Pain: Breaking Through the Barrier is the title of a report from the Chief Medical Officer that at last puts pain as a condition in its own right firmly on the political and health agenda at national level.
Professor Sir Liam Donaldson, the government’s Chief Medical Officer points out that pain is one of the world’s most common symptoms: it affects 7.8 million people in this country. Chronic pain has a major impact on people’s lives, causing sleeplessness and depression and interfering with normal physical and social functioning.
All age groups are affected: a quarter of school-age children report pain (on average lasting more than three years), while most elderly residents of nursing homes experienced frequent moderate to severe pain. It has been estimated that back pain alone costs the economy £12.3 billion per year. The cost of pain from all causes is far higher. Chronic pain and its consequences are not as well controlled as they could be. Early intervention may stop pain becoming persistent.
United Kingdom: pain in numbers
7.8 million people live with chronic pain
£3.8 billion cost of adolescent pain
£584 million spent on prescriptions for pain
1 million women suffer with chronic pelvic pain
1.6 million adults per year suffer with chronic back pain
49% of patients with chronic pain experience depression
25% of sufferers lose their jobs
16% of sufferers feel their chronic pain is so bad that they sometimes want to die
1 pain specialist for 32,000 people in pain
The few specialist pain clinics around the country are inundated with referrals, and only 14% of people with pain have seen a pain specialist. Systems and infrastructure are not adequate to meet need or demand.
Better coordination of services and services designed around the patient’s needs are essential.
Chronic pain may be complex, often with no identifiable purpose or basis. Untreated, pain becomes entrenched and more difficult to treat. The consequences of long-term pain have a serious impact on both patients and society. Over a third of households have someone in pain at any given time. The numbers are rising. Repeated surveys show that chronic pain is two to three times more common now than it was 40 years ago.
"For three years, since I was 14, I’ve had severe pelvic pain. I have tried painkillers and been to see my general practitioner, but nothing much helps. I’ve missed a lot of school, and worry I may fail my A levels or be too ill to sit through an exam. I can’t keep up with my friends’ social activities. Pain is ruining my life.”
Women report chronic pain more frequently. The same is true for people from socially or financially disadvantaged groups and some ethnic minority groups. United Kingdom citizens of South Asian origin are three times more likely to suffer disabling back pain than their non-Asian peers. Women are at greater risk of chronic pelvic pain, report migraine headache three times more commonly than men, and are disproportionately affected by pain syndromes such as fibromyalgia.
Chronic pain becomes more common with age: the probability of suffering chronic pain at age 50 years is double that at age 30 years. However, chronic pain is not only a problem for older adults: the most common time to report chronic pain is in the decade between 40 and 50 years of age. Chronic pain may be neglected at both ends of the age spectrum. In a study of United Kingdom nursing homes, most residents experienced constant or frequent moderate to severe pain, despite the fact that 99% were on pain medication. Conversely, chronic pain affects a quarter of school-age children (a third severely), with pain lasting on average more than three years.
Muscle, bone and joint pain are the main causes of chronic pain, with back pain and osteoarthritis together responsible for over half of all cases. Every year, 1.6 million adults in the United Kingdom develop back pain that stretches beyond three months. At any one time, a quarter of adults over the age of 40 years in the United Kingdom have knee pain, and in around half of them this pain is disabling. On top of this, half a million adults have rheumatoid arthritis, where the joints are attacked by the immune system.
Severe and recurrent headache is common. Around 12% of the population experience migraine, and a further 9% of women and 3% of men suffer with chronic daily headache.
Pelvic pain lasting more than six months affects a million women in the United Kingdom; an additional one in eight women suffer from severe menstrual pain.
Up to 5% of the population are affected by chronic widespread pain of unknown cause, including diagnoses such as fibromyalgia.
