Behavioural Intervention for Opioid Reduction (BIOR)

Chronic pain refers to pain that is experienced long-term, meaning that it persistently occurs beyond the body’s natural healing period of three months. Generally, pain is important for human survival, it is there to protect us from potential harm by sending signals to the brain so that we respond in a protective way to whatever is demanding our attention. The persistent nature of chronic pain means that this demand on attention can be exhausting and overwhelming, and the pain often persists regardless of how much attention we give it.

It is estimated that 43% of adults (around 28 million people) in the UK experience chronic pain, this increases further in older adults, affecting 65% of those over 75 years old [1]. Additionally, more females than males commonly report experiencing chronic pain with figures in the UK ranging from 37% - 52% of females compared to 31% - 49% of males [1].

Chronic pain not only affects the individual experiencing pain, but it also impacts on those supporting the person in pain e.g., family members or carers, as well as pressures put on the healthcare system to support and treat people in pain, and the economic burdens from loss of work and cost to healthcare. Collectively, the economic impact of chronic pain on society is believed to cost more than other chronic diseases such as heart disease, cancer and diabetes [2]. 

The short videos below provide an easy-to-understand explanation of pain and why it happens.

Dr Patrick Hill, a consultant in pain medicine who explains what pain is and why we experience it.

Professor Tamar Pincus, a practising psychologist in chronic pain. In this video Professor Pincus uses a metaphor to demonstrate how psychology influences our experience of pain.

Access short videos (available in various languages) developed by a team of experts in chronic pain. For example:

Hunter Integrated Pain Service (HIPS), University of South Australia, University of Washington and Hunter Medicare Local (Hunter ML)

Brainman’s video on explains how pain is produced by the brain, why some of us have long-term (chronic) pain, how it impacts us and what we can do to better manage it.

A short video explaining how choosing to better understand your pain can lead to identifying ways to better manage it.

^{1. Fayaz, A., et al., Prevalence of chronic pain in the UK: a systematic review and meta-analysis of population studies. BMJ Open, 2016. 6(6).}

^{2. Breivik, H., E. Eisenberg, and T. O’Brien, The individual and societal burden of chronic pain in Europe: the case for strategic prioritisation and action to improve knowledge and availability of appropriate care. BMC public health, 2013. 13(1): p. 1-14.}

Chronic pain affects many aspects of life, the impact of chronic pain is often explained by a combination of biological, psychological, and social factors, commonly known as ‘biopsychosocial’. One of the most significant ways in which chronic pain affects an individual is in terms of its impact on Quality of Life. For example, the constant sensation of pain may restrict your mobility to carry out normal daily activities; this may lead to feelings of depression and anxiety, particularly when the pain doesn’t go away. It may also affect your ability to work, adding financial pressure and intensifying feelings of depression, anxiety, and social isolation. It is understandable therefore how an accumulation of all these factors can reduce perceived quality of life.

The figure below shows some examples of how the biopsychosocial factors associated with chronic pain may affect you; this is not an exhaustive list and experiences may vary by person:

Everyone’s experience of chronic pain is different, people with chronic pain often discuss how it is a very lonely journey, particularly when you feel no one else understands. In the video Renewed lives: people living with pain from the My Live Well with Pain site to hear from people with chronic pain; how it has impacted their life and how the Living with Pain programme run by their local NHS helped them to self-manage their pain and improved their quality of life.

The BBC documentary A Life of Pain investigates the prevalence of chronic pain in the UK population and you can hear some people living with chronic pain sharing their stories.

Maintaining employment whilst living with chronic pain can be difficult. A number of factors may play a role in this including the physical sensation of pain, impaired physical mobility, having to attend medical appointments, the side effects of taking medication for the pain and the psychological effects of living with pain (e.g. anxiety, depression). Forty-one percent of patients attending a pain clinic gave chronic pain as the reason for their inability to work, with a further 16% having to reduce their hours [4]. Not being able to work adds additional stress to the overall experience of chronic pain by increasing financial worries, disrupting career progression, and worsening feelings of social isolation that being part of a working environment sometimes provides.

The People At Work (PAW) toolkit provides some useful information around employee rights in the workplace and how your employer can best support you. There are also useful tips around self-management strategies and how to manage stress and cope better with your pain.

Additionally, the Living Well with Pain website was developed by someone living with chronic pain (sciatica) and provides patient-led insight into living with chronic sciatica, in addition to identifying important elements to facilitate the return to work. The information on the Return to work/education website will be relevant for those with other types of chronic pain too.  Returning to work or education or starting work/voluntary work is recognised as one of 24 key activities to living better with pain. The site provides links to a number of resources including tips on working with chronic pain, the equality act, working with a disability, employee rights and other common work-related concerns.

^{4. Dr Foster Intelligence., National Pain Audit Final Report 2010-2012. 2012, Healthcare Quality Improvement Partnership: British Pain Society.}

The Faculty of Pain Medicine is an official professional body in the UK responsible for developing practice standards and training in the field of Pain Medicine. It provides a range of information for chronic pain patients and healthcare professionals. There is a dedicated section for patients where you can find a series of free downloadable leaflets about medication and interventions used for the management of chronic pain.

Pain Concern is a leading UK charity developed specifically to provide information and support to those living in pain. On their website you can find a range of free downloadable leaflets on various pain conditions. For example: 

• complex regional pain syndrome
• bladder pain
• neuropathic pain
• vulval pain

Alternatively, Pain Concern's leaflets and publications provide further information on how to manage your pain using pharmacological and self-management methods.

The pain toolkit where  you can access 12-steps to better managing your pain are described alongside links to useful resources and videos about pain, medication and self-management.

