FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2134691854> ?p ?o ?g. }

• W2134691854 endingPage "823" @default.
• W2134691854 startingPage "816" @default.
• W2134691854 abstract "There is wide variation in how pain is managed in the UK. Patients often find themselves caught in a sea of referrals while continuing to suffer with poorly relieved symptoms. The British Pain Society’s (BPS) Initial Assessment and Management of Pain care pathway (one of the five new BPS care pathways published by the Map of Medicine®) sets out how best to initially manage persistent pain. Patient education and supported self-management is recommended from an early stage. This pathway focuses on the start of the journey of a patient with pain, where a full diagnostic work-up is not yet complete. The pathway covers diverse recommendations such as appropriate content of a pain consultation, the use of clinical decision management tools to aid stratification of care, and resources to support patients to make informed decisions. Recommendations for monitoring of therapeutic effect are also included. Early identification of people at high risk of chronic disability may allow more intensive management, better use of resources, and reduction in disability. Implementation poses significant challenges; more research is needed to determine the most effective interventions. This article highlights practice points for the non-specialist, discusses areas of controversy, and examines the challenges of implementation. There is wide variation in how pain is managed in the UK. Patients often find themselves caught in a sea of referrals while continuing to suffer with poorly relieved symptoms. The British Pain Society’s (BPS) Initial Assessment and Management of Pain care pathway (one of the five new BPS care pathways published by the Map of Medicine®) sets out how best to initially manage persistent pain. Patient education and supported self-management is recommended from an early stage. This pathway focuses on the start of the journey of a patient with pain, where a full diagnostic work-up is not yet complete. The pathway covers diverse recommendations such as appropriate content of a pain consultation, the use of clinical decision management tools to aid stratification of care, and resources to support patients to make informed decisions. Recommendations for monitoring of therapeutic effect are also included. Early identification of people at high risk of chronic disability may allow more intensive management, better use of resources, and reduction in disability. Implementation poses significant challenges; more research is needed to determine the most effective interventions. This article highlights practice points for the non-specialist, discusses areas of controversy, and examines the challenges of implementation. Editor’s key points•There is lack of a consistent approach to managing pain.•This pathway, developed by the British Pain Society, focuses on the beginning of a patient’s journey.•Early identification of high-risk patients will allow better resource allocation and patient outcome. •There is lack of a consistent approach to managing pain.•This pathway, developed by the British Pain Society, focuses on the beginning of a patient’s journey.•Early identification of high-risk patients will allow better resource allocation and patient outcome. Pain is a universal experience. However, pain that is very severe or that continues longer than expected causes significant distress. At a summit in Montreal in 2011, through expert advice and consensus, the International Association for the Study of Pain re-affirmed the following based on the International Covenant on Economic, Social and Cultural Rights (1966):1Cousins MJ Lynch ME The Declaration of Montreal: access to pain management is a fundamental human right.Pain. 2011; 152: 2673-2674Abstract Full Text Full Text PDF PubMed Scopus (94) Google Scholar •for all people to have access to pain management without discrimination;•for people in pain to have their pain acknowledged;•for people in pain to be informed about how pain can be assessed and managed;•for people with pain to have access to appropriate assessment and treatment of the pain by adequately trained healthcare professionals.Appropriate management includes good assessment and an agreed management plan that includes access to pain medications, best practice interdisciplinary and other integrative non-pharmacological therapies. The services must be delivered by professionals skilled in the safe and effective use of the medicines and treatments; these services should be supported by health policies, legal frameworks, and procedures to assure fair access and prevent inappropriate use. These powerful sentiments were encapsulated in the Declaration of Montreal (2011)1Cousins MJ Lynch ME The Declaration of Montreal: access to pain management is a fundamental human right.Pain. 2011; 152: 2673-2674Abstract Full Text Full Text PDF PubMed Scopus (94) Google Scholar and are the starting point for this care pathway. The impact of any pain that persists is profound. Recently, a large English health survey estimated that 14 million people have long-term pain, with 67% of these reporting anxiety or depression.2Health Survey for EnglandHealth, Social Care and Lifestyles. 