Changing the conversation about health

Community Chronic Pain

CoM Tags:

chronic pain, Alexander Technique, community, integrated health,

Community Chronic Pain is a community based service in Kent helping people who suffer from persistent and severe pains to develop ways to self manage their pain.Their team of specialists in pain management include nurses, doctors, psychologists, physiotherapists, supportive practitioners (Alexander Technique teachers, acupuncturists, and Tai Chi instructors) and an administrative team.

It is difficult to totally relieve chronic pain, and the service aims to involve the patients as actively as possible in managing their pain, so that they can have more control over it and ultimately improve their quality of life.

Alexander Technique is one approach that can be offered to help individuals and is the focus of this project.

Year established
2006
Number of staff
Paid Staff 32.3 full time equivalent (no volunteers)
Number of users
1,800 referrals each year with around 100 referrals internally for Alexander Technique (around 1,200 appointments annually)
Is there a charge to users?
No charges

 

What makes your project sustainable?
We continually strive to provide an effective and efficient pain service that works with patients and commissioners to meet their needs while working within the boundaries of an NHS led service.
Innovation
Providing Alexander Technique lessons as part of a NHS Community Chronic Pain Service is innovative as few pain services provide this approach. By offering Alexander Technique lessons as part of a patient’s care pathway this can encourage and develop the patient’s role in:

• Self managing their pain
• Exploring natural responses to pain which unfortunately may have become habitual causing problems

Challenges have been:-
• Meeting the demand with the service’s capacity
• Maximising capacity of Alexander Technique lessons
• Balancing number of lessons against evidence base, funding and capacity
• Regulations and contracts to provide Alexander Technique lessons

The outcomes of our first Audit showed that patients are really positive about Alexander Technique lessons being part of the service and the benefits they have gained.

Annual Service Development Projects monitor that standards and benefits are being sustained.

Patient-Centred, whole person preventative approach
Our service shares the ethos of the College by providing patients experiencing long term pain with a holistic integrated care approach, which enables patients to develop their ability to self-manage.

A range of services are available within Community Chronic Pain. At the patients’ first appointment an individual care pathway is agreed and Alexander Technique lessons may be offered as a part of that pathway. As a service we aim to involve our patients as actively as possible in managing their pain; learning and applying the Alexander Technique can support improvement in patients managing their own wellbeing.

We have developed an Alexander Technique Patient Information leaflet with the involvement of our patients, and are actively looking at areas where we can further support our patients; this has resulted in producing a Compact Disc, guiding the patient through lying in semi-supine, used in conjunction with their lessons and then for ongoing support.  We are currently at the stage of User Testing an Alexander Technique Workbook for patients, which we hope will further support our patients in their ongoing self-management.

Evidence informed practice/audit and evaluation
  • Our service is committed to Service Development Projects to assess and evaluate the outcomes of Alexander Technique. Please see attached overview of last two audits/SDPs
  • Anecdotal evidence from long term experience of providing Alexander Technique lessons within a Chronic Pain Clinic
  • Service delivery supported by evidence from recently published studies: Little et al (2008) RCT of Alexander technique lessons, exercise and massage (ATEAM) for chronic and recurrent back pain. BMJ 337:a884. Details of further studies past and current can be found on the www.stat.org.uk
Multi-disciplinary collaboration, communication and professional practice
On entry into our service patients receive a full assessment at which an individual care pathway will be agreed with them. As part of this pathway patients may be referred for Alexander Technique lessons, Acupuncture or Tai Chi, as well as the more conventional modalities of pain management courses, psychotherapy, Tens, medicaton review etc. As patients work their way through their individualised pathway they will be reviewed at regular intervals and their progress communicated back to their GP. Practitioners will throughout communicate with each other where appropriate, working together to ensure adequate support for patents and staff. Team members are required to attend our service MDTs, as well as weekly clinical MDTs in each clinic location.

Patients are encouraged to communicate their experience of our service through Service Development Project feedback forms, service evaluation forms/comment boxes/online and through ongoing communication with their practitioners. We continue to strive to provide an effective and efficient pain service that works with patients and commissioners to meet their needs while working within the boundaries of an NHS led service.

All staff are supported with mandatory training and in furthering their professional development, where possible with funding and provision of study leave. Staff receive annual appraisals and regular one to one meetings with their clinical supervisors, where their individual needs and requirements can be discussed.

As a service we continue to explore ways of improving our patients’ experience and communicating what our service can offer both to patients and GPs; this can include ‘Pain Days’ for patients and training days for GPs. We are currently looking at additional clinical measures as part of our total service and as a means of demonstrating the value of our service to Commissioners.

 

Quotes from service users
“I have found my time with the Alexander Technique clinic a great help in my management of my chronic back pain, I am able to keep active which is a great bonus to my physical and mental wellbeing. When I was referred to t
his clinic I did not know what to expect but I am so glad I went and I am sure it will be a very useful tool in my everyday life.””The Alexander Technique adresses the body as a whole and has helped/helps address issues in the body that can build up over time when suffering with chronic pain. It has definitely helped me tremendously.””I was totally unaware how I affected my own pain”.”Very useful course to follow, I have gained a lot of guidance and support in many areas. Strongly recommend this course.”

“Alexander Technique has helped me gain more confidence and freedom of movement.”

Contact details
Karen French/ Heather Hawksley
Community Chronic Pain
Kent Community Health NHS Trust
St Augustine’s Business Centre
125 Canterbury Road
Westgate-on-Sea
Kent CT8 8NLt: 0300 123 1753

e:kfrench2@nhs.net
hhawksley@nhs.net