MyPainMatters
MyPainMatters.ie in an information and self-management platform developed by Beaumont Hospital’s Integrated Community Based Pain Management Team at the iPainCentre to support people living with chronic pain.
On this platform you will find information and links to information about chronic pain including low back pain, radicular pain (leg pain) and chronic widespread pain/fibromyalgia. The information will include the latest evidence for these conditions, symptoms, management strategies and self-management tools and resources. The platform has been developed to compliment your care in collaboration with the iPainCentre team, Beaumont Hospital Pain Service and your General Practitioner (GP). Each sub-section of this platform has an online digital feature where you can securely record information about your specific pain condition and management goals.
This platform has been developed with the support of Sláintecare, Pobal, the HSE and Beaumont Hospital.
We are a multidisciplinary team of professionals working in the field of pain management. Our aim is to improve community based pain management for those living with chronic persistent pain.
Dr David Moore
Dr David Moore is a Consultant in Anaesthesiology and Pain Medicine. He is the Clinical Lead of the Department of Pain Management in Beaumont Hospital, Dublin and Clinical Lead for the Sláintecare-funded iPainCentre in Beaumont Hospital and the MyPainMatters.ie eHealth platform. Dr Moore is Lead for examinations in the Faculty of Pain Medicine, College of Anaesthesiology Dublin and a Council member with the European Society of Regional Anaesthesia and Pain Medicine.
Dr Moore has extensive clinical experience in managing all persistent pain syndromes and has a particular interest in facial pain management and in using intrathecal therapies to manage spasticity and cancer pain.
He is passionate about reforming the way pain management teams work in Ireland and in improving access for all people with persistent pain to the best evidence-based treatments. He shares the vision and ambition shown by Sláintecare in improving community-based care for people living with chronic disease in Ireland.
In parallel to his work with Sláintecare, Dr Moore is also leading the development of a Model of Care for Pain Management in Ireland. He is joined by an experienced multidisciplinary team in this project, including Dr Joanne O’Brien and Ms Roisin Ormond from the iPainCentre clinical team.
Dr Joanne O'Brien
Dr O’Brien is a Registered Advanced Nurse Practitioner in Pain Management with over 20 years clinical experience in the management of acute and chronic pain. She is a past president of the Irish Pain Society, past Irish Councillor to the European Pain Federation and in 2023, the first nurse to be elected to the board of the European Pain Federation which represents over 20,000 multi-disciplinary health care professionals working in the field of pain from 38 different countries.
Dr O’Brien is delighted to be working with the iPainCentre team at Beaumont on the Sláintecare project to reform the way chronic pain is managed in Ireland. She has a particular interest in the management of neuropathic pain and in chronic widespread pain and Fibromyalgia. In 2018 she was awarded an Irish Research Council PhD Employment Based Scholarship to develop an eHealth resource for people living with Fibromyalgia called FibromyalgiaMatters.ie which forms part of the MyPainMatters platform.
Ms Roisin Ormond
Ms. Ormond is a Clinical Specialist Physiotherapist in pain management. She graduated from University College Dublin in 2007 and completed a Masters in musculoskeletal physiotherapy in King’s College London in 2013. She worked in a community pain service in the NHS in London for several years where she gained experience working as part of a multidisciplinary team and facilitating group workshops and pain management programs.
Ms. Ormond has been working in Beaumont Pain Service since 2020. She has an interest in pain rehabilitation, in particular psychologically informed approaches to support people who live with pain. She is currently chair of the Irish Society of Chartered Physiotherapists Pain Physiotherapy niche group.
Dr Komal Hamid
Dr Hamid is a Chartered Senior Clinical Psychologist with more than 8 years’ experience offering clinical services in hospital, private practice and organisational contexts. Dr Hamid has worked with a wide range of individuals across different age groups, addressing various psychological, health related, emotional and interpersonal difficulties.
Dr Hamid specialises in short and long term psychotherapy using an integrative approach tailored to meet each patient's individual needs. To effectively manage chronic pain, it’s crucial to understand its physical, emotional and psychological aspects. Dr Hamid’s goal is to support patients to explore the complexities of their internal world, and to gain an understanding of and find relief from distressing feelings, thoughts, behaviours and interpersonal difficulties which may contribute to their pain.