Recent data from the United States found that, one year after being admitted to hospital for treatment of a serious injury, almost two-thirds of people still reported pain. Surgery itself may be a cause of pain: one year after hernia surgery, almost two-thirds of patients report ongoing pain as a result.
Chronic pain ruins lives: 65% of sufferers report difficulty sleeping and nearly 50% report problems conducting social activities, walking, driving or having a normal sex life. In 49% of those with chronic pain there is depression, and this can result in suicide. Chronic pain reduces quality of life more than almost any other condition. Pain often becomes intertwined with the lives of people living with it. Pain has been described as ‘exhausting’ and ‘mentally draining’, and the experience of living with it ‘frustrating’, ‘isolating’ and ‘humiliating’.
“I’m constantly in agony, and I lost my job six years ago due to ‘performance issues’. My doctor told me I have fibromyalgia, but has been unable to explain the cause of my pain, and I feel my family has no patience with me now. Painkillers do nothing to help. Some days I can’t get dressed, the pain is so bad. I feel that no one really understands.”
Chronic headache significantly impairs quality of life. Disability is common, with 70% of migraine sufferers reporting some disability, of which 25% is severe.
Young people with ongoing pain have more mental health and social problems, miss more school than their peers, and tend to achieve less academically than expected. Taken together, all these factors have the potential to seriously harm a child’s future.
The financial impact for both the sufferers and their families is shattering, and the burden to the economy as a whole is huge. People with chronic pain are seven times more likely to quit their jobs due to ill health than the general population. Overall, 25% of people with chronic pain eventually lose their jobs.
Conditions associated with chronic pain are among the most expensive to treat. Musculoskeletal diseases, such as arthritis, make up one of the most expensive disease groups for healthcare costs.
People with chronic pain account for a significant proportion of general practitioner appointments each year and are relatively high users of accident and emergency, diagnostics and outpatient services. In 2007, on top of money spent by patients on non
prescription medication, the NHS in England spent £584 million on 67 million prescriptions for analgesia and anti-inflammatory drugs.
However, indirect costs, largely due to the loss of work opportunities, may be even greater than this. In 1998, it was estimated that the cost to the United Kingdom of back pain alone was £12.3 billion – 22% of UK health expenditure in that year – and the main part of this cost was due to work days lost.
Chronic pain is the second most common reason for claiming incapacity benefit. People with chronic pain often do not know how quickly, or whether, they are going to recover. This makes it difficult for them and their employers to plan for their return. Very often, people fail to come off these benefits.
Pain is subjective. It is not easily measured, unlike blood pressure or body temperature. Few report their pain being assessed effectively. Only 15% of patients have completed even a simple scoring system. Fewer than half of nursing home residents said that their carers had asked them about their pain. Identifying and assessing pain is an undervalued clinical activity and is not seen as a priority in assessing a patient, particularly in emergency settings.
Assessing complex and chronic pain is rarely of value if undertaken in isolation from assessments of the effects of pain. If people worry excessively about the sources of their pain, they tend to become more inactive. Gauging the potential threat value of pain is difficult for patients. It is vital for healthcare professionals to promote active coping strategies at an early stage to aid recovery. In Australia, a mass television campaign that encouraged people to stay active in spite of their pain had a dramatic and prolonged effect on sickness absence.
Modern pain management should have an integrated approach. Early identification of each patient’s needs allows a plan to be tailored. With appropriate support, some people can be taught the skills to maintain normal function. Others have pain that may become complex and chronic and require more elaborate interventions.
People are generally keen to help themselves. No one wants to be in constant pain. Therefore, given proper support and information, most people will benefit from an integrated approach that addresses different aspects of their pain simultaneously. This may involve a focus on activity and rehabilitation, balanced drug therapies, psychological therapies, electrical nerve stimulation, and, occasionally, appropriate injection techniques. Complementary therapies also have their place. The key factor appears to be ensuring that aspects of care are integrated and joined up, rather than instigated sequentially or in isolation.
