Psychologically informed training offers hope of truly patient-centred pain care

Patients living with pain are set to benefit from unrivalled patient-centred consultations which address both the physical and psychological components of pain following a successful trial.

The NHS’s Health Innovation Network and St. George’s and Kingston Hospitals have supported the development of Psychologically Informed Collaborative Conversations (PIC-C), an innovative training and supervision course for allied health professionals.

With up to half of UK adults experiencing pain, PIC-C aims to create a ‘therapeutic alliance’ between patients and the clinicians who treat them. The training achieves this by supporting clinicians to use psychologically informed techniques with their patients, addressing the psychological elements of pain rather than just focusing on physical components.

The unique course – co-designed by people living with pain and in partnership with the Physiotherapy Pain Association, St George’s and Kingston Hospitals Chronic Pain and MSK teams – has delivered promising initial results and evidence of real changes in practice.  The programme was piloted during 2020/21.

All clinicians in the pilot reported the training reduced their anxiety and increased their confidence in using psychologically informed techniques with their patients. Ninety-six per cent reported that the training had increased their compassion for others as well as overall work satisfaction and resilience. Further positive impacts were observed in reported work satisfaction and reductions in perceived fatigue.

Carole Robinson, who is a volunteer patient representative in Kingston Hospital and was a medical practice manager for the NHS for 44 years, helped co-produce PIC-C.

“I have lived in pain now for 25 years, so it’s been a long, long haul. It’s a constant battle really, physical discomfort as well as mental and emotional side effects.  Nobody asked me how I was managing or coping but I know now that there will be somebody around who will be thinking about that right from the start.

She said that PIC-C helps clinicians focus on the person, such as day to day living and sleep patterns as well as emotional issues alongside the pain. She adds that this more patient-centred approach is one of the biggest medical innovations of the modern day.

“Hopefully PIC-C is going to change the patient/clinician relationship dramatically. I hope that this is going to be a real eye-opener for people to be able to discuss how they feel and how it’s affecting them.”

Health Innovation Network PIC-C Project Lead Amy Semple said:

“Physiotherapists told us that PIC-C fills a known training gap. When pain persists it often leads to increased psychological distress. We know that many physios don’t get the specialist training for this so PIC-C gives them vital skills and confidence in developing alliances with patients in consultations to help generate positive change.

“The unique selling point of PIC-C is its focus on experiential learning – learning through doing – and it has protected supervision and reflection time built into the course to really help embed the learning and discuss complex cases with colleagues.

“We urge commissioners to have a look at the resources on our website and get in touch to see how it could be delivered in their locations.”

St George’s Hospital clinical operation lead Jennifer Graham said:

“I found this course to be highly practical right from the start and I think that is its biggest strength. Right away you are able to pick up things that you learnt from day one and put them into practice. Rather than being therapist led, I think I will direct my practice towards patients taking an active role very early on.

“This was a difficult year in the NHS anyway and I do think that PIC-C played a role in the resilience of our staff. When things didn’t go to plan, a lot of them were able to rebound a bit more easily than they might have done in the past. Some of them, including myself, were able to reframe things when they didn’t go according to plan, which is in line with PIC-C training.”

Read the HIN’s report on Psychologically Informed Collaborative Conversations (PIC-C) on this link.

PIC-C can be delivered to whole teams or as a postgraduate training module within a wider syllabus.  Contact the HIN to find out more.