Cathy Stannard, Consultant in Complex Pain at NHS Gloucestershire discusses how using physical activity to support people living with pain instead of traditional medication is having encouraging results.

Pain and its Impact on the Body and Mind

People can experience chronic pain without injury. Chronic pain is described as pain that has been present for more than 12 weeks.

It can be primary pain (pain with no clear underlying cause) or chronic secondary pain, or both.

Secondary pain is caused by underlying conditions like osteoarthritis or rheumatoid arthritis.

Both types of pain can be very intense and some people have both sorts of pain at once.

“Medicines are very disappointing for pain,” explained Cathy.

“The intensity of the pain we feel is largely not related to the degree of illness or injury.

“It relates to all sorts of things going on in our lives and how much distress we feel. So you can feel severe chronic pain without any injury at all.”

Cathy describes that for example Adverse Childhood Experience (ACE) can significantly worsen the experience of pain even when physical injury is small or absent. The pain is very real and very severe.

She said: “Around 60-70% of people who have experienced an ACE, present with physical symptoms.

“We need to change how we think about and understand chronic pain.

“ACEs and other challenging life circumstances can give rise to pain which is just as severe as pain resulting from signals to the brain from an injured body part.”

 Asking People ‘What Matters to Me’ is the Best Way to Support

“There are lots of questions about how we best support people and we do that by asking what matters to them,” said Cathy.

“Our approach is about holistic assessment, looking at a patient’s life and understanding what they need help with.

“We cannot take away the pain but we can look at all the things they are living with and help them to manage these.

“It’s not about providing new services, what we are doing is leveraging the philosophy of the Integrated Care System (ICS) to engage people so that they are active participants in their health and wellbeing,” she added.

Giving Patients the Tools To Increase Their Activity

People who present with persistent pain in Gloucestershire can be referred to ‘It’s Your Move’, an exercise and physical activity initiative focussed on giving patients living with persistent pain the resources to improve their mobility as an aid to self-managing their pain and its impact.

Active Gloucestershire’s ten-session supervised exercise programme is delivered by community-based exercise professionals and focuses on gentle movement-based activity (such as Tai-chi) and strengthening exercises.

It aims to build a feeling of social connection through shared experiences and gives patients the tools to self-manage their pain and its impact, improving function as well as mental wellbeing and confidence.

Positive Results 

100 people have been referred to It’s Your Move.  The results of the initial pilot of 19 participants showed positive results:

  • 18 out of 19 participants reported a reduction in pain severity.
  • 13 out of 19 participants reported reduced interference from pain in their activities of daily life.
  • 17 out of 19 participants reported improvement in both amount of, and attitude toward physical activity.
  • 12 out of 19 participants reported improved mood and reduced anxiety.

“I cannot over emphasise how ground-breaking our work is,” said Cathy.

“With Active Gloucestershire it’s not about going straight to the gym, it’s about the broader relationship between activity and health and the amazing results.

“We have been praised in Gloucestershire by NHS England for the way we have developed our Clinical Programme Group (CPG) which has wide membership, including the voluntary and community sector.

“It’s been lauded as the right way to do things,” she added.

Activity is a Powerful Tool

“Exercise is a story that needs to be told, it’s been trialled as a treatment in our system and it works,” said Cathy.

“National Institute for Health and Care Excellence (NICE) guidance suggests that exercise is the only treatment that should be offered to everyone with chronic primary pain.

“A lot of the treatments that we used in the past have proved disappointing as we now realise the evidence for them was flawed.

“Current tools for examination of evidence are much more rigorous, and support what we have seen in real life for a while, that medicines didn’t seem very helpful” she said.

Building relationships with Healthcare Professionals 

“Patients need to have a trusting and validating relationship with their GP practice, and we need to equip GP practices and care givers with the right tools.

“If we have a good and trusting relationship with our GP practice we are happier to try alternatives such as activity because we know they have got our best interests at heart.

“NICE guidance suggests that having good relationships with professionals who listen to them, empathic believing relationships, is more important to people with pain than treatments.”