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Core Standards for Pain Management Services in the UK

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Core Standards for Pain Management Services in the UK CSPMS Core Standards for Pain Management Services in the UK October 2015 CSPMS UK Edition 1/2015 Preface Preface Dr Kate Grady, Dean Pain affects all of us on occasion, but thankfully can be controlled or abates over a short period of time. For some, pain is ongoing to the degree of becoming persistent and for many is it significant. An estimated 14 million people in the UK live with chronic pain. The effects can be far reaching; quality of life is known to be as bad as that with a significant neurological illness such as Parkinson’s disease. A reported 41% of people who attend pain management clinics state that their pain has prevented them from working. Startlingly, severe chronic pain is associated with an increased risk of mortality, independent of socio-demographic factors. Persistent pain also affects family and carers. Pain therefore is a frequently presenting complaint across a wide range of health care settings. It presents to primary and community care and specialist (secondary) and specialised (tertiary). For most, their pain is treated, managed or resolved within the primary care and community setting. The pain management of those for whom this does not happen must be scaled up, which means referral to more specialised care. This referral should be timely; persistent pain does not go away but develops and accelerates over time through well recognised neurophysiological processes. The Faculty of Pain Medicine has previously contributed to the Royal College of Anaesthetists Guidelines for the Provision of Anaesthetic Services (GPAS) and detailed best practice for Anaesthetists involved in Pain Management Services. It is important for the whole of the multidisciplinary team to have guidelines and standards, and that is the reason for the collaborative Core Standards for Pain Management Services in the UK (CSPMS UK). Representatives of the Faculty of Pain Medicine, the British Pain Society, the Royal College of Nurses, the Royal Pharmaceutical Society, the College of Occupational Therapists, the Chartered Society of Physiotherapy, the Royal College of General Practitioners, the British Psychological Society and patient representatives have jointly been the authors of this document. The principle driving these standards is to have an acceptable level of care in pain management which is consistent, both geographically and from initial to escalating levels of care. These standards are multidisciplinary, that is to say they apply to all clinical professions to include nursing, physiotherapy, clinical psychology, occupational therapy and medicine. It is intended however that this work is not only a clinical guideline for those working to deliver pain management but that it is a reference and framework for those planning or negotiating pain services in the wider sense, particularly commissioners. Pain management is without a doubt threatened in the current climate. Standards become all the more important at such times. Pain can be all too easy to ignore as it is seen as a non-life threatening condition and the clinical consequences of untreated pain are not immediate or ever highlighted. Frequently therefore pain is under addressed, under managed and under treated. Onward referral for those patients with unresolved pain is often neglected. This is an issue which has been recognised and tackled by the Faculty of Pain Medicine’s ‘Right Patient Right Professionals Right Time’ (RPRPRT) initiative. The RPRPRT documents promote the timely management of persistent unresponsive pain through its onward referral from primary or community care to secondary and tertiary care. They emphasise that specialists in pain medicine as trained to the Faculty of Pain 2 CSPMS UK Edition 1/2015 Preface Medicine’s curricula, assessment and examination must be well within the reach and accessible for all those living with persistent pain and they must be working within the multidisciplinary context required for pain management to be delivered to a defined standard. The CSPMS UK document presents high but realistic standards which are drawn from the evidence base. It is written in sections comprising standards which are a ‘must’ and recommendations which are not simply aspirational but something to be worked towards where they are not currently in place. As pain management evolves so too will these standards such that they become a contemporary and relevant resource for the future. Alongside its multidisciplinary authorship the document has been out to extensive stakeholder consultation. Implicit in this is an acceptance of these standards such that these standards become the cornerstone of the delivery of pain management across the United Kingdom. 3 CSPMS UK Edition 1/2015 Contents Contents Chapter 1 Introduction ............................................................................................................................................ 6 Chapter 2 Commissioning of Services across the UK .............................................................................................. 9 2.1 England ..................................................................................................................................................... 10 2.2 Wales ........................................................................................................................................................ 14 2.3 Scotland..................................................................................................................................................... 18 2.4 Northern Ireland........................................................................................................................................ 21 Chapter 3 Description of Service .......................................................................................................................... 24 3.1 Population Needs of People in Pain attending Specialist Pain Services in the UK..................................... 25 3.2 Access to Pain Management Services ....................................................................................................... 27 3.3 Pain Management Services in the Community ......................................................................................... 30 3.4 Pain Management in the Secondary Care Setting including Specialist Services ...................................... 33 3.5 Pain Management in the Specialised Services .......................................................................................... 36 3.6 Acute Pain Services ................................................................................................................................... 40 3.7 Outcomes .................................................................................................................................................. 45 Chapter 4 Physical Facilities .................................................................................................................................. 48 4.1 Consultation/Assessment Facilities ........................................................................................................... 49 4.2 Equipment & Monitoring (incl. equipment safety and training) ............................................................... 53 Chapter 5 Pain Management Services Team ........................................................................................................ 58 5.1 Definition, Membership and Interaction of the Multidisciplinary and Multispecialty Team .................... 59 5.2.1 Medical Consultants .................................................................................................................................. 62 5.2.2 Staff and Associate Specialist Grades and Specialty Doctors .................................................................... 68 5.2.3 Medical Trainees ....................................................................................................................................... 72 5.3 General Practitioners ................................................................................................................................ 74 5.4 Nurses ....................................................................................................................................................... 76 5.5 Occupational Therapists ........................................................................................................................... 79 5.6 Pharmacists ............................................................................................................................................... 83 5.7 Physiotherapists ........................................................................................................................................ 85 5.8 Psychologists ............................................................................................................................................. 88 Chapter 6 Patient Pathways ................................................................................................................................. 93 6.1 First Consultation, Follow-Up and Discharge ............................................................................................ 94 6.2 Communication with Patients ................................................................................................................... 97 6.3 Chronic (Non-Cancer) Pain .....................................................................................................................
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