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 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 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 11 th, 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 )