When pain continues to be experienced even after tissue has healed and the pain lasts for more than 3 months, this is called persistent or chronic pain.
The St Vincent's Hospital Sydney Department of Pain Medicine offers assessment, management services and programs for patients experiencing persisting pain. This includes post trauma, surgery and pain arising from chronic medical conditions.
Our services include consultation for hospital inpatients and an outpatient chronic pain clinic for people living in the community. For rural and regional patients a telehealth service is also offered via referral from your primary care General Practitioner.
Our multidisciplinary team here at St Vincent’s Pain Clinic are committed to closing the gap for Aboriginal people living with chronic pain. As a result since 2015, we have been offering clinic sessions for patients at the Aboriginal Medical Service in Redfern.
We also deliver rural education weekends and pain clinics in the Southern Local Health District as part of our outreach service.
The Acute Pain Service (APS) offers 24/7 clinical advice, support, supervision and education regarding pain relief practices, symptom management and adjunct therapies for patients admitted to the emergency department, post-surgery and other hospital inpatients who have difficultly managing pain or who have complex pain conditions such as acute or chronic pain, acute pain management in patients with a history of substance use and or addiction, or pain associated with trauma.
The APS team provides oversight of specialised pain relief techniques and modalities including Patient Controlled Analgesia (PCA), Regional Analgesic techniques including Epidural and Peripheral Nerve infusions and multimodal oral analgesic regimens. Ensuring appropriate discharge analgesia and opioid stewardship are also key roles of our APS. The APS team will engage and co-ordinate assistance of other relevant teams (i.e. Palliative Care, Drug & Alcohol Services) and allied health teams when appropriate to ensure that pain is managed within a biopsychosocial framework that utilizes a multidisciplinary approach to pain management.
The Acute Pain Team works closely with our Chronic Pain Service to assist in the management of patients who are at high risk for transition from acute to chronic pain.
St Vincent’s Hospital Pain Clinic
St Vincent’s Hospital Pain Clinic provides pain assessment and management services and programs for people living with chronic pain. A referral is required from either your GP (valid for 12 months) or another medical specialist (valid for 3 months) to the pain clinic once investigations have been completed and acute medical issues have been addressed.
Referrals
Referrals are to be sent electronically by GPs/medical specialists participating in eHealth, faxed to (02) 8382 2788 or emailed to SVHS.ChronicPainService@svha.org.au
Inclusion Criteria
- Pain has significant impact on self-care necessitating the assistance of others
- Pain is impacting on sleep, mobility, work, study, recreation, relationships, emotions
- Pain exacerbations have resulted in frequent Emergency Department presentations or hospital admissions
- There seem to be complex psychosocial influences relating to pain behaviour requiring specialised assessment and care
- Current or past history of addiction or prescribed medication use seem to be complicating current management
- Difficult to control 'neuropathic' pain is suspected
- Persistent pain following trauma or surgery where there is concern regarding transition to chronic pain
Exclusion Criteria
- Patients currently being actively investigated or awaiting treatment for the same condition by other specialties
- Patients presenting with drug and alcohol abuse and/or unstable or complex mental health problems as their primary diagnosis – request assessment from the relevant drug or mental health service. The Pain Service provides consultation to these services.
- Aged <16 years
Referrals need to include the following information: addressed to Prof Steven Faux, patient name, date of birth, address, phone number(s), email address, if an interpreter will be required, Medicare number, reason for referral, history of pain experience, current medications, relevant reports and where relevant Insurer approval. On receipt, the referral will be triaged and an appointment scheduled. An auto-generated text message will be sent to the patient (if they have a mobile phone), and a letter will be sent with the date and time. The GP/medical specialist practice will also be sent a confirmation where a telehealth consultation will take place for rural patients usually at the referring doctor’s practice.
