Reflecting on the Pain Clinic- Medical Student Perspectives

As part of the Newcastle University fourth year curriculum, we completed a longitudinal placement in our hospital's pain clinic. 

The aim of this placement was to gain an understanding of the function of medical clinics on the management of chronic conditions. 

Each Friday morning, we attended the clinic, witnessing the management of complex pain in patients from all walks of life. The source and character of the pain varied with individuals, yet the impact of the pain was a universal factor in each consultation. 

Beginning in September, we started with observational learning, witnessing how to conduct a pain history and decide on management, as the year progressed, we gradually took on more active roles. Starting with taking histories for ourselves, to progressively gaining the experience and confidence to discuss potential management with the consultant and the patient.

Pain medicine is a complex field, that impacts on all aspects of a patient’s quality of life. It is also a field that we had little exposure to earlier in medical school. To structure our patient encounters we needed to learn and refine new skills in taking a holistic history and using the information gathered to come up with a best plan for the patient. 

The history taking within the pain clinic was one of the most extensive we’ve witnessed in medicine, a forty-five-minute consultation where most of the time was dedicated to identifying the nature of a patient’s pain and the impact of the pain on physical, psychological and social aspects of their life. 

Early on in our placement our consultant shared with a personal tip, that he doesn’t look at the clock when speaking to patient, allowing the patient to speak at their own pace and open-up about their experience of pain. Talking to patients following their consultations, this was highlighted repeatedly by them as one of the most beneficial parts of the clinic, as they were able to express in words how they were impacted by their pain and felt validated in their struggles. 

Following the history, the consultant addressed how best to approach management. He taught us the 4Ps of pain management: 

1. Physical
2. Psychological
3. Pills
4. Procedure

We utilised this structure to both decide on management and to explain to the patient each element of management and how it should help address different aspects of their pain. Many patients attended the clinic feeling hopeless, expecting pills that they may have already tried before, and the focus on creating a management plan that incorporated more than medications helps re-instill hope in these patients.

Outside of the clinics we attended a procedural list and saw the delivery of delivery of a variety of interventions.

This allowed us to see some of the management in practice and gave us some continuity in our own learning. It showed us the diversity of pain medicine, from long clinical conversations to theatre-based procedures under X-ray guidance.

Our time at the pain clinic, equipped with us many skills we can carry on into foundation training and beyond. We gained experience in connecting scientific theory to practical life, for example we explained to many patients how to utilise the TENS machine and how it functions using the gated theory of pain. Allowing us practice explaining this in patient friendly terms helped us gain skills to explain other scientific theories we encountered in our practice. We also practiced gathering large histories and then identifying the key elements of them to pass on in a concise handover to the consultant, a skill that we found difficult prior to this placement. We were also able to participate in research as part of our placement, taking part in large internal audits that resulted in our case, in an opportunity to present at the international congress on neuropathic pain in Berlin. 

Overall, our time in the pain clinic taught us invaluable skills, we grew as future clinicians, recognising the impact of pain on the patient. It reminded us that pain is a fundamental aspect of the human experience of illness, and its impacts are far reaching. There will always be a role for a doctor who understands and appreciates a patient’s pain in all elements of medical practice.