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Dr Charlotte Small

Pain Management Consultant, Leva Clinic

Online pain management consultations are enabling specialists to liaise directly with patients from across the UK without them needing to make the journey into clinics.


A digital approach is offering a new dimension to chronic pain management for patients, with online consultations delivering timely guidance and advice on how people can continue with everyday activities despite their conditions.

Pain Management Consultant Dr Charlotte Small explains that most consultations do not require physical examinations, so she is able to see people from anywhere in the UK online, without them having to travel to a clinic.

“Patients can also find consultants with nationally-recognised expertise, or a special interest, in their condition,” she says.

Treatment plan

Alongside her NHS post in Herefordshire, Dr Small works for Leva Clinic, an online chronic pain management clinic.

She says: “We provide a multi-disciplinary assessment and treatment plan; working alongside specialist nurses, physiotherapists for musculoskeletal pain and psychologists.” The online service sees patients living with chronic pain, referred or self-referred, to the clinic for help to improve their quality of life.

“To do that, we have to understand how the pain impacts them, their work and their relationships, and what sort of person they want to be.”

Patients can also find consultants with nationally-recognised expertise, or a special interest, in their condition.

Education and support

With patients having undergone investigations, assessments and examinations by their GP or a specialist, they are assessed by a nursing team and triaged at the Leva Clinic.

“When they come to us, we put together a comprehensive multifactorial plan for them. That looks at medicine optimisation, which might be starting new medications for pain management, or more commonly stopping or reducing medicines such as opiates,” says Dr Small.

Education on pain can help support patients to manage their life with a long-term painful condition, guiding them through its impact on their sleep and mood, as well as looking at non-drug therapies such as acupuncture and heat and cold packs.

Survival mechanism

Consultants get to know how patients want to lead their life and their specific circumstances. “We look at realistic goal setting and reassuring, within reason, that what they want to do is safe and how to do it.”

Dr Small explains that pain is a survival mechanism to heal and avoid harm. However, chronic pain is an ‘aberration in that system’ and tells people what they are doing is harmful, when it is not.

Her approach is patient-centred, individual and tailored. Online consultations are similar to NHS face-to-face appointments, with the proviso that if a hands-on examination is required, the individual can be referred back to their GP or specialist.

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