Clinic hours
The main clinic is held Fridays (except on public holidays)
- Morning session 9:00 am to 11:30 am
- Afternoon session 1:30 pm to 3:30 pm
The Physiotherapists and Psychologist also see some individual patients Monday-Thursday.
Group programs are run several times per year. These programs generally run on Tuesdays and Wednesdays.
St Vincent's Hospital Sydney Telehealth Pain Clinic
An appointment for a telehealth consultation in the Pain Clinic is available for people who live in Southern NSW; including south of Batemans Bay to Eden, Cooma, Yass, Crookwell and Goulburn. A request for a review via telehealth can be made using the same referral criteria as above.
Appointments for telehealth consultations must be arranged in advance. The process for connecting will be outlined when the appointment is confirmed by the Pain Clinic
For enquiries please contact the St Vincent’s Hospital Sydney Pain Clinic via email: svhs.chronicpainservice@svha.org.au or phone: 02 8382 5240.
What happens at the Pain Clinic?
Once your appointment is confirmed you will be sent a questionnaire which we ask you to complete prior your appointment. Your answers will better assist the Pain Specialist and team members to understand how pain is impacting your life and the activities you enjoy.
Your first appointment will be with a Pain Specialist who will conduct a comprehensive assessment of your pain history. This will take approximately one hour. Your case history will then be presented at the clinic’s multidisciplinary team review to formulate your individualised pain management plan. A written report including the assessment findings and management plan will be forwarded to your referring doctor (this can take up to two weeks post consult).
The pain management plan will likely include a number of different strategies such as a referral to the: physiotherapist; psychologist; and/or pain management group program. Information on other resources such as books, websites and apps may be provided which can help to increase your understanding about pain and how to manage pain flare ups. Medication review and education on the appropriate use of medicines will also form an important part of any pain management plan. Follow up review with the Pain Specialist may also be advised.
Meet our team
Director: Prof Steven Faux (Pain and Rehabilitation)
Chronic Pain Clinic Consultant Specialists: Dr Clive Sun (Rehabilitation), Dr Martine O'Neill (Anesthetist), Dr Raj Anand (Rheumatologist)
Additional Consultant Specialists: Dr Jenny Stevens (Anesthetist), Prof Ray Garrick (Neurologist), Prof Richard Chye (Palliative Medicine & Supportive Care Physician) & Prof Milton Cohen (Specialist Pain Medicine Physician & Rheumatologist)
Chronic Pain Fellow: (Rotates Annually)
Psychiatrist: A/Prof Tony Richardson & Dr Kate Mullin
Psychologist: Dr Jane Wheatley
Senior Pain Physiotherapists: Irina Grassi, Mandy Lau & Tania Gardner (Reboot Online Coordinator)
Clinical Nurse Consultants: Bernadette Findlay (Acute Pain) & Áine Killeen (Chronic Pain)
Administrator: Susan Webster
Chronic pain is complex and the most effective way to manage chronic pain is to approach it from various angles. A multidisciplinary program is the best way to provide a holistic and evidence based approach.
Our team offers several programs that have been shown to improve a person’s ability to manage and live life again despite their chronic pain. All programs aim to provide education about chronic pain and support you as your learn the skills that will help you manage pain and regain your function long term. Your suitability for the programs will be determined in consultation with you following your assessments with our team. Prior to these assessments, you may be invited to attend a pre-Clinic Education Session.
Pre-Clinic Education
This a 2 hour education session held every month to provide an understanding of chronic pain and introduce the skills and techniques of pain management, to help you prepare for your appointment.
Reboot
Reboot is a group pain management program held at St Vincent’s Hospital. The group runs one day a week (9.45am-3.30pm) for 10 weeks, on either a Wednesday or Thursday throughout the year.