Ms Tanya Clark
Ms. Clark is a senior administrator who has worked in various departments in Beaumont Hospital for over 22 years. In 2011 she joined the Pain Service as Administration Officer and Clinical Secretary for three Pain Consultants. Ms. Clark has extensive experience in administering the expanding Pain Service in Beaumont Hospital and in recent years managed all waiting lists for both Beaumont Hospital and St Joseph’s Hospital in Raheny. She brings a wealth of experience and knowledge to her role of Administrator of the iPainCentre and will be the point of contact for all patients referred to the team.
iPainCentre Service
Service
The iPainCentre team have developed evidenced clinical pathways for the management of specific chronic pain conditions. Our vision and core values ensure that the following clinical care standards will be adhered to throughout your patient journey:
Initial Assessment
All patients referred to the iPainCentre will be asked to commit to a period of management and review with our team. You will be screened for serious pathology at your initial assessment by a team member where a detailed history and physical examination will be conducted. Our pathways follow international guidelines and evidence for self-management, physical and psychological therapies as first line treatment in chronic persistent pain management.
Imaging
Radiological imaging (MRI) has a limited role in the management of non-specific low back pain and fibromyalgia. You will be referred for imaging if signs and symptoms of an issue are suspected or where imaging may change or determine your management. The result and implications of imaging will be reported to and discussed with both you and your General Practitioner. You do not need to have an MRI before being referred to and seen by the iPainCentre team.
Psychological Assessment
All patients will be psychologically screened for factors that might impact your management prior to your initial clinical assessment and at three monthly intervals in order to monitor your progress. Screening will include your understanding of your pain diagnosis, the impact of pain on your life and any concerns about your pain you wish to be addressed.
Patient Education
Once your referral has been received you may be invited to attend a group information workshop if appropriate, delivered by the multidisciplinary team. The workshop will outline our biopsychosocial approach to pain assessment and management. You will also be provided with evidenced information on chronic pain and links to relevant resources via this eHealth site www.MyPainMatters.ie
Self-management and Physical Activity
One of the best evidence in managing your chronic pain is to remain as active as possible. We encourage you to avoid bed-rest, to stay active and to continue with usual activities including work, or return to work/normal activities as soon as possible. We will support you to engage in graded activity or exercises known to improve function and prevent worsening of symptoms. Self-management strategies will be discussed with you when deciding on an agreed individual management plan.
iPainCentre Interventions
You may be offered physical, psychological or combined physical & psychological interventions based on your individual needs. The role of interventional therapies (e.g. injections) and surgery is limited in chronic pain management, but be assured that best evidenced management strategies will be promoted at all times and you will be referred for the most appropriate intervention for your pain.
Medications
In chronic or persistent pain management, medications are only recommended when there has been an inadequate response to non-pharmacological treatments. We know from research that there is a limited role for opioid medication, benzodiazepines and gabapentinoids in the management of specific pain conditions such as persistent low back pain, radicular pain and fibromyalgia. If required a short course of low dose non-steroidal anti-inflammatory drugs (NSAIDs) may be considered taking risks into account. Medications will be discussed in detail with you during your initial clinic assessment.
Review & Onward Referral
You will be monitored and reviewed over a 12 month period and will be asked to complete a short outcome questionnaire to monitor your progress every 3 months. If we identify on assessment or upon review, any issue requiring further investigation you will be referred onwards as appropriate, for example to our Rheumatology or Neurosurgical colleagues in Beaumont Hospital.
Understanding pain
When you are living with persistent pain it can influence many aspects of your daily life. People living with chronic persistent pain report that learning about and understanding pain can help a person to develop strategies to manage their pain and to continue to enjoy life despite chronic persistent pain.
What is pain?
Pain is a very personal experience and the experience of pain is different for each person.
To try and better understand the process of pain in the body we should first look at a definition of pain.
Definition of pain
“An unpleasant sensory and emotional experience associated with actual, potential, or what resembles tissue damage, or described in terms of such damage”.
- The International Association for the Study of Pain (IASP)
What does this mean?
The first thing this definition tells us is that when you experience pain, this does not always mean that there is damage. You can experience pain with damage, have pain with no damage and have no pain with a lot of damage. The reason for this is because pain is influenced by more than just our body tissue, and this is especially true if you experience pain over time known as persistent pain.
When pain persists over time it is often influenced by your emotions, your sensations, your beliefs about pain and your social circumstances. The positive from these influences is that there are many targets when it comes to managing and improving your experience of pain.
Are there different types of pain and what are they?
"Pain can be classified as nociceptive pain, neuropathic pain or nociplastic pain."
Nociceptive Pain
Nociceptive pain is the pain that everyone feels at some time during their life. This type of pain is often referred to as the body’s “alarm system” due to the presence of multiple sensors in the body which are called nociceptors. These sensors respond to heat and cold and also warn us of damage or potential damage. Nociceptors make us aware of the pain we feel from a paper cut, a stubbed toe, a pulled muscle or the discomfort we feel when constipated. They indicate pain felt after a surgical procedure or with a broken bone. As well as alerting us to damage or injury, these sensors alert us to potential damage, for example if we put our hand too close to a fire.
Nociceptive pain usually refers to pain that comes from structures like muscles, ligaments or joints.
