This page was last updated: January 9th, 2023
All together we hope these resources can help you build up your fitness, reduce your painful symptoms and improve your sleep. Please feel free to look around, click on the links and use our website. Please also give us feedback so that we can continue to develop this resource.
Getting a better night's sleep. Watch this video class that takes you step by step towards a comfortable seated practice of meditation.
A selection of six different meditations, taken from the book ‘Mindfulness: Finding Peace in a Frantic World’
Mindfulness in the Time of Coronavirus is another collection of meditations that will help you explore alternative anchors for your attention, your feet, seat or hands. There are three versions of the Finding Your Ground meditation of different lengths. If you can, try to use the ten-minute version twice a day or the twenty or thirty-minute version once a day.
Sleepio is a six-week cognitive behavioural therapy sleep improvement programme, which you can enrol on for £45 and complete at home.
The Self-help App for the Mind (SAM) is free to download and will help you to understand what causes your anxiety, monitor your anxious thoughts and behaviour over time and manage your anxiety through self-help exercises and private reflection.
Be Mindful is an online course for reducing stress, depression and anxiety based upon mindfulness-based cognitive therapy.
Mindfulness Cornwall is a charity which aims to help people learn about and use mindfulness in their everyday lives. They offer an 8-week courses and individual appointments.
Living with chronic pain is a free to access site which has 10 audio tracks covering a variety of topics including living with chronic pain, how to improve your fitness sleep and diet as well as a step-by-step approach to goal setting, how to use “Relaxation” to get a better night’s sleep.
ESCAPE-pain is an online structured program for people with knee, hip and back pain. It integrates educational videos with an exercise program. The resource is free and available here
The Make A Change Physical Activity page contains links to a variety of local walking, running, swimming and other sports activities. There is something for everyone no matter your age or ability.
The expert patient programme is open to all patients in Cornwall and run by a team of trained volunteers. As part of the course, you attend six weekly sessions, which last two and a half hours, where you will learn how to manage your condition and meet other people who share similar experiences. The registration form and contact details are at the bottom of the page.
Reconnect2life is an interactive webpage where you can click through a series of information pages at home about understanding pain, improving your fitness and how you think about pain and how pain effects your mood. The health and fitness section also includes a step-by-step how to do it guides and videos on Tai Chi and Body conditioning.
Body reprogramming is a course for people who have Chronic Primary Pain, such as fibromyalgia. It provides an understanding of the condition and explores ways to help you reduce your symptoms. The course is composed of 6 sessions, each about 2 hours long.
If you would like to take part please contact your GP because they must refer you directly for this.
The Pain management Plan book, is a self-directed cognitive behavioural therapy learning programme, which can be purchased from Amazon and worked through at home.
painTRAINER is an interactive, free, online program that teaches you effective strategies to manage your pain. The painTRAINER program is made up of 8 sessions, each lasting about 30-45 minutes.
Pathway through pain is an online pain management program which you can enrol on for £40 and complete at home.
Your pelvis is made up of several structures including the bones and muscles of your skeleton, your pelvic floor muscles, as well as your reproductive and urinary organs, rectum, and perineum (the skin around your anus and genitals).
Your pelvic muscles move things by contracting and then relaxing. All muscles work in tandem with other nearby muscles, with them all coordinating various stages of contraction and relaxation to achieve organised movement. Some of this movement is conscious, for example when you choose to cross your legs, and some of it is involuntary, for example when your bladder relaxes and expands so that it can fill with urine.
Your pelvic floor muscles are a specialised set of muscles, positioned at the base of your pelvis, which help keep your pelvic organs in the correct place and control your bladder, bowel, and sexual functions.
Like all muscles, your pelvic muscles can become hypertonic (overactive), which means the muscle may become painful, weaker, less responsive and move out of time with other nearby structures, leading to a loss of the coordinated movement described above.
You won’t necessarily “feel” pelvic muscle overactivity because some of the muscles, such as those in your pelvic floor, are involuntary so you are not conscious of whether they are contracting, relaxing or hypertonic.
As well as pain, the loss of the coordinated movement may cause changes in your bladder and bowel habit and have an effect on your sex life. Symptoms of overactive pelvic muscles include:
Changes in your bladder habit such as:
Changes in your bowel habit such as:
Changes in your sex life such as:
Understandably, any and all of these symptoms are very stressful and can be very distressing, which may lead to thoughts, feelings and behaviours that themselves can cause pelvic muscle overactivity, and so make things worse.
Click here to view a booklet entitled: "An introduction to pelvic pain" (PDF only, 2.2MB) produced by the Pelvic Pain Foundation of Australia. This short guide contains lots of information about different types of pelvic pain, advice about how to reduce your symptoms and is aimed girls, women, men and families.
While all of us have been told to “relax” at some point in our lives, many of us don’t know how to do this properly, and especially how to target specific muscle groups like your pelvic floor muscles.
We would like you to spend about a week learning: 1) How to relax properly; 2) How to relax your pelvic floor muscles; 3) Stretch your pelvic skeletal muscles.
Then we would like you combine all of these activities into a single exercise regimen and build this into your daily routine.
We hope you will quickly notice that your symptoms improve with these changes, and that you will learn over time how much, when and what exercises you need to do to control and manage your symptoms.
