The recent National Institute for Health and Care Excellence (NICE) guideline on chronic pain recommends that GPs prioritise physical activity programmes for people suffering from chronic pain.1 This article describes an innovative scheme in the West Country.
Chronic pain is debilitating. As well as dealing with the challenge of pain, most people with painful conditions also face the tough reality of fatigue, social isolation, and the anxiety that comes with it. Pain clinics have long waiting times and medication brings little solace. At Active Gloucestershire (https://www.activegloucestershire.org) we have been forging new ground, with a successful trial that is now expanding to all GPs throughout Gloucestershire.
Our trial, It’s Your Move, is run in partnership with Gloucestershire Clinical Commissioning Group (CCG). It offers a course of physical exercise classes to people referred by GPs due to chronic pain issues. During the early trial, seven of our eight participants completed the course. Each of these reported a reduction in the severity of their pain. Following this success, a further 11 joined.
Although our sample was small, the results were overwhelming, and the initiative is now being scaled up as a fully-established programme. Following the trials, as well as the reduction in overall pain, almost all participants experienced reduced interference from pain in daily activities such as cooking and dressing. The latest update (as of early June 2021) is that 25 people have now attended the programme, 20 of which have reported a reduction in pain levels and all participants have said that their attitude towards physical activity has improved.
PERSONAL TESTIMONY
Penny*, who took part in the initial trial, agrees. Penny says: ‘The classes definitely increased my mobility. Physically, I am more able, and I have learnt how to stretch out pain — to use my muscles against pain.’
Penny also highlighted how the physical exercise instructor helped to alleviate any anxiety around taking part:
‘The instructor called me before the classes started, which helped to put me at ease and explain how it would all work. Due to Covid, the courses are online, but they helped me to navigate the IT side and it’s been nice to see different people, who have an understanding of each other’s problems, even if we can’t meet in person.’
The NICE guideline on chronic pain1 backs up our findings. Cathy Stannard, a pain consultant who leads the pain programme at NHS Gloucestershire CCG, was clinical lead for the NICE guideline. She said:
‘Clinical evidence tells us that exercise is definitely the most likely intervention to help people living with pain. Encouraging people with pain to exercise has always been considered a challenge. This exciting initiative has shown that helping people get moving can be readily and inexpensively achieved and this will provide encouragement to other parts of the country who are looking to provide evidence-based services for people with pain.’
CHANGING THE CONVERSATION
Importantly, the guideline highlights the connection between pain and wider issues, pointing out that the experience of pain is always influenced by social, emotional, and biological factors, as well as expectations, beliefs, and mental health. Our experience shows that people with chronic pain are living with a complex range of challenges. Our aim is to change the conversation; we challenge anxieties and place the individual’s needs and mental health to the fore.
We would like to thank everyone who took part in the trial, and hope that programmes like It’s Your Move will be replicated to help patients across the country. We are keen to share our findings, so feel free to get in touch with any questions.
- © British Journal of General Practice 2021
