Pain Psychology Service

We know that living with pain doesn’t just affect you physically. Long-term pain also impacts on the way you feel, the thoughts you might have and your overall wellbeing. Our Pain Specialist Psychologists offer support and guidance to help you manage pain and the impact of pain on your mood and everyday life.

Seeing a clinical psychologist does not mean that we think your pain is ‘in your head’.

If you have been referred to the Pain Psychology Service for psychological support, you will be invited to attend a group-based information session to learn more about our service. This will be followed by an assessment appointment if you are interested in working with us.

Our support is usually provided through individual therapy or a group programme. We also provide support for individuals who would like to reduce their pain medicines, alongside our colleagues in pharmacy. 

We also offer psychological assessments as part of the neuromodulation pathway within the Leeds Pain Management Service. This is for people considering having implanted devices including spinal cord stimulators (SCS), posterior tibial nerve stimulators (PTNS, PNS), and occipital nerve stimulators (ONS).

The following psychologists provide input into the Pain Psychology Service:

  • Dr Vivienne Laidler, Principal Clinical Psychologist
  • Dr Andrea Brown, Senior Clinical Psychologist
  • PJ Whitlock, Senior Psychological Therapist
  • Dr Maria Chu, Clinical Psychologist
  • Dr Morgan Crummack, Clinical Psychologist
  • Luke Todd, Postgraduate Trainee Counselling Psychologist
  • Rita Haligah, Assistant Psychologist

Appointments are available at St James’s Hospital (Fielding House) or via video consultation.

Understanding long-term pain

If you are reading this, then you probably have long-term pain, or are close to someone who does. Our aim is not to ‘educate you on your pain’, as you probably know pain better than most people. You know and feel it, you have the ‘lived experience’ of long-term pain. But what you might know less about is the ‘science behind pain’, the physiology of it.

As clinicians, working with people who live with long-term pain, it is our goal to share with you the most up-to-date scientific knowledge about pain. The consensus in modern science is that long-term pain is real. It is not ‘all in your head’. Moreover, long-term pain is as real as acute pain.

We believe that learning about the biology of pain can be extremely valuable, as it can give hope and direction on how to manage it. In this section you will find an explanation of long-term pain, and a list of carefully selected resources to help you learn more about the physiology of long-term pain.

Pain is a protective mechanism – it occurs when your body’s alarm system wishes to alert the brain to actual or potential tissue damage. This is extremely valuable to us as humans.

Some people cannot experience pain. One rare medical condition called Congenital Insensitivity to Pain with Anhidrosis, or CIPA, results in inability to experience pain. People diagnosed with CIPA often die in childhood, due to injuries or illnesses going unnoticed.

Pain is unpleasant and attention-grabbing by design. When it increases, we cannot think, feel or focus on anything else. However, the pain system sometimes acts oddly. The brain could decide that it is not in our best interest to feel pain, despite tissue damage – think of severely injured soldiers who do not report pain until they leave the battlefield, or surfers who cannot feel the pain of a shark bite, until they reached safety.  
Pain can also sometimes hang around for longer than is helpful, after the damage has healed. Think of phantom limb pain – pain in an area of the body that is no longer there (e.g. following amputation).

Events like this show us that the amount of pain experienced does not necessarily relate to the amount of tissue damage; this is particularly true in pain that persists over 6 months. Long-term (chronic) pain often does not indicate on-going damage, even though it feels like it. In fact, long-term pain is often associated with increased sensitivity of the nervous system. This results in an increased response to painful stimuli (hyperalgesia) and even normally non-painful stimuli becoming painful (allodynia) – both are common in people who experience long-term pain.

Information:

Understanding your pain is the first step to better managing it. It often takes time and effort, but it is possible! Please see the resources section of this website to find out more about mechanisms of pain.

Individual therapy

Individual therapy involves talking to a psychologist one-to-one. It’s sometimes called talking therapy. You’ll think together about the things that you are struggling with and the goals that you’d like to work towards.

During your initial appointment there will be time for you to talk to one of our psychologists to discuss your situation, and to agree what might help. It can feel a bit uncomfortable at first, but we will do our best to put you at ease. Just arrive for your appointment and we’ll take it from there. In the first appointment, we will tell you a bit more about how we work, we will ask you a few questions about how you manage your pain, and see if our service is right for you. It is normal to worry about your first appointment, but you will be surprised how quickly time flies in the initial session.