Patients report that being listened to and given choices over treatment are just as important as the therapies themselves. Where patients understand the purpose behind different medicines, it is more likely that they will take them appropriately, and that they will benefit. People with constant pain generally find it easier to manage with slow-release formulations. Treatments such as capsaicin skin cream (derived from chilli peppers) cause an increased release in the nerve endings of ‘substance P’, which creates the feeling of heat or burning and is involved in the transmission of pain. Over time, repeated use of the cream causes the nerves to run out of this transmitter, and the pain is reduced. These new methods of delivery may improve effectiveness, reduce side effects, or be easier for patients to manage.
There is little standardisation of drug treatments, and pain treatments vary widely between countries. The United Kingdom uses significantly fewer non-steroidal antiinflammatory drugs and more opioids than the European average.
Non-drug treatments include transcutaneous electrical nerve stimulator (TENS) machines and can have a significant effect on many types of pain if used properly, often in conjunction with other treatment options. Acupuncture may work in a number of ways; and, although controversial, there is no doubt that some patients report significant benefit for some pain problems.
Maintaining or regaining a degree of physical function is widely accepted as crucial to reducing the effects of pain. Physical therapy and/or appropriate rehabilitation programmes both treat pain directly and give patients the knowledge and skills to maintain their own health and function. This may also help to maintain psychological well-being. This also reduces the risks of heart disease and obesity.
Cognitive behavioural therapy can help patients break the cycle of pain, fear, immobility and disuse that leads to ever-worsening pain. This approach also helps to develop self-management and coping strategies, and to improve social and physical functioning, even where the underlying pain cannot be improved significantly. The newer, third-wave therapies such as mindfulness and acceptance-based therapies have proved to be very useful.
Participation in expert patient programmes allows people with chronic pain to learn from the experiences of others. Patients gain the skills to become confident in managing their own pain and learn how to work in partnerships with their clinicians. Although these programmes may work better for some patients, they report the need to have advice from a healthcare professional as well.
Patient support groups such as Pain Concern and Action on Pain can play a vital role in mentorship
Helping patients remain in, or return to, work is an essential goal. Remaining in work is essential to physical and mental health, and improves quality of life and self-esteem. Employers play a key role in understanding and contributing to rehabilitation and the patient’s reintroduction to work. A constructive approach, looking at flexibility of roles, retraining, modification of hours and other options, can yield rewards for the patient, the employer and society.
Over a third of chronic pain patients in the United Kingdom reported inadequate control of their pain. More than two-thirds said that at times their medication was unable to control their pain completely. Across Europe, 42% of sufferers agreed that they would spend all their money on pain treatment if they knew that it would work, and one in six felt that some days their pain was so bad they wanted to die. Only 14% of people in pain have seen a specialist in pain medicine. While the majority have seen their general practitioner about their pain, 16% have not consulted anyone at all in the previous year.
“For the last 20 years I’ve had violent migraines that can last for days at a time. This happens once or twice a month, and when I feel like this I can’t work. I’m a self-employed plumber, and lose a lot of income as a result. Also, I’m a single parent, and when I have a migraine I really struggle to manage to look after the children. Medication just doesn’t
seem to help.”
All healthcare professionals encounter people in pain. However, local pain services are very thinly spread around the country, and the design and level of integration varies widely. Teaching at undergraduate level is patchy and inconsistent. Pain management services in primary care across the United Kingdom are unequal and inconsistent and suffer from insufficient funding. Prescribing was inconsistent, and guidelines were lacking. Even where services exist, there may be a significant hidden demand within communities.
A major initiative to widen access to high-quality pain services would improve the lives of millions of people. In moving towards such an ideal, it is important to establish the orientation, philosophy and model of care delivered by local pain services. Firstly, the range of approaches to pain needs to be wide, including techniques such as cognitive therapy. Secondly, there must be a strong focus on the impact of pain, rather than purely on the pain itself. Thirdly, services must be multidisciplinary, involving many specialist professions, not just doctors, and should integrate healthcare and community services.