2011http://www.ic.nhs.uk/catalogue/PUB09300Google Scholar Epidemiological research in Scotland found that severe chronic pain is associated with an increased risk of mortality although the exact nature of the association is unclear.3Torrance N Elliott AM Lee AJ Smith BH Severe chronic pain is associated with increased 10 year mortality. A cohort record linkage study.Eur J Pain. 2010; 14: 380-386Crossref PubMed Scopus (189) Google Scholar Chronic pain has deleterious effects on employment prospects and access to housing, and results in high healthcare usage.4Chief Medical Officer’s Report 2008: pain breaking through the barrier, Available from http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/AnnualReports/DH_096206 accessed 25 March 2013.Google Scholar 5National Pain Audit, Available from http://www.hqip.org.uk/assets/NCAPOP-Library/NCAPOP-2012-13/Pain-National-Audit-Report-pub-2012.pdf accessed 25 March 2013.Google Scholar The health service costs of treating pain are also high. In 2010, England spent on average £8.80 per head of population on analgesics, with the figure in the North being as much as £15 per person.6Data Analysed and Produced by SSentif Intelligence, Available from http://www.ssentif.com/archive/5_nov2011.shtml accessed 12 February 2013.Google Scholar In view of this significant impact, strategies are needed at a governmental level to address the burden of pain. A recent survey by the International Association for the Study of Pain found that seven countries had developed such strategies.7Desirable Characteristics of National Pain Strategies: Recommendations by the International Association for the Study of Pain, Available from http://www.iasp-pain.org/Content/NavigationMenu/Advocacy/DesirableCharacteristicsofNationalPainStrategies/default.htm accessed 8 September 2013.Google Scholar Part of any strategy to effect change in practices will involve clinical guidelines that reduce variation in healthcare provision and produce greater consensus among professionals.8Woolf SH Grol R Hutchinson A Eckles M Grimshaw J Potential benefits, limitations and harm of clinical guidelines.B Med J. 1999; 318: 527-530Crossref PubMed Scopus (1768) Google Scholar Guidelines for pain are generally considered to reduce disability by ensuring that patients are more likely to receive proactive care.9Waddell G Aylward M Models of Sickness and Disability Applied to Common Health Problems. Royal Society of Medicine Press, London2010Google Scholar 10Institute for Clinical Systems Improvement (ICSI)Health Care Guideline: Assessment and Management of Chronic Pain. ICSI, Bloomington, MN2009http://www.icsi.org/search.aspx?SearchFor=chronic+pain&x=0&y=0Google Scholar Recognizing the complexities in management of pain and the myriad of healthcare professionals involved, the report of the chief medical officer of England, ‘Pain: breaking through the barrier’, specifically recommended model pathways to guide practitioners in the management of pain.5National Pain Audit, Available from http://www.hqip.org.uk/assets/NCAPOP-Library/NCAPOP-2012-13/Pain-National-Audit-Report-pub-2012.pdf accessed 25 March 2013.Google Scholar In response to this recommendation, an executive committee of the British Pain Society (BPS) commissioned five pathways of care in 2012: the Initial Assessment and Management of Pain (presented here); Chronic Widespread Pain, Including Fibromyalgia;11Lee J Ellis B Price C Baranowski AP Chronic widespread pain, including Fibromyalgia. A pathway for care developed by the British Pain Society.Br J Anaesth. 2014; 112: 16-24Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar Low Back and Radicular Pain;12Lee J Gupta S Price C Baranowski AP British Pain SocietyLow back and radicular pain: a pathway for care developed by the British Pain Society.Br J Anaesth. 2013; 111: 112-120Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar Pelvic Pain;13Baranowski AP Lee J Price C Hughes J Pelvic pain: a pathway for care developed for both men and women by the British Pain Society.Br J Anaesth. 2014; 112: 452-459Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar and Neuropathic Pain.14Smith BH Lee J Price C Baranowski AP Neuropathic pain: a pathway for care developed by the British Pain Society.Br J Anaesth. 