Important advice:

There are three types of talking therapies that we typically offer:

  • Cognitive Behavioural Therapy (CBT) 
  • Acceptance and Commitment Therapy (ACT)
  • Compassion Focused Therapy (CFT)

Cognitive Behavioural Therapy (CBT) is a very practical, hands-on, goal-oriented psychotherapy treatment that aims to help the person identify and change patterns of behaviour and thinking that can be unhelpful when living with long-term pain. CBT is a very popular approach, with a good evidence base supporting its use in managing long-term pain, as well as other problems such as depression, anxiety, and panic attacks. For more information about CBT you can visit Get Self Help.

The focus of Acceptance and Commitment Therapy (ACT) is creating a rich and meaningful life, while accepting the pain that comes with it. Instinctively, we as humans want to reduce the pain so it becomes a much smaller part of our lives. However, the reality is that this is not always possible. In these circumstances, ACT aims to help people add more to their life, make their life bigger, so the pain becomes more manageable. ACT can help to deal with long-term pain by developing mindfulness and acceptance-based techniques. For more information about ACT you can visit Get Self Help website.

Compassion Focused Therapy (CFT) encourages the person to respond to their pain using skills of compassion. It helps to deal with shame and self-criticism, which often accompany people living with long-term pain. CFT can help to deal with this by developing self-soothing, mindfulness and compassion-based techniques. CFT is a biopsychosocial approach developed to help people understand how their brains and bodies work, and recognise that by design we have “tricky brains”. For more information about CFT you can visit Get Self Help website. 

Often more than one type of therapy may be beneficial for a person, so do not worry about trying to pick the right one for you. We will discuss your options with you at your first appointment and suggest a treatment plan tailored to your needs.

Living with Pain Group

The Living with Pain group is based on a holistic model of pain. This means that we understand that your pain affects not just physical functioning, but also the things you do, your thoughts and feelings, and the people you are close to. The Living with Pain group aims to help you manage your symptoms better, so that these have less impact on your life. It aims to help you to engage in the things in life which are important to you.

The Living with Pain group is a group for people with long-term symptoms. There are up to around 12 people in the group. The group format means that you can gain ideas and support from other people who also live with long-term pain. The group is run by the multidisciplinary team from the Leeds Pain Management Service including psychology, physiotherapy, pharmacology, and pain consultants.

During the group sessions we will look at a range of physical, psychological and practical ideas for managing your symptoms and their impact on your life.  The sessions will involve teaching, discussion and practical tasks. These ideas will work best if you put them into practice in your daily life, so we will encourage you to work on these ideas between sessions.

To find out more about our Living with Pain Group please speak to a member of the Leeds Pain Service.

Three photos showing a mindfulness seminar, with clinicians presenting to patients who are sat taking notes.

Pain and medication

Medication can play a role in helping to live with long-term pain. But all medications have side effects, and side effects can become very difficult to live with over time, sometimes to the point where continuing to take the medication seems unhelpful. If this is the case, it might be worth considering reducing your pain medication. However, we know this is extremely challenging. Being afraid of what might happen if you reduce your medication is one of the biggest challenges. Many people fear that they may not be able to cope if the pain gets worse.

Unfortunately, when you first start reducing your medication, things could get worse before they get better, but the benefits can be worthwhile! After reducing medication, many people report feeling clear-headed and return to feeling more like their normal selves again. Other benefits might include improved attention, memory, and concentration, as well as reduced mood swings.

Your benefits might not become clear until after you start reducing your pain medication – you may find that it was actually making you feel worse rather than better, or that it is just as helpful at a lower dose and has fewer side effects.

Important advice:

Here are some ‘top tips’ from people who have reduced their pain medication:

  • Try and approach it with an open mind
  • Talk to people that are close to you about how you’re feeling
  • Remind yourself of how well you’ve done whenever you reach a goal
  • Take it slowly, reduce gradually
  • Remember there will be ups and downs when reducing your pain medication, but there were ups and downs when taking high doses too!
Learn more about pain and medication

Activity and Pacing

It is very common for people with long-term pain to do less over time. Following an injury, pain can be really useful in reminding us to slow down and avoid further damage as we heal. However, when pain persists even after the damage has healed, inactivity is no longer helpful and can even be detrimental to our wellbeing. Not doing enough can lead to muscle weakness, stiffness, and low mood, which in turn leads to more pain.