In 2007, the Royal College of Anaesthetists established a Faculty of Pain Medicine. There are currently nearly 500 fellows in the United Kingdom, most of whom work less than full time in pain medicine. This roughly equates to one full-time pain specialist for a quarter of a million people: the Royal College of Anaesthetists and the British Pain Society recommend one per 100,000. This means that there are about 32,000 sufferers per full-time specialist. It is unsurprising that services around the country feel overwhelmed by referrals and unable to cope with the workload, let alone concentrate on delivering change.
Pain services face a number of challenges in meeting patient need. Most services are funded according to the number of patients seen, rather than the complex services they provide. Invisible services, such as supporting general practitioners or other services, are not accounted for. Where new ways of working reduce the number of patients who need to be seen in specialist clinics, this can result in a significant loss of funding for the service, further risking innovation and even the viability of local services.
Care for long-term conditions such as complex and chronic pain should be focused on the patient, and services should work together seamlessly, delivering the elements that patients need quickly and effectively.
The Chief Medical Officer closes his report on pain by recommending the following actions
1. Training in chronic pain should be included in the curricula of all healthcare professionals.
2. Consideration should be given to the inclusion of the assessment of pain and its associated disability in the Quality and Outcomes Framework for primary care.
3. For patients in hospital, a pain score should become part of the vital signs that are monitored routinely.
4. The feasibility of a national network of rapid-access pain clinics providing early assessment and treatment should be explored.
5. A model pain service or pathway of care with clear standards should be developed by experts.
6. All chronic pain services should supply comprehensive information to a National Pain Database.
7. Agencies involved in the management of patients with chronic pain should form local pain networks to work together to improve the quality of local services.
8. The Health Survey for England should routinely collect data on the impact of pain on quality of life.
Source: CMO 2008 Annual Report Chapter: Pain: Breaking Through the Barrier
http://www.dh.gov.uk/en/News/Media/DH_096271
Professor Sir Liam Donaldson, the government’s Chief Medical Officer points out that pain is one of the world’s most common symptoms: it affects 7.8 million people in this country. Chronic pain has a major impact on people’s lives, causing sleeplessness and depression and interfering with normal physical and social functioning.
All age groups are affected: a quarter of school-age children report pain (on average lasting more than three years), while most elderly residents of nursing homes experienced frequent moderate to severe pain. It has been estimated that back pain alone costs the economy £12.3 billion per year. The cost of pain from all causes is far higher. Chronic pain and its consequences are not as well controlled as they could be. Early intervention may stop pain becoming persistent.
United Kingdom: pain in numbers
7.8 million people live with chronic pain
£3.8 billion cost of adolescent pain
£584 million spent on prescriptions for pain
1 million women suffer with chronic pelvic pain
1.6 million adults per year suffer with chronic back pain
49% of patients with chronic pain experience depression
25% of sufferers lose their jobs
16% of sufferers feel their chronic pain is so bad that they sometimes want to die
1 pain specialist for 32,000 people in pain
The few specialist pain clinics around the country are inundated with referrals, and only 14% of people with pain have seen a pain specialist. Systems and infrastructure are not adequate to meet need or demand.
Better coordination of services and services designed around the patient’s needs are essential.
Chronic pain may be complex, often with no identifiable purpose or basis. Untreated, pain becomes entrenched and more difficult to treat. The consequences of long-term pain have a serious impact on both patients and society. Over a third of households have someone in pain at any given time. The numbers are rising. Repeated surveys show that chronic pain is two to three times more common now than it was 40 years ago.
"For three years, since I was 14, I’ve had severe pelvic pain. I have tried painkillers and been to see my general practitioner, but nothing much helps. I’ve missed a lot of school, and worry I may fail my A levels or be too ill to sit through an exam. I can’t keep up with my friends’ social activities. Pain is ruining my life.”