2013; 111: 73-79Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar They can be viewed on the BPS website (http://bps.mapofmedicine.com) and via Map of Medicine (www.mapofmedicine.com). The Initial Assessment and Management of Pain pathway aims to: •guide the practitioner in the initial management of any type of pain;•support recognition of those with complex pain and at risk of disability;•recommend appropriate monitoring arrangements.The pathway provides extensive information and advice both to patients and practitioners on the broad principles of pain management. It draws upon a considerable body of evidence on identification and management of those at high risk of chronic disability. The pathway also aims to take the non-specialist, regardless of setting, through a series of steps to ensure that pain is well managed alongside any ongoing investigations or treatments and, importantly, when pain appears to persist for no apparent reason. Unlike the other pathways in this series, it can be applied to any type of pain and in any circumstance. This article describes practice points of note in the pathway, discusses areas of controversy, and examines the challenges in adoption of this pathway with recommendations as to how these may be overcome. An overview of Initial Assessment and Management of Pain care pathway is shown in Figures Fig 1, Fig 2.Fig 2Pain: ongoing evaluation: initial assessment and early management of pain. Reproduced from The Map of Medicine and British Pain Society: Initial Assessment and Early Management of Pain. International View. London: Map of Medicine; November 2012 with permission from Map of Medicine©.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Effective self-management to promote active coping strategies is an established therapeutic goal for chronic pain.15Barlow J Wright C Turner A Hainsworth J Self-management approaches for people with chronic conditions: a review.Patient Educ Couns. 2002; 48: 177-187Abstract Full Text Full Text PDF PubMed Scopus (1745) Google Scholar 16Keefe FJ Somers TJ Kothadia SM Coping with pain.IASP Pain Clin Updat. 2009; 17: 1-5Google Scholar The use of passive coping strategies has been found to be associated with higher disability rates.17Mercado AC Carroll LJ Cassidy JD Cote P Passive coping is a risk factor for disabling neck or low back pain.Pain. 2005; 117: 51-57Abstract Full Text Full Text PDF PubMed Scopus (95) Google Scholar Whether or not the pain actually disappears or fades over time or with treatment, the principles of self-management, explanations as to how pain can persist, social support, educating oneself and others, and self-care are all needed. Bair and colleagues18Bair MJ Matthias MS Nyland KA et al.Barriers and facilitators to chronic pain self-management: a qualitative study of primary care patients with comorbid musculoskeletal pain and depression.Pain Med. 2009; 10: 1280-1290Crossref PubMed Scopus (172) Google Scholar found that significant barriers to self-care in pain are many and include lack of family support, financial barriers, and fear of exacerbations through increased activity. Difficult patient–physician interactions were also highlighted as a factor. Proactive self-management support is recommended with written information and access to peer support or professional help; this is often available from voluntary or charitable groups. While it might be intuitive that support to self-manage makes a difference, evidence for this in the form of high-quality randomized trials is limited.19Pearson L Mattke S Shaw R Ridgely MS Wiseman SH Patient Self-Management Support Programs: An Evaluation. Agency for Health Care Research and Quality, Rockville, MD2007Google Scholar 20Woolacott N Orton L Beynon S Myers L Forbes C Systematic Review of the Clinical Effectiveness of Self-Care Support Networks in Health and Social Care. University of York, York2006Google Scholar The pathway recommends that commissioners should ensure structured education with appropriate resources in place. Information that patients require is diverse. It is unclear how much patients benefit from structured education, but by extrapolating from diabetes care, cancer pain, treatment for alcohol dependency, and learning from the Expert Patient Programme experience, it is clear that a proportion will benefit. However, those at a higher risk of more severe impact of pain on their lives are likely to require a more significant investment—individualized care plans are often advocated in this circumstance.21Coulter A Ellins J Patient-Focused Interventions: A Review of the Evidence. Health Foundation, London2006www.pickereurope.org/Filestore/Publications/QEI_Review_AB.pdfGoogle Scholar 22Battersby M Von Korff M Schaefer J et al.Twelve evidence-based principles for implementing self-management support in primary care.Jt Comm J Qual Patient Saf. 2010; (Available from) (accessed 25 March 2013): 561-570http://www.ncbi.nlm.nih.gov/pubmed/21222358Abstract Full Text Full Text PDF PubMed Scopus (138) Google Scholar There are a myriad of definitions pertaining to acute and chronic pain. These cause confusion in terms of both clinical management and service delivery. Pain of a short duration has less impact on the individual, and thus a single practitioner could be expected to reasonably manage most episodes. Severe enduring pain may require a whole team to support the patient. A popular alternative definition of chronic pain is ‘pain that extends beyond the expected period of healing’.23Turk DC Okifuji A Pain terms and taxonomies.in: Loeser D