iMSK – Community Pain Management

This leaflet tells you about the iMSK – Community Pain Management service, what it offers, what to expect at your appointments, and how the Living Well with Pain Programme can help you manage persistent pain. It also explains what the service does not provide and how to contact the team for support.

Who is the iMSK – Community Pain Management service for?

The iMSK – Community Pain Management service (CPM) supports people with a diagnosis of non-cancer pain lasting longer than 6 months, often called chronic or persistent pain.

What is the iMSK – Community Pain Management (CPM) service?

The Community Pain Management service is part of the Integrated Musculoskeletal service (iMSK). CPM is a Psychology and Physiotherapy led service. It consists of a team of Psychologists, Psychological Therapists and Physiotherapists who specialise in pain management. Our service works in the community for example in community health centres and more traditional settings such as in hospital outpatient areas. You may have been referred to us from services such as the Secondary Care Pain Team (Pain Clinic), iMSK – Musculoskeletal Advanced Assessment, iMSK – Physiotherapy, Rheumatology, or your GP.

What do we not offer?

We do not offer medication reviews, scans such as X-rays or MRIs, medical interventions, such as injections, or medical advice. For these services we advise you contact your referrer or GP.

What can the iMSK – Community Pain Management Service do for you?

Our primary intervention is a Living Well with Pain Programme (LWWP).

This is a group-based treatment, which takes into account the wider impact of pain (lifestyle, psychological and social factors). In doing so, this programme aims to give you a toolbox of strategies to manage your pain and everyday activities better.

We cannot take the pain away but we can help you to have a better quality of life despite the pain.

This programme offers an alternative treatment approach to medical interventions and medications. The LWWP programme is jointly facilitated by psychology and physiotherapy, aiming to provide you with a holistic(complete) approach to care.

This programme runs for either 6 or 9 weeks depending on your assessed needs. Each session runs between 2½ to 3 hours with a 20 minute break during the session. These sessions will occur once a week for the determined number of weeks on either a morning or afternoon.

While attending the LWWP programme, you will develop skills that help you cope with and manage your pain. These skills include:

• Understanding both the psychological, biological and social components of persistent pain.
• Learning about managing everyday activities, such as hobbies and work.
• How to relax both your mind and body.
• How to pace your activities to reduce the pain you experience.
• How to improve your ability to do activities that are meaningful to you.
• How to improve your confidence to cope with persistent pain.

Based on your assessed needs, in some cases, you may be referred for 1 to 1 support with a Psychologist/Psychological Therapist or Physiotherapist within the CPM service.

What will my first appointment look like?

A member of our team will help to see if our services are suitable for you.

In most cases, your initial appointment will be with a member of the Psychology team. This appointment is called a ‘Psychology Triage Assessment’ and is usually done over the telephone lasting about 1 hour. During this appointment, they will ask you questions so they can learn more about the pain you experience and give advice about further interventions available within the service.

Alternatively, your first appointment may be with a member of the Physiotherapy team. See ‘What to expect in a 1:1 physiotherapy session’ below for further details.

What will happen after my Psychology Triage Appointment?

Once you have been assessed, you will be added to the waiting list for your agreed intervention, or signposted to a local service that may better meet your individual needs. For example, mental health services or services which support with physical activity within the community.

Based on your assessed needs, if a Living Well with Pain Programme was deemed the most appropriate intervention for you, you will be offered a taster session. This session runs for 90 minutes and it is a chance to meet some of the CPM team, whilst gaining an understanding of the content of the LWWP programme in greater detail, a chance to ask questions, experiencing what it is like to be in a group environment and potentially meeting other individuals who may attend the programme.

After the taster session, you will be added to our waiting list for the Living Well with Pain Programme. When a group becomes available you will be invited to attend the group. The usual process would be for our administrative staff to send a text message asking you to contact the service and you will be given dates of when the next group is running.

Please note that due to room capacity and confidentiality, we are unable to accommodate friends and family members in these LWWP programmes.

What to expect in a 1:1 pain psychology session?

A 1:1 pain psychology session is usually a calm, supportive conversation where you and the clinician explore how your pain affects your daily life, mood, sleep, and activities, learn how chronic pain works in the nervous system, and start building practical tools like pacing, relaxation, and thought‑based strategies to help you feel more in control. It also gives you space to talk about the emotional impact of living with pain, and you will typically leave with a small, manageable plan or technique to try between sessions.

What to expect in a 1:1 pain physiotherapy session?

A 1:1 pain physiotherapy session is usually face-to-face lasting about 1 hour. The first session is mostly a supportive conversation where you and the clinician explore how your pain affects your daily life, mood, sleep, and activities.

You will learn how chronic pain works in the nervous system, and start building practical tools like pacing, relaxation, and gentle exercises to help you feel more in control.

You will identify activities that are meaningful to you and that are difficult due to pain (such as picking things up from the floor or getting out of a chair), and will explore ways to improve your ability to do these activities. You will typically leave with an agreed pain management plan to try between sessions.

How can I access the iMSK – Community Pain Management service?

We accept referrals from the Secondary Care Pain Team (Pain Clinic), iMSK – Musculoskeletal Advanced Assessment, iMSK – Physiotherapy, Rheumatology, or your GP.

If your pain is in one location such as your lower back, you can self-refer to the iMSK – Musculoskeletal Advanced Assessment service which will review the information and can refer you into CPM. If iMSK – Musculoskeletal Advanced Assessment think further assessment is needed they may ask your GP to do some further tests, or offer you an appointment with them. You can self-refer to iMSK – Musculoskeletal Advanced Assessment here: 

If you have pain in multiple locations you will need to be referred to the Integrated Musculoskeletal service by your GP or First Contact Physiotherapist within your GP practice.

