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Practice comment

We must not forget acute pain when improving pain services

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The chief medical officer’s recent recommendations to improve services for chronic pain managementare long overdue, but we must not forget the problem of acute pain, argues Sharon Wood

At last the poor provision of effective pain management for people with chronic pain is being recognised as a national problem. The chief medical officer for England’s report recognises that an estimated 7.8m people in the UK experience moderate to severe pain that has lasted over six months (Donaldson, 2009). This number is steadily rising and, given the expected increase in the older population, the number of people suffering unnecessary chronic pain is likely to escalate further and more rapidly.

It is very timely, then, that this report sets out vital recommendations to improve coherent chronic pain management across primary and acute care. 

The CMO makes a range of recommendations, including:

  • Training in chronic pain should be included in the curricula of all healthcare professionals;
  • Including pain assessment in the GP Quality and Outcomes Framework should be considered;
  • The feasibility of a national network of rapid-access pain clinics should be explored;
  • A model pain service or pathway of care should be explored.

Training in chronic pain for healthcare staff is imperative and currently is not available equitably across the UK. Undergraduate training programmes, however, should incorporate both acute and chronic pain management as compulsory elements and should be aligned with summative assessment strategies. Postgraduate education could then build on this.

Without education on pain management, pain will continue to be a neglected phenomenon and patients will continue to suffer unnecessarily.

Routine assessment and documentation of chronic pain in primary and acute care is essential if it is to be recognised and managed appropriately. Nurses may be the first to identify chronic pain as a problem. A systematic approach to assessment, supported with appropriate training, will enable nurses to implement a pain assessment strategy immediately. This immediate identification and assessment of chronic pain would enable referrals to an appropriate pain management service, care pathway or rapid-access pain clinic.

Patients first report pain to their GP and so access to high-quality pain services directly in the community makes sense. The composition of multidisciplinary primary care teams is not prescriptive and the area a team would cover is unclear in the report. These need to be considered carefully to provide parity of pain management provision across the country.

A national network of rapid-access pain clinics would raise the profile of chronic pain, not only for patients, but also within the health service as a whole. They would provide much-needed rapid referral to appropriate specialists and prompt treatment strategies. Where pain is not well managed, then a referral to specialist pain services would provide complex pain management.

However, the CMO’s report does not provide guidance for managing chronic pain and acute-on-chronic pain in hospital. This is often a neglected area and if hospital pain services focus on complex pain referrals this group of patients may be missed. The provision of acute pain management still remains poor and patients still experience moderate to severe pain. This should not be forgotten nor have resources reduced in order to implement the CMO’s chronic pain recommendations.

In addition, the report discusses the incidence of chronic pain in children but does not provide any distinct recommendations for its future management.

This is a long overdue report that recognises the suffering of millions of people. The change of focus of pain services from acute to primary care may have a profound impact on some patients.

Sharon Wood is lecturer in nursing, University of Leeds

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Readers' comments (1)

  • Chronic pain is a much bigger problem than it is generally reconised. It is as important as acute pain which in itself is poorly managed even by acute pain teams in hospital. I do agree with more training however, we also need to have specialist clinics as Sharon Wood suggests as chronic pain is multifactorial.

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