Butler SH Chapman JJ Bonica‘s Management of Pain. 3rd edn. Lippincott Williams & Wilkins, 2001: 18-25Google Scholar The term ‘chronic’ has been identified as suggestive of depression and futility,24Weiner DK Herr K Comprehensive interdisciplinary assessment and treatment planning: an integrative overview.in: Weiner DK Herr K Rudy TE Persistent Pain in Older Adults. Springer Publishing Company, Inc., New York, NY2002: 18-57Google Scholar so the pathway group felt that it was better to use the term ‘persistent’. The pathway group also felt that the term ‘chronic pain patient’ may lead to a failure to assess and reassess the causes of pain; on the other hand, the term ‘persistent’ recognizes that there is a pain condition but this does not lessen the clinical imperative to reach an appropriate diagnosis. Identification of psychosocial factors that may increase pain and associated disability are also critical; these will prolong pain problems. If these are present, then the pain is described in the pathway as ‘problematic’. However, at a recent consensus meeting the decision was made to term this group ‘complex’ and a commitment made to develop a research programme centred on this. The guidance will need to be updated to reflect the emerging consensus on terminology. Coding practices are also likely to require a review to ensure that the terminology is consistent. A purely biomedical perspective is unlikely to get to the bottom of why pain persists in many people. The pathway highlights that an assessment may be difficult because pain can be complex with entwined physical and psychosocial factors. At a pathological level, systemic diseases may be masked by changes in pain, development of new problems, and psychological issues. Getting the balance right is essential for a successful outcome. Research has highlighted that patients may not present with pain but with its consequences such as: employment issues; a threat to benefits; deteriorating mental health; or medication or treatment failure, or both.25Kendall NAS Burton AK Main CJ et al.Tackling Musculoskeletal Problems: A Guide for Clinic and Workplace—Identifying Obstacles Using the Psychosocial Flags Framework. TSO, London2009http://www.kendallburton.com/Library/Resources/Tackling_Muscle_and_Joint_Pain_a_Quick_Guide_for_the_Workplace.pdfGoogle Scholar This can make assessment extremely challenging. The pathway group recommends simple tests and nothing more in the initial assessment and management of pain. For example, X-rays to exclude trauma and erythrocyte sedimentation rate for suspected inflammatory disease are regarded as sufficient initial investigations. This list is not exhaustive, and the important point is to move away from the continuous cycle of investigations and encourage non-specialists to utilize a bio-psychosocial assessment for management. The pathway contains a list of recommendations on how to identify those at risk of chronic disability and suggests psychosocial interventions that may reduce disability. While there has been extensive research into this for chronic back pain, the situation is less clear for other types of pain. Nevertheless, the pathway draws upon the research into persistent low-back pain, making use of the ‘yellow flags’ approach.26Kendall NAS Linton SJ Main CJ Guide to Assessing Psychosocial Yellow Flags in Acute Low Back Pain: Risk Factors for Long-Term Disability and Work Loss. Accident Rehabilitation & Compensation Insurance Corporation of New Zealand, and the National Health Committee, Ministry of Health, Wellington, New Zealand1997http://www.kendallburton.com/Library/Resources/Psychosocial_Yellow_Flags.pdfGoogle Scholar The STarTBack tool for low-back pain is a short questionnaire that stratifies people into high, medium, and low risk of chronic disability. High-risk patients are offered a cognitive behavioural therapy (CBT)-based intervention with physical therapy, whereas the low-risk respondents are initially just given advice; it is a good example of how a risk assessment coupled with matched treatments may provide timely and cost-effective care.27Hill JC Whitehurst DG Lewis M et al.Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial.Lancet. 2011; 378: 1560-1571Abstract Full Text Full Text PDF PubMed Scopus (887) Google Scholar The effect size in terms of cost-effectiveness was small in the STarTBack trials and, while it represents a promising start, significantly more research is needed to refine the approach to a point where it can be widely implemented across conditions and settings. The Faculty of Pain Medicine of the Royal College of Anaesthetists has been tasked with supporting the research process through its newly formed Clinical Research Network for Pain. In primary care, the bio-psychosocial assessment forms part of a ‘patient-centred’ consultation to deal with undifferentiated problems and psychosocial issues. Other interventions include ensuring a strong therapeutic alliance and shared decision-making. While this is the bedrock of a consultation in primary care, the relationship between the specific format of a patient-centred consultation and the outcome is unclear and further work is needed on this.28Mead N Bower P Patient-centred consultations and outcomes in primary care: a review of the literature.Patient Educ Couns. 