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.