NHS: Pain Management Services

Lord Luce Excerpts

Wednesday 7th July 2010 Lords Chamber

Tabled by

[Lord Luce]

To ask Her Majesty’s Government what action they will take to provide access to multi-disciplinary pain management services in the National Health Service for those experiencing chronic pain.

[Lord Luce]

My Lords, I am most grateful to the Minister for replying to this debate and to all noble Lords who are taking part in it. Why do I raise the subject? For over 40 years, I have suffered from chronic back pain due to musculoskeletal problems, but I am fortunate in that I have managed to live a full life with various public responsibilities due almost entirely to prompt, effective and dedicated support from specialists in the private sector. Very few people have access to it. Some 7.8 million people in this country suffer from chronic, as opposed to acute, pain, and my plea today is that the Government ensure that every single one of them has access through the National Health Service to multidisciplinary rehabilitation to help them to stay in their jobs and to live a life of at least tolerable quality. Given this support, I believe we can learn to manage our own pain.

The facts are horrific. One in seven individuals suffers from chronic pain, of which musculoskeletal pain or osteoarthritis is the commonest cause, although it includes cancer pain. It can be deeply damaging to the quality of life, causing sleeplessness and depression while interfering with normal physical and social life. Milton wrote,

“… pain is perfet miserie, the worst

Of evils, and excessive, overturns

All patience”.

Moreover, it has an adverse effect on the economy of the country as well as on the individual. Chronic pain takes up the equivalent of 4.6 million GP appointments, costing approximately £70 million per annum. In 2000, it was calculated that the total cost of back pain was just over £12 billion, and today 119 million working days are lost per annum because of back pain. A recent pain survey in Europe showed that 25 per cent of people in chronic pain had lost their jobs and that a considerable proportion of them never return to work. In the present economic climate, it is worth stressing that an effective preventive service could save overall costs in the long term.

A turning point came with the report on pain by the previous Chief Medical Officer, Sir Liam Donaldson, in 2008. He stressed that pain affects all age groups, not just the elderly. Worryingly, a quarter of school-age children have reported pain and 8 per cent suffer from chronic pain. Sixty-eight per cent of pain clinics in the UK do not see children, according to the British Pain Society. The most affected are those at work in their 40s and 50s. Sir Liam highlights the fact that only 14 per cent of those suffering from chronic pain have seen a pain specialist, normally an anaesthetist, and that the infrastructure is inadequate, unco-ordinated and unevenly resourced, which results in a variable quality of service provision—in other words, a postcode lottery. Generally, interest from primary care trusts and strategic health authorities in establishing better pain services seems to be low.

The report’s conclusion is clear; pain needs to be recognised as a disease in its own right, and a pain score should become one of five vital signs to be monitored routinely in hospitals and elsewhere. Above all, it advocates that a multidisciplinary approach should be vital in the prevention, assessment and management of pain and that there should be a national network of rapid-access pain clinics providing early assessment and treatment, as early intervention is critical for improving the long-term outcome. The report adds that all health professionals dealing with patients should be trained in chronic pain and that the assessment of pain should be included in the quality and outcomes framework in primary care. Other recommendations include the creation of a model pain service of pathways of care and the maintenance of a proper database.

I am delighted to say that, to help us in all this, is the Chronic Pain Policy Coalition, under the chairmanship of Dr Beverly Collett, who runs a successful pain management unit in Leicester. It also supports an all-party parliamentary group—Anne Begg MP was re-elected today as its chairman—that has a growing membership, in this new Parliament, of more than 20 parliamentarians. We are now most anxious to see the recommendations of the former Chief Medical Officer implemented.

For my part, I have witnessed some successful multidisciplinary operations in the NHS. In my own county, I have visited the West Sussex Primary Care Trust and seen its chronic pain management services in Bognor, where it aims to achieve integrated musculoskeletal, rheumatology and pain management services. Key to this is its provision of tools for patient self-management with the help of hydrotherapy, muscle-pain clinics, physiotherapy, fit-for-work schemes and clinical psychology. I was particularly impressed by my visit to the Pain Management Centre, which is led by Dr Baranowski at the National Hospital for Neurology and Neurosurgery in London. It has had success in treating patients on a multidisciplinary basis.

Another centre of excellence is the Pain Management and Neuromodulation Centre at Guy’s and St Thomas's in London under the leadership of Dr al-Kaisy, whose excellent residential unit gives prospects of a better life for many patients who had been in despair from their suffering. I have also seen the support given to cancer patients suffering longer-term pain at the Palliative Medicine and Pain Unit of the Royal Marsden Hospital, which is led by Dr Williams. The unit has a multidisciplinary strategy that gives options ranging from medication, physiotherapy and psychology to interventional support. It is good that pioneering work, principally on the spinal cord and the brain, is being carried out, mainly in some university research departments. I hope that it may eventually lead to improved methods of treatment.

There is therefore clear evidence to show that, with the right expert support, people can be encouraged to manage their own pain, improve the quality of their lives, and in many cases stay in employment or, indeed, return to work. The provision of access to multidisciplinary pain clinics would in itself be a good investment for the country. This is best highlighted by Dame Carol Black's 2007 review of the health of Britain's working-age population. She stressed the business case for employers' investment in employees’ health. Much can be done through preventive and remedial measures with more flexible working patterns and wider provision of support and therapeutic sessions. A key recommendation was to change the nature of the GP’s sick note so that the GP focuses on what can be done to encourage the patient to go back to work rather than stay at home.

I should highlight the fact that Scotland has set something of a lead in managing chronic pain. In 2007, the Scottish Health Minister recognised pain as a long-term condition in its own right, and he has appointed a pain tsar to co-ordinate all pain service development. Last summer, I was briefed by the pain management service in the Shetlands, which caters for a population of 20,000. The Welsh Assembly Government have recognised pain management as one of five areas for improvement by providing services nearer to people's homes.

I am glad to note that the National Institute for Health and Clinical Excellence has issued guidelines on the early management of persistent low-back pain. I understand that the new National Quality Board is considering where chronic pain fits into the level of clinical priorities for quality improvement in healthcare.

I hope that the Minister will be prepared to meet me and some interested parliamentary colleagues before long to discuss the way ahead. The previous Government can take credit for laying the foundations, and I look to this new coalition Government to make a determined effort to establish multidisciplinary rehabilitation pain management services that are accessible to all those suffering from chronic pain in England. My experience tells me that if they do that, they will give hope to many people of all ages in this country.