2002; 48: 51-61Abstract Full Text Full Text PDF PubMed Scopus (455) Google Scholar When moderate-to-severe pain instinctively drives a practitioner to look for its sources, there is a risk that psychosocial factors get overlooked and remain unaddressed. Equally, there can be too much focus on psychosocial factors if they are readily identified, and the medical factors then get overlooked. A collaborative care model, which includes a two-session clinician education programme, patient assessment, education and activation, symptom monitoring, feedback and recommendations to clinicians, and facilitation of specialty care, has been shown to have promise in patients with musculoskeletal chronic pain.29Dobscha SK Corson K Perrin NA et al.Collaborative care for chronic pain in primary care: a cluster randomized trial.JAMA. 2009; 301: 1242-1252doi:10.1001/jama.2009.377Crossref PubMed Scopus (253) Google Scholar Such models are being pursued with some success in the USA across a broad number of common conditions and allow greater flexibility of approach compared with services working in isolation. Research is urgently needed into the nature and style of a pain-related consultation that can best deliver successful outcomes earlier in the patient journey. Active patient involvement in care requires a strong relationship and an information exchange in line with patient values and preferences. This can be formalized into a process known as shared decision making (SDM). SDM has been defined as ‘an approach where clinicians and patients share the best available evidence when faced with the task of making decisions, and where patients are supported to consider options, to achieve informed preferences’.30Elwyn G Coulter A Laitner S Walker E Watson P Thomson R Implementing shared decision making in the NHS.Br Med J. 2010; 341: c5146Crossref PubMed Scopus (590) Google Scholar To ensure that decision-making is truly shared may require not only simple patient information sheets but also interventions that encourage patients to consider key issues and evaluate relevant options. An example of such interventions is the patient decision aid, which breaks down decision-making into sequential steps while at the same time tries to elicit patient values and preferences.31Elwyn G Frosch D Thomson R et al.Shared decision making: a model for clinical practice.Gen Intern Med. 2012; 10: 1361-1367Crossref Scopus (2047) Google Scholar The pathway allows visual representation of those steps and potential options. These complex interventions have recently been developed to suit a range of decision-making styles in areas relevant to Pain Medicine. SDM has been found to improve patient satisfaction. However, SDM’s impact on clinical outcomes and unwarranted variation is less clear.32Stacey D Bennett CL Barry MJ et al.Decision aids for people facing health treatment or screening decisions (Review).Cochrane Database Syst Rev. 2011; : CD001431doi:10.1002/14651858.CD001431.pub3PubMed Google Scholar Further evaluation of SDM is necessary to achieve more widespread implementation, but has the potential to significantly improve the outcomes of care for people in pain when faced with decisions about treatment. A useful mnemonic contained within the pathway is the concept of the four A’s for effective treatment monitoring: •Analgesia (pain relief).•Activities of daily living (psychosocial functioning).•Adverse effects (side-effects).•Aberrant drug taking (addiction-related outcomes).33Passik SD Weinreb HJ Managing chronic non-malignant pain: overcoming obstacles to the use of opioids.Adv Ther. 2000; 17: 70-80Crossref PubMed Scopus (151) Google ScholarThe rising tide of opioid-related deaths and development of addiction in the USA have highlighted the need to monitor pain-relief prescriptions more closely.34Ballantyne JC Mao J Opioid therapy for chronic pain.N Engl J Med. 2003; 349 (1195): 1943Crossref PubMed Scopus (823) Google Scholar 35Sullivan MD Ballantyne JC What are we treating with long-term opioid therapy?.Arch Intern Med. 2012; 172: 433-434Crossref PubMed Scopus (49) Google Scholar Initial investigations in the UK suggest that prescriptions have increased sharply. As a result, the BPS recommends a minimum of six-monthly monitoring for strong opioids.36Opioids for Persistent Pain: Good Practice, 2010, Available from http://www.britishpainsociety.org/book_opioid_main.pdf accessed 25 March 2013.Google Scholar Such monitoring should only apply to stable patients; more frequent monitoring is needed when establishing a pain-management plan. Moore and colleagues37Moore A Derry S Eccleston C Kalso E Expect analgesic failure; pursue analgesic success.Br Med J. 2013; 346: f2690Crossref PubMed Scopus (213) Google Scholar suggest that one should expect analgesic