Why pain should be on everyone’s agenda

Dr Beverly Collett

Consultant in Pain Medicine

University Hospitals of Leicester

Board Member Faculty of Pain Medicine

Chair of the Chronic Pain Policy Coalition

Personal Cost

• 7.8 million people live with chronic pain in UK• 13% UK population have chronic pain• Average annual incidence is 8.3% (5 million

people)• Annual recovery rate 5.4% • 25% lose their jobs• 22% - 49% of patients with pain develop

depression• 23% thought that their doctor did not know how to

treat their pain

Economic cost• £3.8 billion spent per year on IB for those with chronic

pain• Pain is second most common reason given by claimants

of IB• £584 million per year on prescriptions for analgesics• 4.6 million GPs appointments per year• 70% people living with chronic pain are of working age• Cost of back pain was £12.3 billion (22% of UK health

expenditure) - mainly due to work days lost. • 49% of those diagnosed with chronic

pain take time off work.

Pain in children

• 8% -12% of children experience severe pain• 25% of those report distress and disability• £3.8 billion cost of adolescent pain • Musculoskeletal• Headache• Abdominal pain• Menstrual pain

– 5% to 14% girls regularly miss school

Pain is real when you get other people to believe in it. If no one believes in it but you, your pain is madness or hysteria.

Naomi Wolf

• Chronic pain training for all HCP• Assessment of pain and disability in QOF• Pain score part of vital signs in hospital• Rapid access pain clinics• Pathway of care with clear standards should be developed by experts• Pain services to supply data to national pain database• Local pain networks• Health Survey for England should collect data on impact of pain on QOL

• Reduce the time to satisfactory diagnosis and treatment of chronic pain from 2.8 years to a few months (BK)

• Ensure that chronic pain becomes a ‘high street’ disease (LD)

• Create integrated systems to eliminate the perpetual pinball (EH)

• Create right conditions to support people to remain in and return to fulfilling work (CB)

National Pain Audit

• Phase 1

To identify and collect data from service providers

214 clinics. • Phase 2

Information re: patient journey to pain service

9,588 patients• Phase 3

Outcomes at 6/12

4,414 patients (3,192 complete)

National Pain Audit

• Variation in availability of services

• Quality of life

• Healthcare utilisation

November 2011

The NHS Atlas of Variation in HealthcareReducing unwarranted variation toincrease value and improve quality

http://data.parliament.uk/DepositedPapers/Files/DEP2012-0065/DEP2012-0065.pdf

40% of English Pain Clinics

60% Welsh Pain Clinics

are multidisciplinary

28% PCTs /LHBs had no pain service

Staffing• Minimum staffing for MDT: psychologist,

physiotherapist, specialist doctor– 40% in England– 60% Wales

• 52% clinics had access to physiotherapy

• 29% clinics no consultant support

• 18 week target: 80% England; 50% Wales

• Psychologically based rehab: 48% (England) and 60% (Wales) had psychology input

Quality of Life

• Mean Quality of Life (EQ5D-3L) = 0.4

• Post Rx:

• 56% improvement in EQ5D-3L

• 76% improvement in pain-related QoL (BPI)

Healthcare Utilisation

• Emergency Dept visits

• 16% visited ED in 6/12 before Pain Clinic

• 9% visited ED after Pain Clinic visit

Ten areas for improvement

1. Identification of services: code 191

2. Clinic information and timely access

3. Staff skills mix: multidisciplinary

4. Staffing competencies

5. Service commissioning +health needs assessment

6. Quality of care: quality standards needed

7. Information for patients

8. Coding

9. Impact on healthcare resource use

10.Treatment information