BPS Pain Pathways

Dr Andrew Nicolaou

Consultant Pain Medicine

St.George’s Hospital, London

Pain Patient Pathways Background

• 2008: CMO report

- pain as a clinical priority

- consensus on best practice pathways

- improve HCP pain education• 2010: White Paper- Coalition’s commissioning agenda

- unprecedented change

- do nothing was not an option

- meetings with BK, DoH, NICE, Commissioners

Pain Patient Pathways Trajectory

• 2011-12

-5 BPS pathways developed by >80 members

-Atlas of Variation

-Chronic pain proposed for NICE guidelines

and Quality Standard

-Pain Summit ( BPS, CPPC, FPM, RCGP, Patient organisations )

• Strategy to preserve and improve pain medicine in the UK to benefit our patients

• These endorsed pathways will provide the basis for:

-Commissioning

-Teaching and training material

Pain Patient Pathways

• Initial pain assessment and early management

• Spinal Pain• Musculoskeletal Pain

( non-inflammatory )• Neuropathic Pain• Pelvic Pain

Pain Patient Pathways

• Current Status• All 5 pathways completed and

submitted to MoM

• MoM internal process negotiated

• Evidence base re-reviewed

• Independent scutiny

• First 2 published 19/10/12

• Final 3 published 19/11/12

• Implementation and Dissemination the current phase…

Initial assessment and management

• Timely screening, assessment and management• Generalist, community / primary care perspective• Self-management resources• Risk stratification – medium to high risk of disability• Support tools• Simple investigations to identify serious pathology

Spinal Pain

• Risk stratification • STarTBack Tool from 2 weeks after onset of pain• Encouragement of self care• Fit-notes• Differing levels of psychological support• Timely access to specialist care when needed 3 months

or earlier radicular pain, 6 months or earlier for LBP• Interventional pain management• Strong Opioids

Chronic Widespread Pain

• Support non-specialist care with a multidisciplinary approach• Identification of underlying diseases requiring treatment and

patients with complex pain needs then early referral to appropriate specialised care.

• Tramadol only opioid advised• Self management resources• Not ‘medically unexplained symptoms’

Neuropathic Pain

• The pharmacological management of neuropathic pain in adults in non-specialist settings CG96

• Assessment recommendations developed• Specialist setting pathways of care• Patient centered individualised care plans, self-help advice• Gabapentin included• Strong opioids – specialist use• Specialist therapies SCS, drug infusions

Chronic Pelvic Pain

• Non-specialist management• Role of secondary and tertiary care• Psychosocial, sexual, behavioural assessment / management• Multisystem disorders• Multidisciplinary pain management programmes• Specialist interventions

Strategy

• Underpin:- Commissioning- Training and Education- Quality agenda

- Quality standard & NICE endorsement

Through:

- Implementation and Dissemination of the

Pain Patient Pathways

Implementation and Dissemination 4 Workstreams:

• Patients – BPS PLC with Anne Taylor,CPPC, Pain UK

• Commissioners- Ollie Hart with RCGP

• Primary /Community Care- Martin Johnson with RCGP

• BPS membership- Nick Allcock

- link to Pain Summit workstreams, partner organisations ‘e-learning for pain’…

- funding secured

Patient Workstream

• PLC Chair appointed 11/2012• Patients involved in all workstreams• Patient information across a variety of formats

- Web-based, Apps• 15 things you would expect from your pain service• ‘Business’ Cards, social media• Links into pathways from patient organisations• Patient scenarios• Illustrate pathways – ‘shared decision making’• Publications

Commissioning

• Develop consistent commissioning support materials

-Providers

toolkit for engagement / negotiation

‘language’ of commissioning

‘top-tips’, differing levels of information

overview of process, likely scenarios / actual examples

-Commissioners

costings, value (gain to outcome)

Links to Pain Summit strategy 3, NICE endorsement

Primary and Community Care

• Educational material

- with RCGP

( embedded in Clinical Priority programme )• Commissioning materials

- workshops• ‘Train the Trainer’• Accreditation and training of GPwSI• Publications, e-guidelines, 10min consultation Handbooks

BPS membership

• Disseminate pathways and commissioning materials

- Pain News and special edition

- Website, links, site for commissioning examples

- Membership email

• Country/ regional workshops

- Primary and secondary care, Multiprofessional

FPM, Google-group, EFIC, IASP, SIP

Other publications / routes- BJA, Apps

Specific Projects• Country / regional workshops

- Scotland, Wales, NI, England x 6

( London March 11th , ASM April, NoE May )

• Assessment tools

- Relevant to QOF

• Problematic Pain

• NICE endorsement

Project Management

• Executive Group

- Chair, 4x Workstream Leaders, Project Leaders,

President/President Elect, BPS Secretariat Manager

- Project Co-ordinator• Steering Group

-As above

-Partner Organisations ( FPM- Commissioning Beverley Collett, RCGP, CPPC )