300. Attending a Pain Management Programme Reduces Hospital Investigations, Appointments and Interventions Over the Next Three Years

Abstract

Background: Patients with chronic musculoskeletal pain are often frequent attenders at GP surgeries and hospitals. Previous research showed that patients attending our rheumatology pain clinic at University College London Hospitals (UCLH) had poor self-efficacy despite multiple previous interventions and investigations. Continuing this pattern of healthcare use is ineffective. Pain management programmes (PMP) based on cognitive behavioural therapy seek to help patients to accept that the chronic pain cannot be cured and thus to engage coping strategies to improve quality of life. We sought to investigate whether attending a pain management programme reduced the number of hospital appointments, interventions and investigations over a three year period. Methods: We reviewed the medical records of 74 patients who had attended the pain management programme at the National Hospital for Neurology and Neurosurgery, London in 2008–9. We recorded the numbers of hospital appointments, interventions (injections, physiotherapy, and acupuncture) and investigations (X-rays, scans, EMG but excluding blood tests) over the 3 years before the programme and the 3 years after it. We also recorded demographic data and main diagnosis for each patient. Results: Of the 74 patients, 60 were women and 14 were men. Mean age was 45 years (range 19–74). All types of hospital encounter were reduced in the 3 years following the PMP compared with the 3 years before, as shown in Table 1. These reductions were seen equally in men and women and equally in people over and under 45 years old. 29 patients had joint hypermobility syndrome and attended a modified JHS-specific PMP. Similar reductions in appointments, investigations and interventions were seen in JHS and non-JHS patients. Conclusion: Attending this pain management programme led to a decrease in hospital appointments, investigations and interventions in people with chronic musculoskeletal pain. This has implications for cost-effectiveness of such programmes as they potentially reduce ineffective use of healthcare resources.