Easing chronic pain

GPs and primary care practitioners are being offered the chance to gain new skills to better identify and support patients in chronic pain thanks to a £250,000 University funding boost.

Experts in chronic pain from the School of Medicine have teamed up with NAPP pharmaceuticals to offer a 12 week e-learning Foundation course to provide new skills and techniques to better manage the increasing numbers of patients asking for help with chronic pain.

There are an estimated 7.8 million people in the UK living with chronic pain and of those, 1.6m have chronic back pain. 49% will experience depression and 25% will lose their jobs. 16% feel their pain is so bad that they feel suicidal.

As the gateway to the NHS GPs and the primary care team are the first port of call for many patients experiencing pain and the new e-learning course is designed to equip primary care staff with the latest pain management expertise and communication techniques so that more patients can be treated in community settings instead of being referred to secondary care.

Ann Taylor, Reader in Pain Education and Research at the Department of Anaesthetics, Intensive Care and Pain Medicine, School of Medicine, said pain management has been seen as a "Cinderella service" but says the increase in people presenting with pain means it is slowly being recognised as a discipline in itself rather than an add-on.

"Acknowledging someone's pain makes an enormous difference to someone's quality of life," says Ann who worked as an academic in the pain management field for more than 20 years.

"We want to educate clinicians about the importance of early intervention and screening for problematic or potentially problematic pain, as well as early treatment which not only improves patients' quality of life but also lessens the burden on the NHS and Society in the long term.

"Patients with severe pain are twice as likely to die of heart disease and two and a half times more likely to die of respiratory disease, therefore the old myth that no-one dies of pain so it isn't important has to be dispelled" she explained.

"A fifth of these patients will be those with chronic back pain. Yet many clinicians still don't understand the impact chronic pain has on people's lives because there is no way to measure it objectively and there are myths and misconceptions around subjective reports of pain. Pain is a neglected subject in most undergraduate health professional curricula so good pain assessment and management is not covered, leading to under confidence when qualified ."

The University's Department of Anaesthetics, Intensive Care and Pain Medicine has received more than half a million pounds of support from NAPP pharmaceuticals to support post graduate pain management learning and the additional funding is designed to support the department's expansion into primary care.

The new funding will also help develop the department's websitewww.paincommunitycentre.org - a free online resource for pain management specialists generating 150 new users every day.

Plans are underway to develop a 'toolkit' which will provide evidence-based treatment options for practitioners needing advice for specific conditions as well as a series of webinars led by pain management experts.

Phil Groom, Public Affairs Manager for NAPP Pharmaceuticals said pain management was a major challenge for the NHS and, with the continuing increase in chronic disease there was a need for more awareness among health professionals.

"Research has shown that 22% of all GP consultations are in relation to chronic pain but less than half are confident in how to treat it," he said. "More chronic conditions could be treated in the community and not referred to hospital but there is a need for more education. We want to see more healthcare professionals receive training in pain management so that they are able to use the right drug at the right time in the right place. We believe that increased awareness about chronic pain and how to manage it correctly will result in fewer mistakes and better outcomes for patients."

Chronic non malignant pain (CNMP) covers a range of painful conditions which affect people physically, psychologically and socially. These conditions can result in disability and can have a significant impact on a person's quality of life. Managing these conditions requires input from a range of professionals.

The growing need for services to support people with chronic pain is placing increasing demands on the NHS and social care system particularly in secondary care, yet there are clear indications that most forms of CNMP can be managed in primary and community care settings.

Conditions causing chronic pain vary, from musculoskeletal and neuropathic conditions to vascular and post-operative complications including osteoarthritis and rheumatoid arthritis, fibromyalgia, migraine, lower back pain, neck pain, multiple sclerosis, post stroke pain, and repetitive strain injury.

Staff nurse Anna Morris is a recent graduate of the e-learning foundation course and works in the pain clinic at Poole Hospital in Dorset. She said the course enabled her to share expertise with colleagues, work better with GPs and considerably benefited her own patients.

"It was the first time I had embarked on an e-learning course but working online allowed us to share our experiences and if we had any problems with an assignment we could discuss them with other students and lecturers. It was good to learn about pain management from an academic perspective to learn about new treatments and how to critically evaluate the evidence and also how pain affects a person both physically and psychologically. I was then able to share that knowledge when I got back to work.

"The case study I used for the course was one of my patients who had complex regional pain syndrome and what I learned helped me see her as a whole person and to treat her holistically rather than just focus on treating the pain. I also learned more about government policies around pain management and new guidelines coming up about this particular condition which has been really useful."