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Pain Is A Team Sport

Dr Claire Elphick has recently joined our community team as a Principle Clinical Psychologist in charge of psychological therapies and supervision.  Recently we shared a story from our Pain Lead Karen Cox about the Pain Redesign project. Click here to read her post.  Claire joined the team in April this year, below Claire shares how it has been since joining the Sussex MSK Partnership’s team within the community.

How have you found the transition from working in hospitals to working in the community?

I am really impressed with the buildings and working environments in the community setting.  I cover predominantly Mid-Sussex so have been working at the Vale and Sidney West. For me the transition has enabled much more joined up working with the Advanced Practitioners (AP’s) than we were able to offer before.  Before the pain psychologists were based in the Princess Royal Hospital and the AP’s were in other settings and it was much harder to communicate.  Rather than patients having to go to one place for their psychology assessment and another for their AP assessment, they can now come and see us together and experience a truly integrated appointment.  This also allows us to work better together as a team.  I think it’s also a relief for patients not having to repeat themselves all the time.  As clinicians we all like to hear the patients story from them, but hopefully if we are doing more joined up working we can hear that story at the same time and then work together with the patient to think about what to do going forward.

For many pain patients, their pain is unlikely to change; by having joined up treatment earlier on we are better able to equip them with tools that may make a difference to how they manage pain.  We can support people to learn to live alongside their pain and do the things that matter to them.  This can be empowering for patients who in the past might have felt that they have to put their lives on hold waiting for their pain to go away.

What called you to becoming a Pain Psychologist?

When I first qualified as a clinical psychologist nearly 20 years ago, I worked in pain management.  I worked in the area for about three years, but it didn’t feel it was set up well enough as a psychologist working in that field so I moved out of pain.  I have always had a split between mental health jobs and clinical health psychology jobs, so I have worked in many different areas and then about three years ago came back to pain, bringing with me my mental health and clinical health experiences.  The area has really changed in the right way over that 20 year period.

It was much more hierarchical 20 years ago whereas now it is much more integrated.  In the MDT structure everyone’s opinion holds weight.  It feels now that the diversity of people’s experience is much more valued.  It feels like a much more holistic way of working.  Now we are all trying to put the patient at the centre, which I think is the biggest shift over the past 20 years.  It’s more collaborative across the board. 

What have been some of the challenges?

The pain psychologists transferred to the community pain service at the beginning of April which of course was during lockdown.  It was challenging to have an induction when you can’t meet your team face to face.  Obviously that was a challenge the team or organisation couldn’t do anything about.  If you ask me in a years’ time it will hopefully be very different. 

Have you noticed a difference during lockdown of how people are experiencing pain?

Many people living with persistent pain have other physical health conditions and have had to shield, so people have been less able to get out, exercise and move.  Getting out, walking around, doing the things that would normally help both physically but also emotionally.  When people have to spend a long period indoors it is obviously going to have a big impact on them.  I’m sure that has been the same for lots of people in society, not just people living with persistent pain, but for people who were using the gym to exercise or swimming to control their pain, I think it has been really hard for them.  And also if you are indoors all the time and aren’t able to see anybody, and have less in life to focus on, that is going to impact people’s experiences of pain. The pandemic has impacted on many people’s mental health and we know that stress and emotional issues can impact on pain.

Before COVID as pain psychologists we did not often offer telephone assessments, we would prefer people to come in for their assessment. Due to COVID we have been forced to work in different ways. Having telephone assessments and therapy sessions has actually been quite effective for a lot of people, so I think moving forward, the choice for patients around what we offer and what we should be prepared to offer is really going to shift.  It’s different working with people over the phone, but I think it’s also about us as clinicians shifting our expectations of how we can work with patients.  It’s interesting times for the whole of health and COVID has presented a lot of challenges, but also moving forward it’s about looking at how you can use the challenges around what you do, to deliver better patient care.  For patients who might be experiencing a flare up, in the past they would have had to cancel their appointment, whereas now we can be more flexible to meet their needs.  We don’t know if that will affect outcomes hugely, and it’s something we will have to follow up, but it is a way of doing things differently.

What are some of the benefits you have personally experienced?

For me it’s about knowing you are not always making decisions on your own and being able to share expertise with colleagues, who are in the same building. This in turn gives the patient the experience of looking at what living with persistent pain means from a physical experience, but also emotionally and what that means to them.  It links the mind and the body together. We are not only sharing knowledge with the patient, but we are also sharing knowledge with each other.   

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