation
• Regular exercising and stretching to maintain and improve range of movement, mobility and symptom progression and subsequently quality of life (This includes core exercises, non-impact exercises, such as swimming, cycling, walking, Yoga, Pilates, Tai-Chi)
• Physiotherapy for specific exercises and physical therapy (including hydrotherapy, massage, acupuncture as applicable)
• Operations (for some patients an operation may be considered after consultation with a surgeon, e.g. hip or knee replacement, treatment of endometriosis, median or ulnar nerve release, lumbar or cervical fusion or discectomy or decompression)
• Medication (topical-numbing patches, tablets, Morphine-patches) / Principles: Pursue analgesia, but expect failure, most medications are used as “trial and error”, “start low and go slow” (it is often the tolerated dose rather than the effective dose to avoid side effects)
• Injections around the spine with X-ray or around peripheral nerves under ultrasound guidance. Injections are not solving a long-term pain conditions, but they may provide more than 50% pain relief for up to 6-12 months. Sometimes risks outweigh the benefit of an injection. The primary principle is not to harm patients. Therefore, a less invasive injection therapy may be tried first. Examples of injections are: Facet joint injections, Sacroiliac Joint Inj., Radiofrequency-denervation, pulsed Radiofrequency, Dorsal Root Ggl., Nerve root blocks, Epidurals, Peripheral nerve blocks, Greater occipital nerve, TAP, IIN+IHN, ICN, PVB, Genitofemoral nerve, Genicular branches, Stellate ganglion, coeliac plexus, symp. Blocks, Bier‘s blocks, intravenous Infusion of Lidocaine or Magnesium, Trigeminal Nerve Blocks, RACS-catheters, Spinal Cord Stimulators (SCS) (for further information see: http://www.painspa.co.uk/procedures/all-procedures.html
• Complimentary treatments which are often self-funded / privately funded (TENS-machine, Acupuncture, Chiropracter, Osteopath)
• Talking Therapy (Counselling, Psychology, Psychiatry as 1:1 or in groups)
• Attendance of an in-patient or out-patient pain management programme (Education, goal-setting, mindfulness, awareness, employment, exercising, sleep, social interaction, use of medication, relaxation, sleep hygiene)
• Referral to other specialists (e.g. For a scan, Neurologist, Rheumatologist, Surgeon, Physiotherapist, tertiary pain management centres for specialist treatments such as spinal cord stimulators, deep brain stimulation, peripheral nerve stimulation, refractory CRPS)