Shifting the conversation

Breaking the persistent pain cycle

Using knowledge about the impact of pain on a person’s life as a route to change

Persistent pain has a large impact on an individual’s health, life and future. Yet pain symptoms are resistant to change with medical treatments, so if we concentrate on medication alone we are focusing on one of the least changeable aspects of the person’s long-term condition.

On the other hand, if the focus can be shifted towards areas of a person’s life more amenable to change, patients can begin to see how self management can lead to real improvements in their quality of life.

An important first step is for clinician and patient to develop a common understanding of how pain is affecting the person’s life. There are a number of key skills and tools which you can use to help achieve this, and we explain these below.

Dr Tim Williams suggests two skills are key to helping shift the patient’s focus towards the role of self-management. These are:

1) Take your time

  • Pain is a long term condition so continuity of consultations is crucial
  • Give 40 minutes over 3- 4 consultations, spread over 8-12 weeks

2) Listen to the whole story

  • Listen to ‘the pain story’ from start to finish. Hear how Dr Tim Williams does this here:

duration of video: 1 minute

(This video in one of Dr Tim Williams’ 10 Top Tips for GPs Towards Self Management of Persistent Pain. Watch all 10 top tips here.)

The Pain Cycle is a visual aid that helps patients recognise how pain can affect a different aspects of their life in negative and self-reinforcing ways.

Its companion visual aid, the Self Care Cycle shows the positive outcomes of adopting a range of self-management approaches to undo or limit the impact of pain.

Download the Pain Cycle tool

How to use the Pain Cycle tool

Using the skills suggested by Dr Tim Williams (see ‘Skills you can use’, above):

  • Listen to the patient’s story and actively tick off areas that are apply to them on the Pain Cycle sheet, showing it to the patient.
  • Explain why it will help to shift the focus towards those aspects of their life that they can change
  • Give the patient the Pain Cycle sheet and ask the patient to tick off the three most important areas they want to change now. You can repeat these steps for this month / next month
  • If the patient is not sure which areas to change, let them take the Pain Cycle away and agree to review their three choices at the follow up

See how Dr Frances Cole uses the Pain Cycle tool in this video of a patient consultation:

(duration 11 minutes)

Help patients prioritise

If, having explored the Pain Cycle, a patient expresses a desire for change across all areas it may suggest pain has a large impact on their health both physically and psychosocially. Explore further and guide them to make priorities. Use the two questions skill and resource

Where change happens

Most change in thinking and behaviour happens between consultations, not within the consultation itself. Encouraging patients to actively use the Pain Cycle visual aid between consultations may help them to embrace change.

The difference you’re making

Dr Frances Cole writes: “For patients, living with persistent pain is both tough and isolating; having a clinician who understands and will support them to change is incredibly therapeutic in itself.”

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