Women report chronic pain more frequently. The same is true for people from socially or financially disadvantaged groups and some ethnic minority groups. United Kingdom citizens of South Asian origin are three times more likely to suffer disabling back pain than their non-Asian peers. Women are at greater risk of chronic pelvic pain, report migraine headache three times more commonly than men, and are disproportionately affected by pain syndromes such as fibromyalgia.
Chronic pain becomes more common with age: the probability of suffering chronic pain at age 50 years is double that at age 30 years. However, chronic pain is not only a problem for older adults: the most common time to report chronic pain is in the decade between 40 and 50 years of age. Chronic pain may be neglected at both ends of the age spectrum. In a study of United Kingdom nursing homes, most residents experienced constant or frequent moderate to severe pain, despite the fact that 99% were on pain medication. Conversely, chronic pain affects a quarter of school-age children (a third severely), with pain lasting on average more than three years.
Muscle, bone and joint pain are the main causes of chronic pain, with back pain and osteoarthritis together responsible for over half of all cases. Every year, 1.6 million adults in the United Kingdom develop back pain that stretches beyond three months. At any one time, a quarter of adults over the age of 40 years in the United Kingdom have knee pain, and in around half of them this pain is disabling. On top of this, half a million adults have rheumatoid arthritis, where the joints are attacked by the immune system.
Severe and recurrent headache is common. Around 12% of the population experience migraine, and a further 9% of women and 3% of men suffer with chronic daily headache.
Pelvic pain lasting more than six months affects a million women in the United Kingdom; an additional one in eight women suffer from severe menstrual pain.
Up to 5% of the population are affected by chronic widespread pain of unknown cause, including diagnoses such as fibromyalgia.
Recent data from the United States found that, one year after being admitted to hospital for treatment of a serious injury, almost two-thirds of people still reported pain. Surgery itself may be a cause of pain: one year after hernia surgery, almost two-thirds of patients report ongoing pain as a result.
Chronic pain ruins lives: 65% of sufferers report difficulty sleeping and nearly 50% report problems conducting social activities, walking, driving or having a normal sex life. In 49% of those with chronic pain there is depression, and this can result in suicide. Chronic pain reduces quality of life more than almost any other condition. Pain often becomes intertwined with the lives of people living with it. Pain has been described as ‘exhausting’ and ‘mentally draining’, and the experience of living with it ‘frustrating’, ‘isolating’ and ‘humiliating’.
“I’m constantly in agony, and I lost my job six years ago due to ‘performance issues’. My doctor told me I have fibromyalgia, but has been unable to explain the cause of my pain, and I feel my family has no patience with me now. Painkillers do nothing to help. Some days I can’t get dressed, the pain is so bad. I feel that no one really understands.”
Chronic headache significantly impairs quality of life. Disability is common, with 70% of migraine sufferers reporting some disability, of which 25% is severe.
Young people with ongoing pain have more mental health and social problems, miss more school than their peers, and tend to achieve less academically than expected. Taken together, all these factors have the potential to seriously harm a child’s future.
The financial impact for both the sufferers and their families is shattering, and the burden to the economy as a whole is huge. People with chronic pain are seven times more likely to quit their jobs due to ill health than the general population. Overall, 25% of people with chronic pain eventually lose their jobs.
Conditions associated with chronic pain are among the most expensive to treat. Musculoskeletal diseases, such as arthritis, make up one of the most expensive disease groups for healthcare costs.
People with chronic pain account for a significant proportion of general practitioner appointments each year and are relatively high users of accident and emergency, diagnostics and outpatient services. In 2007, on top of money spent by patients on non
prescription medication, the NHS in England spent £584 million on 67 million prescriptions for analgesia and anti-inflammatory drugs.