By gradually increasing your activity, you can reverse this negative cycle.

When you first increase your activity, it is likely you will still feel pain. That’s okay! Remember that pain does not equal damage. The important thing is to pace yourself.  This could mean doing less than your best on a good day, but could also mean pushing yourself on a bad day. You should aim to gradually increase your activity even if pain is present, but stop activity before the pain becomes unbearable.

You might find it useful to plan your activity. Adjust how you carry out your tasks so you can achieve them – this could involve adding in rest breaks, planning your journeys, and asking for help when it’s needed.

Mindfulness

Being mindful simply means paying attention, with flexibility, openness, and curiosity. This tells us that mindfulness involves being aware of your experience in the present moment, and being able to consciously direct your attention to different aspects of the experience (as opposed to being lost in your thoughts). Even if this experience is difficult, painful, or unpleasant, mindfulness can allow you to be open and curious about it instead of avoiding or fighting it.

For several decades, mindfulness-based therapeutic approaches have been used by psychologists and other healthcare professionals that work with patients experiencing long-term pain. There is evidence to show that mindfulness can be useful to individuals with all kinds of concerns, including long-term pain, but also stress, sleep problems, anxiety, and high blood pressure.

Whilst mindfulness practice is not designed to alleviate pain, it can help reduce distress. It does so by helping you to connect with the ‘here and now’, to notice what is happening, and thereby giving you an opportunity to take positive action and move towards what is important to you.

Goal setting

SMART-ER Goals

Goal setting is an essential part of life. We all need goals to help guide our lives towards what is important to us. However, we are often discouraged, or even scared, about setting goals. This tends to be caused by our human tendency to set unspecified, unrealistic, and not well thought-through goals. Another common mistake is setting ‘other people’s goals’, doing what other people tell us to do. Most of us will also be scared of failure, preferring not to set any goals in order to avoid disappointment. Long-term pain makes it extremely difficult to set goals and to find motivation. More than anything you will need a good strategy in setting your goals. One strategy that we find particularly useful is the SMART model.

SMART is an acronym that can be applied to the goals we set for ourselves in order to make them easier to tackle. It specifies that our goals should be:

  • Specific (What exactly would this look like? What do I need to start?)
  • Measurable (How much? How many? How will I know when it is accomplished?)
  • Achievable (How realistic is it? Is this the right time?)
  • Relevant (Is this really important for me?)
  • Time-bound (When? What can I do today?)

More recently the SMART model had an upgrade to include two more important aspects of goal setting. The new and improved SMART-ER model takes goal setting two steps further. It encourages us to always Evaluate the goals we set, and to Reward our efforts. An example how this model can be used is presented below.

Jane, who lives with long-term pain due to a failed back surgery and arthritis, has found it very difficult to find time and motivation to do her hobbies. She wanted to ‘be creative’, and to feel like she ‘achieved something’ in her day. Initially Jane did not know how that would look like. She said that in the past she really enjoyed drawing and painting.

There were many obstacles for Jane to set a right goal. She was scared that she will set her hopes high, spend a lot of money on art supplies, and end up not doing anything, and feeling worse in herself. She was also worried about being able to hold the pencil or brush for a prolonged period of time. She said that sometimes she has a hand tremor, which can make it difficult to hold a pen, and was worried that her drawings will be ‘ugly’.

In the end Jane’s SMARTER plan looked like this:

  • Specific: I want to start drawing again
  • Measurable: I would like to draw something everyday, a small sketch maybe
  • Achievable: I could start with simple pencil drawings, I found some video tutorials online, this will make it easier to start
  • Relevant: Drawing makes me feel like I have done something useful, and I am being creative. I always enjoyed arts and crafts, specifically drawing and painting.
  • Time-bound: I will start small, 15 minutes a day, from tomorrow
  • Evaluate: After the first two weeks I noticed that on some days I don’t have the time to draw, so a more achievable goal is to do it 3 to 4 times a week. I also notice that having my pad and pencils next to the sofa reminds me to draw, so I always leave it there.
  • Reward: I noticed that it gives me great pleasure to show my drawings to my family. After the first week I also got myself a bigger notepad so that it is more comfortable for me to draw.

If you would like to learn more about setting goals you can go to our resources section

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