The aim of the group is to equip you with knowledge, confidence and skills to help self-manage your pain, improve your quality of life and function. To achieve these aims the Reboot program provides information and training in:
- Understanding chronic pain, how it works and how you can manage it differently
- Improving your movement with stretching, strengthening, aerobic exercise and tai chi
- Managing your mood and improving the way you think and feel about pain
- Using strategies, such as goal setting and pacing, to gradually increase your activity and return to doing things that are important to you
Rebalance
Rebalance is a group management program specifically designed for those with lower levels of physical function who may need to start with more targeted balance and strengthening exercise, as well as for those aged over 65 years who experience chronic pain. The group runs for 3 hours (10.00am-1.00pm) a week over 6 weeks. The program covers the normal Reboot components in a less intensive format.
It is normal to feel anxious or worried about joining one of these groups. Some patients wonder if they will be able to cope with the hours. Please be assured that the programs are designed for people with chronic pain and are run by experienced team members. Past participants of the programs often report that a helpful part of the program was simply meeting others who also experience chronic pain as this condition can be quite isolating.
If you are unable to attend one of our face to face programs we also offer an online pain program that we have adapted “Reboot online”.
Reboot Online
The Reboot Online Program is a collaboration between the Clinical Research Unit for Anxiety and Depression (CRUfAD), headed by Prof Gavin Andrews and the Department of Pain Medicine, St Vincent’s Hospital, Sydney, headed by A/Prof Steven Faux.
We have developed this automated, clinician-guided pain management program that is delivered over the internet to consist of educational lessons, personalised graded exercise plans and video demonstrations, relaxation strategies and various resources to help patients learn to self-manage their pain and improve their quality of life. Designed to enhance patient care, Reboot Online provides a low-cost, easily accessible intervention for patients with chronic pain who cannot be reached by our service, and for those who require additional support after completing the on-site Reboot Program.
Reboot Online is based upon St Vincent’s Hospital’s ‘Reboot’ Pain Management Program (face-to-face service) and modelled on existing internet-delivered cognitive behaviour therapy (iCBT) programs successfully disseminated by the Clinical Research Unit for Anxiety and Depression (CRUfAD).
The Reboot Online program is unique in that it includes activity based components and a graded exercise program, alongside traditional CBT modules (including pacing, goal setting, activity planning, thought challenging, communication skills, reactivation and stress management).
https://thiswayup.org.au/how-we-can-help/courses/chronic-pain/
What is the evidence for this program?
To gain preliminary evidence of the feasibility and acceptability of Reboot Online, we have conducted a consumer focus group (May, 2015), and a pilot trial with 20 patients with chronic pain (completion date: 30 September, 2015). To further evaluate this program, we completed an Australia-wide randomised controlled trial (RCT) to compare the acceptability, feasibility and efficacy of Reboot Online to a control group who receives ‘usual care/treatment’ for chronic pain.
If you are a patient and are interested in our online program you need be referred to the program by your clinician (Dr, nurse, physiotherapist or psychologist).
Clinicians need to be registered to be able to refer a patient. Clinicians can register at www.thiswayupclinic.org/users/clinicianRegistration
If you are interested in one of our programs make sure to discuss this with our team at your pain clinic assessment appointment.
Aboriginal Medical Service
Our multidisciplinary team here at St Vincent’s Pain Clinic are committed to closing the gap for Aboriginal people living with chronic pain. As a result since 2015, we have been offering clinic sessions and case conferencing for patients at the Aboriginal Medical Service in Redfern. We provide patient assessment, education and management plans and the GPs can link people with local providers, such as exercise physiologist, psychiatrist, psychologist, and dieticians.
Chronic Pain Outreach
Outreach Pain Management Education and Services between Southern NSW Local Health District, COORDINARE and St Vincent’s Health Network was established in 2015 with the vision to facilitate capacity building education for GPs and allied health practitioners that will reinforce a shared evidence base for chronic pain management in the community. Our multidisciplinary team provides four annual outreach visits that involves delivering rural education weekends and running pain clinics in Sothern NSW (i.e. Eurobodalla and Moruya, Narooma, Batemans Bay, Goulburn, Yass, Queanbeyan, Bega, Pambula, Merimbula, Cooma, Jindabyne).