However, indirect costs, largely due to the loss of work opportunities, may be even greater than this. In 1998, it was estimated that the cost to the United Kingdom of back pain alone was £12.3 billion – 22% of UK health expenditure in that year – and the main part of this cost was due to work days lost.
Chronic pain is the second most common reason for claiming incapacity benefit. People with chronic pain often do not know how quickly, or whether, they are going to recover. This makes it difficult for them and their employers to plan for their return. Very often, people fail to come off these benefits.
Pain is subjective. It is not easily measured, unlike blood pressure or body temperature. Few report their pain being assessed effectively. Only 15% of patients have completed even a simple scoring system. Fewer than half of nursing home residents said that their carers had asked them about their pain. Identifying and assessing pain is an undervalued clinical activity and is not seen as a priority in assessing a patient, particularly in emergency settings.
Assessing complex and chronic pain is rarely of value if undertaken in isolation from assessments of the effects of pain. If people worry excessively about the sources of their pain, they tend to become more inactive. Gauging the potential threat value of pain is difficult for patients. It is vital for healthcare professionals to promote active coping strategies at an early stage to aid recovery. In Australia, a mass television campaign that encouraged people to stay active in spite of their pain had a dramatic and prolonged effect on sickness absence.
Modern pain management should have an integrated approach. Early identification of each patient’s needs allows a plan to be tailored. With appropriate support, some people can be taught the skills to maintain normal function. Others have pain that may become complex and chronic and require more elaborate interventions.
People are generally keen to help themselves. No one wants to be in constant pain. Therefore, given proper support and information, most people will benefit from an integrated approach that addresses different aspects of their pain simultaneously. This may involve a focus on activity and rehabilitation, balanced drug therapies, psychological therapies, electrical nerve stimulation, and, occasionally, appropriate injection techniques. Complementary therapies also have their place. The key factor appears to be ensuring that aspects of care are integrated and joined up, rather than instigated sequentially or in isolation.
Patients report that being listened to and given choices over treatment are just as important as the therapies themselves. Where patients understand the purpose behind different medicines, it is more likely that they will take them appropriately, and that they will benefit. People with constant pain generally find it easier to manage with slow-release formulations. Treatments such as capsaicin skin cream (derived from chilli peppers) cause an increased release in the nerve endings of ‘substance P’, which creates the feeling of heat or burning and is involved in the transmission of pain. Over time, repeated use of the cream causes the nerves to run out of this transmitter, and the pain is reduced. These new methods of delivery may improve effectiveness, reduce side effects, or be easier for patients to manage.
There is little standardisation of drug treatments, and pain treatments vary widely between countries. The United Kingdom uses significantly fewer non-steroidal antiinflammatory drugs and more opioids than the European average.
Non-drug treatments include transcutaneous electrical nerve stimulator (TENS) machines and can have a significant effect on many types of pain if used properly, often in conjunction with other treatment options. Acupuncture may work in a number of ways; and, although controversial, there is no doubt that some patients report significant benefit for some pain problems.
Maintaining or regaining a degree of physical function is widely accepted as crucial to reducing the effects of pain. Physical therapy and/or appropriate rehabilitation programmes both treat pain directly and give patients the knowledge and skills to maintain their own health and function. This may also help to maintain psychological well-being. This also reduces the risks of heart disease and obesity.
Cognitive behavioural therapy can help patients break the cycle of pain, fear, immobility and disuse that leads to ever-worsening pain. This approach also helps to develop self-management and coping strategies, and to improve social and physical functioning, even where the underlying pain cannot be improved significantly. The newer, third-wave therapies such as mindfulness and acceptance-based therapies have proved to be very useful.
Participation in expert patient programmes allows people with chronic pain to learn from the experiences of others. Patients gain the skills to become confident in managing their own pain and learn how to work in partnerships with their clinicians. Although these programmes may work better for some patients, they report the need to have advice from a healthcare professional as well.
