What the Pain Clinic Offers
The pain clinic offers a bio-psycho-social assessment and approach to
helping patients manage chronic pain.
Often a combination of treatments may be used. Referrals for a specific
treatment (such as ‘an injection’) are often unhelpful – appropriate treatment
plans will be made according to a detailed assessment.
Biological approaches

Medication advice

Simple interventions such as TENS advice

Acupuncture as part of a management plan (up to 10 sessions only –
the expectation would be that ongoing treatment is provided in primary
care).

Injections such as epidurals, facet joint injections and nerve root blocks

Complex neuromodulation interventions for lower limb neuropathic pain

Intrathecal pumps for spasticity
Psycho-Social approaches

Pain Management Programme (for musculoskeletal pain, neuropathic
pain and CRPS)

Specific exclusions include Fibromyalgia, abdominal pain, headache.

The pain management department does not have the capacity to offer
individual psychological treatment programmes (such as CBT).
When are spinal injections not likely to be helpful?

Where risks outweigh likely benefits (e.g. where body habitus or
comorbidities mean the injection cannot be performed safely)

When they work, injections typically offer a period of pain relief, which
should allow patients to engage with physiotherapy/weight
loss/exercise programmes. Failure to engage with these approaches
usually results in relapse of symptoms.

Long-term relief from injections is unlikely in patients whose symptoms
have been present for many years or who do not have an underlying
cause that will improve with time.

Psychosocial yellow flags and significant untreated psychological comorbidities are relative contraindications to injections as outcomes are
often poor.

When injections have previously failed to help.