Understanding Pain
Pain comes from the brain and is our body’s normal way of protecting us from harm. However, pain that persists over a long period of time may not necessarily be a reflection of ongoing harm or damage. The brain is constantly weighing up incoming messages from the body and environment. These may include danger signals from body tissues that are under threat or damaged. The signals are simply chemical and electrical messages that run up to and down from the brain. The brain will interpret these messages and decide whether or not we feel pain. This nervous system is made up of many different nerves and brain cells in the body and we refer to it as the “pain system”. There are two main types of pain: acute and chronic.
Acute pain lasts a short time while chronic or persistent pain is of longer duration (3 months or more). Acute pain typically signifies damage to bodily tissues e.g. a broken arm or a surgical procedure. It is a signal that we need to become more aware of the body part, to rest and help facilitate healing. This type of pain usually settles as the tissues heal. In some cases acute pain does not settle once the tissue has healed and goes on to become chronic.
Chronic pain is usually more about the pain system being sensitised and less about damage to tissues. When pain persists, the signal is no longer a signal of tissue damage but more about a hypersensitive pain system resulting in the brain’s interpretation of danger. Many things can contribute to the hypersensitivity of the pain system. Often our thoughts and feelings about the pain will keep the pain system sensitised e.g. thoughts and fear of serious damage or anger about the circumstances of the injury. Chronic pain often leads to reduced activity and results in deconditioning and further fear and lack of confidence about moving. When pain becomes chronic the challenge is to move away from a focus on the initial tissue injury and switch to modifying the brain interpretation of danger and winding down the pain system.
Key messages
It is time to think differently about chronic pain:
- Chronic pain is complex and many factors can be contributing to the hypersensitivity of the pain system – you need to look at all aspects for successful management of pain.
- Know that chronic pain can change.
- Chronic pain becomes less about damage to body structures (bones, muscles, discs, joints and ligaments) and more about changes to the brain and nervous system.
I have pain related to a medical condition (e.g. diabetes, inflammatory bowel disease, multiple sclerosis, osteoarthritis or rheumatoid arthritis). Does the Understanding Pain information apply to me?
Yes. The same principles apply for pain related to medical conditions and injuries.
What do my scans/tests have to do with my pain?
Scans and investigations show structural changes but they can't show pain. Your doctor may have ordered scans to look for a structural reason for your pain experience (e.g. a broken bone, nerve injury or cancer). Some structural problems can be treated. However, something seen on a scan is not always the reason for experiencing pain. Once you rule out a harmful structural problem, strategies aimed improving what you are able to do and how well you can participate in what you enjoy are more effective.
Will I get injections at the St Vincent’s Hospital pain clinic?
Probably not. Injections are not done often as there is limited scientific evidence for benefit in chronic pain.
Will my medication need to be changed?
Your medications will be reviewed considering your individual circumstances. This may mean that there may be some recommended changes to what you have been taking. For the majority of patients, short term use of pain relieving medication is appropriate for acute pain, however most chronic pain will mean that medications will become less effective over time. Any changes in medications will be made in consultation with you, your pain specialist and GP.
Why do pain medications work less and less?
Over time, your body gets used to pain medications like opioids. This is called tolerance. Developing tolerance to a medicine means that you then need more or higher doses to get the same effect. Increased doses most often contribute to other side effects such as nausea, constipation, itchiness, sedation, inability to concentrate and sometimes addiction.
Why do opioids make your pain worse overtime?
Scientific studies also show that over time use of opioids can actually contribute to making your pain worse. This is a phenomenon known as opioid-induced hyperalgesia (OIH). It happens because taking opioids has made specific nerves and the brain more sensitive to pain. The appropriate approach to treating OIH is to wean slowly from a high dose of opioids to a lower dose whilst also using other alternatives to manage pain such as non-opioid medications, behavioural interventions and physical therapy.