How do you know if the pain is Nociceptive Pain?
There are distinct words we tend to use when describing nociceptive pain – such as pain that is sharp, dull, aching, gnawing, heavy or dragging in nature. Nociceptive pain is usually short lived or acute, lasting until the paper cut has sealed, the stubbed toe is forgotten, the constipation has been relieved or the muscle strain has healed.
Nociceptive pain is the kind of pain we find easy to treat – by rubbing the area, using heat or cold packs, relieving the symptoms of constipation, taking a short course of pain medicine such as an anti-inflammatory or in the case of potential damage – removing ourselves out of harm’s way!
Neuropathic Pain
Neuropathic pain is pain that is felt due to damage, pressure or dysfunction of our nerves and our nervous system.
How do you know if the pain is Neuropathic Pain?
This pain is often described as a burning, freezing, numbing, tingling, shooting, stabbing or electric type of sensation. Those with neuropathic pain may also feel pain and sensitivity to things that aren’t usually painful, such as cold air or clothing against skin. Examples include the experience of scar pain/sensitivity after surgery or pain as a result of shingles. Unfortunately neuropathic pain can be difficult to treat and does not respond well to many pain medications.
Nociplastic Pain
Nociplastic Pain is a different type of pain because it doesn't necessarily come from actual tissue damage or inflammation, although some of the words used to describe it are similar to nociceptive and neuropathic pain. Nociplastic pain is a type of pain where the nervous system itself has become hypersensitive, sending pain signals to the brain even when there is no injury or damage, or when healing has already occurred.
Why is it important to understand the different types of pain?
Understanding that there are different types or causes of pain is very important because it affects how we approach treating and managing pain. While nociceptive pain might respond well to treatments aimed at reducing inflammation or promoting tissue healing, neuropathic and nociplastic pain usually require different strategies such as pain education, graded exercise, mindfulness, and in some cases medications or X Ray/Ultrasound guided injections.
Some of the strategies that help with persistent pain might seem counterintuitive and not make sense. For example you may think that having pain means you need to stop activities, sports, exercise and some of the things you used to enjoy in case doing them could make your pain worsen. This is actually the opposite to what is best because research has shown us that a lack of movement or avoiding activity may actually result in increased pain and decreased function.
When you are experiencing persistent pain it is actually better to keep moving, to exercise, continue working or resume your hobbies. Those living with chronic persistent pain who engage and are active participants in their own pain management tend to have better health outcomes.
How is pain processed?
No matter what type of pain you are experiencing, nociceptive, neuropathic or nociplastic, pain is always processed by the brain.
When injury or damage occurs the body releases different chemicals at the site of injury which trigger nearby nociceptors, the body's alarm sensors, to transmit electrical impulses along the sensory nerve towards the spinal cord.
The spinal cord then categorises the type and severity of the danger signal received before transmitting the information onwards to the brain. At the level of the spinal cord the danger signals can be modified by various mechanisms. At one level chemical messengers called neurotransmitters are released which amplify or turn up the volume of the signal received indicating danger. In contrast, preventative neurotransmitters may be released which dampen down or suppress less dangerous or intense impulses, indicating less danger.
Pain impulses, processed at the spinal cord, travel upwards to the brain via a number of pathways, which relay the information to different regions of the brain. This is when the brain interprets the received signals as pain. This perception of pain involves complex cognitive and emotional processes that are influenced by many individual factors, including a person’s past experience of pain, their beliefs about pain and their emotional well being – all reasons why pain is such an individual and personal experience.
Acute and Chronic Pain
When we talk about pain we also talk about acute and chronic pain.
Acute Pain
Acute pain is pain that typically comes on suddenly and is often sharp or intense. It's usually a signal from your body that something is wrong or that you've injured yourself. For example, if you strain a muscle in your lower back while lifting something heavy, you might experience acute pain in that area. Acute pain is generally short-lived and tends to resolve as the underlying injury or condition heals.
Chronic Pain
Chronic pain is pain that persists over a longer period, typically beyond the expected time for tissue healing. If pain lasts for more than three months despite treatment or persists beyond the normal healing time for an injury, it's usually considered chronic. Chronic pain can be more complex than acute pain and may involve changes in the nervous system that make the pain more persistent or difficult to treat.
Links
The important thing to remember is that learning about pain can help promote healthy behaviours and can make it easier for you to talk to health care professionals and family and friends about your pain.
Click on the links below to learn about understanding and managing persistent chronic pain
References ⇣
Australian Commission on Safety and Quality in Health Care. Low Back Pain Clinical Care Standard. Sydney: ACSQHC; 2022.
Foster et al., 2018. Prevention and treatment of low back pain: evidence, challenges and promising directions. www.thelancet.com Vol 391