Patient support groups such as Pain Concern and Action on Pain can play a vital role in mentorship
Helping patients remain in, or return to, work is an essential goal. Remaining in work is essential to physical and mental health, and improves quality of life and self-esteem. Employers play a key role in understanding and contributing to rehabilitation and the patient’s reintroduction to work. A constructive approach, looking at flexibility of roles, retraining, modification of hours and other options, can yield rewards for the patient, the employer and society.
Over a third of chronic pain patients in the United Kingdom reported inadequate control of their pain. More than two-thirds said that at times their medication was unable to control their pain completely. Across Europe, 42% of sufferers agreed that they would spend all their money on pain treatment if they knew that it would work, and one in six felt that some days their pain was so bad they wanted to die. Only 14% of people in pain have seen a specialist in pain medicine. While the majority have seen their general practitioner about their pain, 16% have not consulted anyone at all in the previous year.
“For the last 20 years I’ve had violent migraines that can last for days at a time. This happens once or twice a month, and when I feel like this I can’t work. I’m a self-employed plumber, and lose a lot of income as a result. Also, I’m a single parent, and when I have a migraine I really struggle to manage to look after the children. Medication just doesn’t
seem to help.”
All healthcare professionals encounter people in pain. However, local pain services are very thinly spread around the country, and the design and level of integration varies widely. Teaching at undergraduate level is patchy and inconsistent. Pain management services in primary care across the United Kingdom are unequal and inconsistent and suffer from insufficient funding. Prescribing was inconsistent, and guidelines were lacking. Even where services exist, there may be a significant hidden demand within communities.
A major initiative to widen access to high-quality pain services would improve the lives of millions of people. In moving towards such an ideal, it is important to establish the orientation, philosophy and model of care delivered by local pain services. Firstly, the range of approaches to pain needs to be wide, including techniques such as cognitive therapy. Secondly, there must be a strong focus on the impact of pain, rather than purely on the pain itself. Thirdly, services must be multidisciplinary, involving many specialist professions, not just doctors, and should integrate healthcare and community services.
In 2007, the Royal College of Anaesthetists established a Faculty of Pain Medicine. There are currently nearly 500 fellows in the United Kingdom, most of whom work less than full time in pain medicine. This roughly equates to one full-time pain specialist for a quarter of a million people: the Royal College of Anaesthetists and the British Pain Society recommend one per 100,000. This means that there are about 32,000 sufferers per full-time specialist. It is unsurprising that services around the country feel overwhelmed by referrals and unable to cope with the workload, let alone concentrate on delivering change.
Pain services face a number of challenges in meeting patient need. Most services are funded according to the number of patients seen, rather than the complex services they provide. Invisible services, such as supporting general practitioners or other services, are not accounted for. Where new ways of working reduce the number of patients who need to be seen in specialist clinics, this can result in a significant loss of funding for the service, further risking innovation and even the viability of local services.
Care for long-term conditions such as complex and chronic pain should be focused on the patient, and services should work together seamlessly, delivering the elements that patients need quickly and effectively.
The Chief Medical Officer closes his report on pain by recommending the following actions
1. Training in chronic pain should be included in the curricula of all healthcare professionals.
2. Consideration should be given to the inclusion of the assessment of pain and its associated disability in the Quality and Outcomes Framework for primary care.
3. For patients in hospital, a pain score should become part of the vital signs that are monitored routinely.
4. The feasibility of a national network of rapid-access pain clinics providing early assessment and treatment should be explored.
5. A model pain service or pathway of care with clear standards should be developed by experts.
6. All chronic pain services should supply comprehensive information to a National Pain Database.
7. Agencies involved in the management of patients with chronic pain should form local pain networks to work together to improve the quality of local services.
8. The Health Survey for England should routinely collect data on the impact of pain on quality of life.
Source: CMO 2008 Annual Report Chapter: Pain: Breaking Through the Barrier
http://www.dh.gov.uk/en/News/Media/DH_096271
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