Pain and sleep

Studies have shown that interrupted sleep leads to muscle tenderness, enhanced sensitivity to pain and an increase in pain levels.

There is a 2-way relationship: pain can make sleep worse, and poor sleep can make pain worse. With this in mind, we are not powerless to poor sleep just because we have pain. There are some things that we can control in relation to our quality of sleep.

Learn more about improving your sleep here:  

Pain, exercise, and activity pacing

We know chronic pain can make it very difficult to exercise and remain active. Often people with chronic pain avoid activity and they then become unfit which we know leads to nervous system sensitivity and ultimately more pain. It is also common for people to go through the over activity, under activity cycle (also called the boom-bust cycle). This is where they do a much larger than normal level of activity which leads to their pain getting much worse called a ‘flare up’ that can last days. During the flare up activity levels are very low and can lead to the person becoming more unfit and in more pain.

We know exercise is one of the best treatments for chronic pain BUT the dose (how much) is important.

Learn more about how to pace activities here: https://livewellwithpain.co.uk/resources-for-people-with-pain/ten-footsteps-to-living-well-with-pain/pacing/

Access online exercises here:  https://www.nhs.uk/conditions/nhs-fitness-studio/

Access exercise in Hartlepool here: https://hartlepoolnow.co.uk

Access exercise in Stockton here: https://www.teesactive.co.uk/

How can relaxing my body help with my pain?

When we feel pain, it is very common to tense our muscles. But when this happens over and over, the muscles never get a chance to relax. This constant tension irritates the muscles, which then makes the pain even worse. In other words, pain leads to muscle tension, and muscle tension can increase the pain. Just like anyone would become irritable if they had to work non-stop, muscles also become irritated when they are constantly ‘on duty.’ When muscles stay tight all the time, they pull on the structures they attach to, which can also become painful. This ongoing tension can contribute to or worsen chronic pain. Learning ways to relax your muscles can help break this cycle and reduce pain.

Learn to relax your muscles here:

Pain and Emotions

Pain and emotions are interconnected, each shaping and amplifying the other in powerful ways. When someone experiences physical pain, the brain regions involved in emotional processing such as the amygdala and prefrontal cortex become more active, which can heighten feelings of stress, frustration, sadness, or anxiety. At the same time, difficult emotions can intensify the perception of pain, making sensations feel sharper or harder to cope with. This creates a cycle where emotional distress increases pain, and pain increases emotional distress. Positive emotions, social support, and a sense of control can help interrupt this loop, reducing the intensity of pain and improving overall wellbeing. Understanding this mind–body connection is key to managing pain in a more holistic and compassionate way.

Pain and Thoughts

Just like emotions, pain and thoughts are also closely connected. When you are in pain, it is easy for your mind to focus on the worst possibilities, which can make the pain feel stronger. Negative thoughts like “This will never get better” can increase stress and tension in the body, which then makes the pain harder to cope with. On the other hand, calmer or more balanced thoughts can help reduce the intensity of pain and make it feel more manageable. Because of this mind–body link, learning to notice and challenge unhelpful thoughts can be an important part of coping with pain.

Learn more about the thinking, feeling and pain here:

Microsoft Word – Manage your emotions v.2.0 WEB REFS

recovery+strategies+final+book+june+2017.pdf (see page 40)

https://www.retrainpain.org/languages/english

You can also watch these videos:

Mindfulness

Mindfulness is the practice of paying full attention to the present moment, noticing what we are thinking, feeling, and sensing right now without judging ourselves. Mindfulness practice can help the mind stop spiralling. It can help to calm the body’s threat response. Learning to gently shift unhelpful thoughts, to focus on the present moment, and to treat ourselves with kindness can gradually reduce stress and reduce the impact of pain on daily life.

Learn more about mindfulness here:

NHS – Mindfulness overview: https://www.nhs.uk/mental-health/self-help/tips-and-support/mindfulness/

Oxford Mindfulness Foundation: https://www.oxfordmindfulness.org/

Breathworks (some free resources on mindfulness): https://www.breathworks-mindfulness.org.uk/free-resources

Why Mindfulness is a superpower: https://youtu.be/w6T02g5hnT4?si=_wmrlW5V4TsXELLR

Other Useful links

Here are a list of links that you may find helpful:

• https://livewellwithpain.co.uk/ten-footsteps-programme/
• https://www.paintoolkit.org/
• https://www.meccgateway.co.uk/nenc
• https://www.versusarthritis.org/
• https://ppa.csp.org.uk/content/links-people-living-pain

For non-English speakers see:

• https://www.retrainpain.org/

How to Contact us

Community Pain Management – Specialist Services Admin

Telephone: 01429 522471 option 2

Monday to Friday: 8:30am to 4:30pm excluding bank holidays

Please contact us if you have any further questions about your appointment, require any special considerations or if you would like to rearrange/cancel your appointment.

Patient Experience Team (PET)

North Tees and Hartlepool NHS Foundation Trust would like your feedback. If you would like to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Team who will help you to do this.  

This service is based at the University Hospital of North Tees but also covers the University Hospital of Hartlepool, our community hospitals and community health services.

North Tees and Hartlepool NHS Foundation Trust

Telephone: 01642 624719

Freephone: 0800 092 0084

Opening hours: Monday to Friday, 9:30am to 4:00pm

Email: [email protected]

Out of hours

Out of hours if you wish to speak to a senior member of Trust staff, please contact the hospital switchboard who will bleep the appropriate person.

Telephone: 01642 617617