A Patient’s Guide to the Pain Self-Management Programme (PMP)

The idea behind what we do is to help you do more in your life, even though you have a lot of pain. We don’t use drugs or other treatments. Instead, we teach you how to be more in charge of your life. All this begins when you are with us, but you will be able to continue to improve when you are at home again.

People who have been in pain for a long time often become unfit or are out of condition, because they aren’t able to do as much as they used to. This lack of fitness makes a person have other aches and pains. Also, unfit people seem to feel pain more. One of the things that we do is to help you become fitter.

We aim to teach you ways of planning your day so that pain is less of a problem. We also can teach ways of relaxing to allow you to deal with pain better.

For more information please look at the booklet produced by the British Pain Society: www.britishpainsociety.org/static/uploads/resources/ files/book_pmp2013_participant.pdf or the Pain Toolkit: www.paintoolkit.org, written by a patient with pain.

At RNOH, the programmes are 1, 2 or 3 weeks long and are residential. This arrangement enables intensive work with specialist therapists.

Patients are resident from Monday to Friday in the Rehabilitation Ward and go home at weekends. If you are coming from a long distance or you are unable to get home, you have the following options:

• To stay in local accommodation (we are able to provide a list of potential accommodation)
• To stay in 4 single rooms without ensuite (if available and if appropriate to your physical abilities)

All of the above will be at your own expense.

The Pain Management Programme is run by a multi-disciplinary team which includes physiotherapists, occupational therapists, therapy technicians, clinical health psychologists and nurses with input from the medical consultants as required.

You will be expected to attend daily physiotherapy and occupational therapy sessions, with additional input from clinical health psychologists and nurses. This is a multi-disciplinary approach and therefore you are expected to participate in all aspects. Many sessions are one-to-one while others are group based (including recreation and water based activities). Everybody is expected to join in and contribute to these sessions unless it has been agreed that they are not appropriate for you. The group sessions allow you to share your experiences with other patients with similar problems and to help you learn from each other.

Chronic pain involves complex biological, psychological and emotional processes. Additionally, living with chronic pain can be accompanied by distressing feelings such as anger, anxiety and hopelessness. Therefore, through understanding how distress interacts with pain, and learning strategies to manage unhelpful thinking and behaviour, you can develop a healthier relationship with the experience and learn to live well with chronic pain.

No. Unless is has been otherwise agreed that the sections are inappropriate for you to participate in. The programme is a carefully designed package with all the different components complementing each other. If you miss sessions, you may not fully gain the potential benefits of the programme.

We will work with you and personalise the therapy to your needs as much as possible. Please ensure that you tell the therapists if certain things are too much. If despite everything, you feel that it is not right for you and that you are not getting any benefit, you are free to leave the programme at any time.

You will learn some exercises and stretches that you will be able to continue as part of a home exercise programme. You will learn some new pain coping strategies and new ways of approaching everyday tasks which previously may have been difficult or impossible to manage. You will gain a better understanding of your condition and will develop a plan to help you deal with flare ups.

The programme is not a cure for chronic pain. But there are a range of strategies that can allow you to control the effects long term pain has on your life. However this is not a “quick fix”; you and your family should not expect you to reach the maximum benefit within the three-week programme. This is the start of an ongoing slow, but hopefully, steady and progressive improvement.

As the emphasis is on rehabilitation and self-management strategies, we need to warn you to expect that some of your pain might worsen a little as you will be using muscles that may not have been used for some time. This reaction is a quite normal and common one and we will work with you to try and achieve the right balance.

We do not anticipate making any changes to your medication during the programme because you should concentrate on your work with the therapists during this period. You will be asked to bring all your medications and your prescription with you. For hospital based patients, please bring everything except Oramorph (liquid morphine); this will be provided if you normally take it at home. If you use a Dosette box, it will be screened by pharmacy. If you are suitable for, and happy to self-medicate (i.e. take your tablets independently and without nursing staff help or supervision), you will be provided with a key to the lockable bedside cupboard. Controlled drugs will need to be handed over to nursing staff and are not a part of the self-medication scheme.

We accept patients with a wide range of physical impairment from those who are still managing to work to those who have been wheelchair users for long periods and struggle with even simple everyday activities and tasks. The Jubilee Rehabilitation ward also admits patients for rehabilitation programmes and patients with various forms of chronic arthritis and orthopaedic problems. Therefore, you are likely to see others who may have different problems to those that you experience.

As in any situation in which strangers are brought together and have to interact and live with each other, there is the potential to make strong friendships or to find that you just don’t get on well with someone else. If unfortunately you do clash with someone, you will be expected to behave in a reasonable manner to avoid the situation escalating to a point where it is preventing you or the group from making the most of the programme. We expect you to be respectful of each other and to take responsibility for your own behaviour. If you are experiencing problems, you are encouraged to inform members of the team at an early stage so that this can be resolved openly and fairly. We have a code of conduct, and we operate a yellow / red card system. Anyone who breaks the code of conduct despite prior warning may be discharged. For all participants, agreeing to, and signing the ward code of conduct is mandatory.

The Rehabilitation Ward has a male and a female wing. It is an open style ward with beds on both sides, and separating curtains between beds. There are no single rooms on the ward. There are however, separate male and female bathing and toilet facilities.

Relatives can stay but will need to find either local accommodation or book hospital accommodation (if available) at their own expense. We ask that relatives keep to visiting times (generally after 17:00) and not to attend therapy sessions, so that you are able to concentrate on your own needs and what you are learning from the programme. If you would like a family member to engage with some of the work you are undertaking, please mention this to the therapist that you are working with.

We are able to cater for many dietary needs such as gluten-free, vegetarian, vegan, lactose-free, egg-free, kosher or halal. If you have other requirements, please discuss this at your pre-assessment visit and let us know. Presently we are not able to support a FODMAP diet. If you still have queries, please contact the Jubilee Rehabilitation Ward Manager on 020 8909 5341. There are two fridges available on the ward for patient use, and you are permitted to bring in a small amount of food and drink. This will not be the responsibility of the hospital and will be at your own risk. We would encourage you to label your personal food clearly. The ward fridges will be emptied on Friday. 

• Comfortable clothes for exercise
• Suitable shoes for exercise
• Swim wear (e.g. swimsuit, shorts, t-shirt)
• A water bottle to bring to all your sessions
• A book if you have gaps between sessions
• Specific dietary supplements, etc. (fridges are available on the ward)
• All your medication with packaging and your prescription
• Headphones for mobile devices to avoid disturbing other people 
• You are welcome to bring your own pillow or blanket to use on the ward if you would prefer.

Free Wi-Fi is available both on the ward.

In the unfortunate event that you develop an infectious illness during the programme, or are too unwell to continue, you will be discharged and we will arrange a future admission. If you are ill just before the programme and have not recovered in time for your admission, please contact the Rehabilitation Co-ordinator. (see telephone number below).

Rehabilitation Co-ordinator for admissions
Telephone: 020 8909 5783
 

Physiotherapy / Occupational
Therapy Telephone: 020 8909 5818

Nursing / Ward
Telephone: 020 8909 5341

Rehabilitation Co-ordinator for admissions
Telephone: 020 8909 5783

Psychology
Telephone: 020 8909 5521

Author of leaflet: Dr Andrew Lucas, Head of Psychology