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Pain services must widen scope

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Margaret M. Dunham, BA (Hons), MSc, RN.

Lecturer in Nursing and Pain Management, School of Nursing and Midwifery, University of Sheffield

Patients experience pain in many more clinical areas than is acknowledged in the literature. For example, patients can be in varying degrees of pain in A&E, X-ray departments, endoscopy suites and in medical wards, to name but a few non-surgical areas.

Patients experience pain in many more clinical areas than is acknowledged in the literature. For example, patients can be in varying degrees of pain in A&E, X-ray departments, endoscopy suites and in medical wards, to name but a few non-surgical areas.

The two papers in this supplement address issues of great importance to patient care: pain in sickle cell anaemia and adolescent chronic pain. It is good to see the use of patient-controlled analgesia (PCA) being considered for non-surgical pain such as that experienced in sickle cell disease. Sickle cell is a potentially debilitating and damaging disease of younger people, which needs to be recognised and managed effectively, alongside other conditions that cause chronic pain in adolescence.

Now that acute pain teams are well established in surgical wards it may be time to consider the wider use of advanced pain techniques such as PCA. The general organisation of pain services is expected to undergo changes, and with pressure on chronic pain teams to provide a more community-based service, acute pain teams and critical care outreach teams are going to become increasingly more stretched.

The increasing pressures on specialist nurses make it all the more necessary for pain nurses to promote good nursing practice in pain management, which should be underpinned by a sound research and education base.

The implications of the Shipman inquiry on the provision of pain relief in the community.

The public inquiry into the case of GP Harold Shipman, chaired by Dame Janet Smith, continues its deliberations, despite the death last month of the Manchester doctor, convicted in 2000 for the murder of 15 of his patients.

The findings of the inquiry are likely to have widespread repercussions on how patients receiving controlled drugs are managed and how controlled drugs are monitored in the community.

At present, family practitioners have little restriction on prescribing controlled drugs for their patients. However, in future, their freedom to prescribe and dispense controlled drugs may be restricted and GPs are likely to find themselves more closely supervised.

Similarly, the freedom many district nurses have had in administering controlled drugs in the community may be revised. It is likely that in future two nurses will be required to check patients' drugs, with major resource implications for community nursing teams.

The question of who is allowed to collect controlled prescriptions for patients is also being considered, alongside much tighter regulation of pharmacies.

While the Shipman inquiry is progressing through its various phases, many pain nurses across the country are working hard to gain prescribing qualifications to support and enhance existing pain services.

It is regrettable that the horrific acts of one individual may compromise the ability of health-care professionals to provide pain relief to vulnerable patients.

- The Shipman inquiry's First Report was published in 2002 and the Second and Third reports last year. For full details of these, and further information on the Inquiry, visit: www.the-shipman-inquiry.org.uk.

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