Meeting the needs of patients with chronic pain

Abstract

The relief of pain is one of the fundamentals of health care. It is a natural human response to wish to alleviate pain in others. It may therefore come as a surprise, to say the least, that treatment and support for the 7.8 million people in the UK with chronic pain has been described as patchy. This was the conclusion of Sir Liam Donaldson, the then chief medical officer, in his 2008 and 2009 annual public health reports. (Donaldson, 2008). The report voiced concern about the ‘often inadequate’ treatment accorded people with chronic pain, adding that ‘improving the quality and availability of services would benefit the lives of millions of people.’ At the recent first National Pain Summit, a joint initiative of the Chronic Pain Policy Coalition, the British Pain Society, Faculty of Pain Medicine and the Royal College of General Practitioners, the parliamentary under-secretary for health, Earl Howe, and NHS medical director Sir Bruce Keogh acknowledged that little had improved since Sir Liam brought the issue to national attention three years ago. According to Sir Liam’s report, only 14% of those with chronic pain have seen a pain specialist – hardly surprising, when there is only one pain specialist for every 32 000 people with pain. The pain summit heard from a 17-year-old who said that a succession of health professionals simply refused to take seriously her claim to be experiencing chronic pain. Such statistics and personal accounts suggest chronic pain really is the Cinderella of chronic conditions. And yet severe chronic pain affects as many people as heart disease and diabetes (National Centre for Health Statistics, 2006). Nurses have a pivotal role in ensuring that identification and assessment of pain is rigorous and timely. Community nurses in particular, notably in their work with people with long-term conditions, have a significant role to play here. With the increase in nursing responsibilities, nurses can play a much larger role as patient advocate and within the multidisciplinary team. However, as with the other health professions, many nurses will require additional training and education. All health professionals see patients with chronic pain, and therefore they should have a good understanding of pain management – but the evidence presented at the Pain Summit suggests that many do not. Assessments need to cover every aspect of the individual’s conditions and needs. Assessment and diagnosis must be followed by evidence-based management within primary and community care. This should be underpinned by the five ‘R’s – right patient, right time, right treatment, right place and right professional. Faced with the often dismal status quo, individuals affected will be only too pleased to embrace self-management and shared decision-making. However, it will need a big improvement in commissioning if the variations identified by Sir Liam and in subsequent national surveys and audits of pain services are to be addressed. It will also require primary and secondary care services to work together, adhering to an integrated strategy. The Pain Summit Steering Group has begun to raise awareness of the scale and impact of chronic pain. Now community nurses should join other health professionals in ensuring local services respond to the quiet desperation of millions of people. After all, if we as health professionals are not motivated by the relief of pain, we need to ask just what it is that gets us out of bed in the morning. BJCN