How to manage opioid withdrawal symptoms?
Withdrawal symptoms can occur when you decrease the amount of opioids you are using (or abruptly cease any opioid medicine) due to physical or psychological dependence. Dependence can take as little as one month to develop. When a dose is lowered (tapered), withdrawal’ symptoms may be experienced. Generally, symptoms last for 4 to 10 days and may include: sweating, nausea, abdominal pain/cramping, diarrhoea, trouble sleeping, muscle aches, fast heartbeat and anxiety. While unpleasant, these side effects are not dangerous or life threatening. Each symptom can be managed with the assistance of self-management strategies such as relaxation techniques (e.g. listening to music/meditation) and the support of your GP.
Once the symptoms of withdrawal subside the benefits of opioid weaning and tapering can be significant and include:
- Feeling more alert and in a better mood
- Ability to increase activities, socialising and capacity to work
- Being able to drive
- Less pain
- Lower risk of overdose or other harm
I have tried everything including physiotherapy, strong pain medication and acupuncture before. Nothing works. Is it worth coming to the pain clinic?
Yes. The specialist team at the Pain Clinic can help you move from reliance on less effective medical treatments that are aimed at shrinking pain and towards increasing and building skills that can help you manage your pain more effectively. Our aim is to help you to increase your ability to participate in things you enjoy and improve your quality of life.
Does stress affect pain?
Yes, you have probably noticed that stress may exacerbate your pain. Whether it’s from depression, insomnia, relationship or financial problems, stress affects us by its effect on the nervous system. Our muscles can become tight, particularly in certain areas of the body (e.g. back, shoulders, neck), it can affect our gut causing upset stomachs, reflux and diarrhoea. Over time, a persistently stressed nervous system causes chronic muscle tension, which becomes painful in itself. Our specialist pain psychologist will help you to understand how stress may be impacting on your experience of pain. They can assist in teaching you how to explore different ways of coping with life’s difficulties. By reducing the amount of stress in your life, you will often also reduce pain.
Why do I need to fill out a pain questionnaire before the initial consult?
The doctors need this information to see how your pain affects your life. This helps the team identify strategies most suited to your individual story that can help better manage your pain.
How long is the waiting list for the pain clinic?
The waiting time is approximately 12 weeks. Our friendly admin staff will contact you to book your appointment once we have received a copy of your referral. You will be sent a reminder SMS of your appointment date & time. If you need to change/cancel your appointment please give at least 48 hours’ notice. Pease be advised that we operate a strict discharge policy for unattended without notice or regularly cancelled appointments on two consecutive occasions. This enables us to manage our waiting times more effectively.
Many resources are available to learn more about chronic pain. Below is a selection of useful links and resources to find out more.
Websites
Provides information, videos, and resources to help understand chronic pain and learn about ways to manage it.
Pain management resources for the Aboriginal and Torres Strait Islander communities can be found here.
Clinically supported information, tips, support and personal stories to help manage musculoskeletal pain.
The Pelvic Pain Foundation of Australia is a not-for-profit organisation formed to build a healthier and more productive community by improving the quality of life of people with pelvic pain.
Videos
Brainman
Information from the Hunter Integrated Pain Service about chronic pain and what to do about it.
Books
Manage Your Pain (3rd edition) is an Australian bestseller and self-management book developed by Professor Michael Nicholas along with a multidisciplinary team of pain specialists.
Explain Pain - Demystifies the process of understanding and managing pain. It brings the body to life in a way that makes an interesting read for therapists and pain sufferers alike.
The Pain Book - Finding hope when it hurts Siddall P, McCabe R, Murray R - Offers a step-by-step multidisciplinary approach to pain management, to help people live happier, more purposeful lives.
Pelvic Pain - 20-page free e-book - By Dr Susan Evans and based on the book Endometriosis and Pelvic Pain.