Framing a pain consultation

HOPES

H: Hear the story - active listening with empathy for impact on life

O: Other causes considered - assess for organic pathology and active mental health problems

P: Plain explanation - that chronic pain is a long-term condition, it's not 'fixable' but goal is improved function and quality of life. Be honest about the roles and limits of medications and other interventions

E: Engage - by asking what matters most in their lives, what they want to do? Integrate a medication review if appropriate

S: Supported self-management plan - using online resources, support network, third sector, primary care MDT and other NHS resources

SUGAR

S: Self-management and social prescribing - Link with local groups or activities to help reduce social isolation, improve mood, increase physical activity and so improve quality of life. Also direct individuals to self-management resources.

U: Understanding pain and the individual - Discuss what chronic pain is to help people improve their understanding of chronic pain and how it can be managed. This is reassuring for individuals and helps them to understand that chronic pain can exist without serious underlying cause, while still being a very real pain. Communication and listening are key to finding out what is important to people and how chronic pain affects their daily life.

G: Goal setting - Discuss and agree achievable realistic goals to engage people in their treatment and to help them assess their progress.

A: Acceptance – Assist people to accept that chronic pain is a long-term medical condition. Emphasise that further investigations or surgeries may not be useful. Accepting that they can make changes to their lives to help manage their pain is important. This helps them to take control of their lives again.

R: Relationship, reducing medication and review - Build rapport and trust before attempting to reduce medication. The decision to reduce medication should be a joint one, with a plan agreed between clinician and individual. Regular review and support is essential.