“Enjoying life rather than enduring life”

Frances Cole


Shifting the focus to self-management

Persistent or chronic pain is a huge challenge (1). It is the single biggest reason people in the UK visit primary care and in 2019 was recognised by the WHO as a priority disease. Persistent pain is bio-psycho-social phenomenon and cannot be ‘fixed’ or cured. It requires person-centred management to help people live healthy and better lives. (2)

Health care professionals (HCPs), realise the need to change how they work with people with persistent pain as this long-term health condition is such a leading cause of distress and disability in all age groups. Its economic impact is in excess of 1.5 billion and includes, loss of work and unemployment with extensive cost in benefits. Then added cost is the over consumption of harmful opioid medicines that fail to address pain intensity symptoms. Around £200 million pounds annually is spent in the UK on opioid medications with their range of harmful side effects both short and long-term. This financial cost has risen along with the death rate since 2008. The 2020 OFNS identifies the North East continues to have the highest rate of deaths relating to drug poisoning which includes drug misuse (104.6 deaths per million people vs. UK average 79.6 deaths per million). Nationally half of all drug poisoning deaths involved an opiate (49.6%; 2,263 deaths) and the North East has one of the highest prescribed opioids regions in England.

The crucial problem is that clinicians in primary and community care services lack confidence in their knowledge and skills to support self-management and reduce reliance on opioid and gabapentinoid medicines. (3) There is no clear funding streaming for such person-centred pain management education within the NHS or universities for undergraduate or postgraduate training. So, it is not surprising that the use of opioids and gabapentinoids has been rising since 2008 as clinicians and patients rely on biomedical approaches. (4)

Compassion changes everything – compassion heals the wounds and memories of pain and enables the brain to regain control and guide recovery.

Frances Cole

We are looking now at how self-management can support and enable people to have enjoyable and rewarding lives and good health. So shifting from enduring pain to taking steps on a journey of change in understanding pain and the brain and acceptance are part of the Ten Footsteps online programme at www.my.livewellwithpain.co.uk. This offers access to explore and discover useful things about how the body works, what are normal sleep patterns, how to pace activities on “bad pain” days and how to be more kind and compassionate to oneself. Each Footstep explains some key information or approach, how to deal with it with examples of people’s stories of success in addressing their challenge. The resources are in a range of different options: video, podcast, animation or written or illustrated leaflets.

Currently there is much work on ways to introduce this approach into Primary Care through training and integration into GP practices. Live Well with Pain www.livewellwithpain.co.uk is a key web resource for clinicians around the UK and world to access ways to have different conversations focused on patient agenda’s and self-management.

This helps both clinician and person with pain towards lessening reliance on medication and guide them to find ways to soothe over sensitive brain and nerve networks. It helps in an aim for recovery for some and rewarding ways to live. Lots of story examples of people that have taken that approach and the wins for them. Pain that persists is increasingly seen as “curable” or “recoverable” by taking an “accept and manage” approach in a very holistic way.


  1. Versus Arthritis – Chronic Pain in England: Unseen, Unequal, Unfair
  2. Medicines optimisation in chronic pain
  3. Medicines optimisation – quality standard
  4. Gabapentinoids: has reclassification really solved the problem?