The Action on pain website provides information and support for people with chronic pain and those who care for them. Resources on their website provide easy to read information on different types of chronic pain, tips on how to manage flare ups and medication for chronic pain, including issues you should be aware of and what to ask your Doctor.

Smile Liverpool is a community member (£3 week) support group for people with chronic pain. It offers a network for people to share experiences, practise exercise and relaxation techniques, and builds social support. Those interested in joining can call (07598528779) or email to find out more.

Sefton Community and Voluntary Service (CVS) helps manage local programmes that provide support to people within the community, including improving health and wellbeing. They have developed a directory of local services. An information and signposting service is also available (0151 920 0726).

Living Well Sefton is a free service to help support people with issues affecting their health and wellbeing, to make the changes needed to live better. Living mentors provide 1-1 support and help identify areas of your life where changes could be made. This includes, eating more healthily, stopping smoking/drinking, losing weight, exercising and mental well-being. It hosts regular events and drop-in sessions, including free health checks, walking football, pensioner club, film club and stress clinic.

Mobilecraft4u is a not-for-profit organisation located in Sefton, it delivers craft kits and community projects to help improve individuals’ health and well-being.

Partners with Living well Sefton, Brighter Living is a service that strives to provide social inclusion and improve quality of life by delivering art and crafts events, cooking/healthy eating and learning different coping skills. Their contact number is 01704381983.

A drop-in support service for anyone diagnosed with fibromyalgia or chronic fatigue syndrome. They work alongside Fibromyalgia Action UK and Pain Clinic Plus Ainsdale.

Life rooms is a free NHS service that provides support and signposting to a range of services (from volunteering & employment to physical and mental well-being). They operate a telephone support line rather than the usual drop in due to COVID-19.

Wellbeing Liverpool is a service that brings together GPs, social prescribers (link workers) and community groups to improve wellbeing across Liverpool. Individuals can refer themselves or ask their GP to refer them and put together a personalised health and well-being plan.

Future Learn offers free online psychological first aid training in regard to the emotional impact of COVID-19. 

New Beginning is a social prescribing service that refers people to a range of non-clinical services to improve their mental health and wellbeing, with separate groups for men and women to take part in.

Daisy UK offer courses and workshops to young and adult disabled people and wider community, they promote classes that develop self-motivation, independent living and learning and enriching life through health activity and improving wellbeing.

Wellbeing Enterprise (WE) operates across Halton, St. Helens and Knowsley to deliver asset based social prescribing (non-medical sources of support). This includes psychological therapy prescriptions (e.g. life skills/CBT, stress management, mindfulness) and social inclusion prescriptions (e.g. activity bases classes). They work with HCPs, local community and businesses to promote well-being. This report describes the services of social prescribing and healthcare very well.

Think Wellbeing St Helens is a team of well-being psychological practitioners and CBT therapists providing free NHS support to make positive life changes. The service offers well-being workshops, group therapy, 1-1 support and telephone support for adults aged 16 and over with common mental health problems such as anxiety or depression that are also linked to long-term physical health conditions.

Pain UK lists 36 UK based charities providing support to patients living with a range of chronic pain conditions. The charities listed are mostly run by patients and a platform for people to share experiences, get information about pain and telephone support numbers for specific pain conditions.

Pain Concern has downloadable information resources, a radio station and podcast providing news updates, videos, and links to information about self-managing pain and breaking down barriers to coping better with pain. They also have a helpline telephone number (03001230789) and a private members community forum.

Opioids aware shares patient testimonials of working with pain specialists to improve how to live better with pain.

The pain toolkit has compiled a number of links to free resources around the UK that help support people in chronic pain to better manage their pain. They also have free access to an online café for anyone to talk about pain and self-management.

ESCAPE-pain is a free a 6-week educational self-management and exercise programme produced in the NHS by the Health Innovation Network and Salaso Solution Ltd for people with knee and hip pain, and chronic lower back pain. The courses are available for free online in a web-based version or can be downloaded onto a smartphone app. 

Flippin Pain provides information on understanding pain and self-management, moving towards recovery and information for health care professionals, including booklets, videos and podcasts/audio books.

Action on pain is a volunteer led charity to support people with chronic pain and their carers. There is a telephone helpline (0345 6031593) and a national network of support groups, with a mobile support unit for advice and support that travels around the UK.

NHS pages on managing chronic pain and 10-ways to reduce pain provide some brief and generic information (as well as links to examples) on using exercise, staying at work, physical therapy and using painkillers to help manage chronic pain.

To better days gathers links to (limited) offline support groups available around the UK and also online information resources. You should also visit their Facebook account and the To Better Days Instagram pages where they share the latest information and chronic pain advice. There is also provision for a WhatsApp support service available on their Facebook page.

Burning nights is a guide, blog and forum sharing information on various therapies and techniques to better manage CRPS and chronic pain. It is a resource that mostly addresses CRPS, providing information on what it is, symptoms and treatment. It provides a summary of places and people to reach out to for support, including links for families and carers. Also see their 18 tips on how to prepare for your pain appointment.

The British Pain society is a multidisciplinary professional organisation dedicated to all matters related to pain. Useful for both healthcare professionals and patients. The resource for patients provides information on support available for people in pain, BPS publications and recommended reading sources, links to other useful organisations for different types of pain and videos of patient voices. It has a list of FAQs that patients might find useful including questions around medication.

Steps2wellbeing offers a body and mind service to help individuals manage the impact of long-term conditions such as chronic pain through use of CBT.

Talking Health provides a platform where individuals with various long-term health conditions can share their experiences.