Start by reading this handout entitled "The Mitchell Method of Physiological Relaxation" (PDF only, 927KB) produced by the Pelvic, Obstetric and Gynaecological Physiotherapy Network. This guide describes how to relax.
Try to practice this for 5-10 minutes, once per day, every day, for one week or until you become comfortable with the process and can develop a pleasant feeling of comfort through your whole body.
Once you have done this, move onto the next step.
Click here to reach the Pelvic Physiotherapy website, which aims to help patients with pelvic pain and other disorders.
The webpage describes a series of exercises to help relax your pelvic floor called “Sniff, flop and drop”. Try to familiarise yourself with these exercises and practice them for 5-10 minutes, once per day, every day, for one week or until you become comfortable with them.
Now try to combine the two, by first using the “Mitchell” relaxation routine to relax your whole body, before then working though the “Sniff, flop and drop” exercises from the website.
Once you feel settled with this, move onto the next step.
Click here to view a handout entitled: "Easy Stretches to Relax the Pelvis" produced by the Pelvic Pain Foundation of Australia. These exercises are suitable for both men and women.
Try to familiarise yourself with these exercises and practice them for 5-10 minutes, once per day, every day, for one week or until you become comfortable with them.
Now try to combine all three exercises, by first using the “Mitchell” relaxation routine to relax your whole body, then work though the “Sniff, flop and drop” to relax your pelvic floor and then finishing with the easy stretches to relax your pelvis.
If you find it difficult to understand or perform these self-directed exercises, or would simply prefer to be seen in person, you may benefit from seeing a specialist pelvic floor physiotherapist. Please contact your GP about it. You may need to arrange this privately depending on what services are available in your area.
If your pelvic floor muscles are so painful that you cannot complete any physiotherapy, you may benefit from seeing a gynaecologist with a specialist interest in this area, who may be able to perform injection to relax some of the overactive muscles in your pelvis. Please contact your GP about it. You may need to arrange this privately depending on what services are available in your area.
A small proportion of people may obtain good pain relief with opioids long-term if the dose can be kept low, and especially if their use is intermittent.
The risk of harm increases substantially at doses above an oral morphine equivalent of 120 mg/day.
If a patient has pain that remains severe despite opioid treatment it means they are not working and should be stopped, even if no other treatment is available.
Further information can be found on the Opioids Aware website resource which has been produced for patients and healthcare professionals and aims to support safe prescribing of opioid medicines.
Click here to view Faye’s story, which describes, from her parent’s perspective, the sequence of events that ultimately led to her untimely death from respiratory depression.
Click here to view Sean’s story, which describes the devastating impact strong opioid prescribing had on his life, and how he has engaged with more effective non-drug therapy that has been life-changing.
Calculate the total daily dose for each opioid drug your patient is taking and multiply this by the relevant conversion factor to generate an oral morphine equivalent dose for that drug.
Sum the oral morphine equivalent doses for each drug together to generate their total oral morphine equivalent dose.
There are many ways to do this. We recommend tapering the drug dose by ~10% every fortnight starting with the morning dose. However, the amount and the time of day when the taper starts can be varied to accommodate patient preference.
Initially keep the “regular” (modified-release) dose of the drug the same and taper the “when required” (immediate-release) doses of the drug.
Keep the same frequency of the “when required” (immediate-release) doses of the drug (i.e., 4 times per day), but decrease the dose each week (i.e., 15 mg to 10 mg to 5 mg etc) until it is stopped entirely.
Then taper the regular modified-release dose of the drug as described in the section above.
This could be arranged as 2-, 4- and 6-month appointments for example.
Consider using clinical withdrawal scale as part of your assessment.
If you have severe pain whilst you are taking a large dose of opioid medication, it means the drugs are not working and should be reduced or stopped.
The risk of harm increases substantially at doses above an oral morphine equivalent dose of 120 mg/day.
Side effects are extremely common with opioid drugs and include nausea, vomiting, constipation, pruritus, dizziness, dry mouth, sweating and sedation.
If you are suffering from any of these symptoms it is likely because of your opioid medicine and reducing or stopping the drug will mean you will suffer less from these unpleasant side effects.
Patients who take opioid medicines for a prolonged period are at risk of several long-term harms including:
Endocrine function should be monitored regularly if a patient reports symptoms consistent with potential dysfunction, such as decreased libido, sexual dysfunction or fatigue.
Recommended tests include:
Opioid Risk Tool (ORT): This is a quick 5-point questionnaire which assesses prospective risk for opioid abuse or aberrant drug related behaviour. A score of 0-3 is low risk, 4-7 moderate risk, and 8 or higher is considered high risk for opioid misuse.
Pain medications should not be withheld simply because a patient is considered high risk for opioid misuse, but other non-opioid treatments should be trialled in the first instance where possible.
If the use of an opioid is unavoidable, your patient may benefit from regular assessment using the COMM questionnaire below, and limiting the quantity and duration of their prescriptions. Consider referring your patient to pain clinic for further advice.
Current Opioid Misuse Measure (COMM): This is a 17-point questionnaire which aims to identify opioid misuse during chronic opioid therapy. A score of 9 or higher is suggestive of opioid misuse.
If your assessment is suggestive of opioid misuse, your patient may benefit from a referral to a drug addiction specialist service.