failure, as the evidence would suggest that patient response is very individualistic, and only small cohorts will respond to each analgesic: the challenges in establishing a stable plan are therefore considerable. Trials of analgesia accompanied by close monitoring are recommended, with the imperative to stop if there is no or little response. The four A’s approach provides a useful method to achieve this with timing matched to need. The awareness of the likelihood of analgesia failure needs to be raised with the general population and, rather than just discarding analgesia, persistence needs to be encouraged. Imaginative solutions will be needed to deliver this recommendation, perhaps making better use of pharmacists, although a recent small randomized controlled trial had mixed results.38Bruhn H Bond CM Elliott AM et al.Pharmacist-led management of chronic pain in primary care: results from a randomised controlled exploratory trial.BMJ Open. 2013; 3: 4Crossref Scopus (66) Google Scholar The pathway group recommends additional interventions for those identified at high risk of chronicity. Enquiry into patient beliefs and expectations are fundamental to this. Beliefs about pain often need some adjustment in the high-risk patient. While metaphors can be useful in explaining pain,39Gallagher L McAuley J Moseley GL A randomized-controlled trial of using a book of metaphors to reconceptualize pain and decrease catastrophizing in people with chronic pain.Clin J Pain. 2013; 29: 20-25Crossref PubMed Scopus (108) Google Scholar it is important to avoid terms that are recognized as causing concern.40Sloan TJ Walsh DA Explanatory and diagnostic labels and perceived prognosis in chronic low back pain.Spine. 2010; 35: E1120-E1125Crossref PubMed Scopus (46) Google Scholar Recent UK recommendations are to use an advocate or carer to help convey messages to those with communication or cognitive difficulties, and ensure that the patients receive full and up-to-date information about pain-management services alongside the evidence base for treatment in a suitable format for them to understand.41Department of HealthEssence of Care 2010: Benchmarks for the Prevention and Management of Pain. Department of Health, London2010http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_119978.pdfGoogle Scholar 42Healthcare Improvement ScotlandBest Practice Statement: Management of Chronic Pain in Adults. Healthcare Improvement Scotland, Edinburgh2006http://www.healthcareimprovementscotland.org/his/idoc.ashx?Docid=d2f145c6-4900-4aef-8e2b-89a46db9c59f&version=-1Google Scholar Significant support from patient and other organizations will be needed to explain the rationale for this and thus enable implementation of this recommendation. The pathway group also recommends a review within 6 months for those at high risk of disability once a management plan has been agreed. In addition, a specialist assessment should be achieved within 8–12 weeks if there is no sign of improvement. If pain impacts significantly on work, the time frame should be shortened in line with guidance such as that produced by the UK National Institute of Clinical Excellence on prevention and management of long-term sickness and incapacity.43Management of Long-Term Sickness and Incapacity for Work NICE Public Health Guidance 19, . NICE 2009 www.guidance.nice.org.uk/ph19 accessed 8 September 2013.Google Scholar The overall aim of this pathway is to educate the non-specialist, provide information to the patient, and support decision-making. There are significant barriers to implementation that will need to be overcome. Basic pain assessment and management is taught at an undergraduate level to most healthcare professionals. However, the time spent on this is short and many argue it is too brief to be meaningful. A BPS survey of 19 higher education institutions delivering 108 undergraduate programmes found that pain education accounted for <1% of programmed hours of teaching for some disciplines. Veterinary students received the greatest number of hours of teaching. The survey concluded that ‘pain education is woefully inadequate given the prevalence and burden of pain’.44Briggs EV Carr EC Whittaker MS Survey of undergraduate pain curricula for healthcare professionals in the United Kingdom.Eur J Pain. 2011; 15: 789-795Crossref PubMed Scopus (121) Google Scholar The impact of this is that those at risk of the most severe disruption to their lives may go unrecognized and inadequately managed until it is too late to be effective. In response to this, the Faculty of Pain Medicine and the BPS have sponsored the development of multiple e-learning modules through the e-learning for health programme ‘e-pain’ (http://www.e-lfh.org.uk/projects/pain-management/). One of the aspirations of the first English Pain Summit was to enable pain to ‘become a high street disease’ and reduce the time to diagnosis and management of chronic pain to a few months.45Pain Summit, 2011 http://www.painsummit.org.uk/ accessed 18 September 2013.Google Scholar Through local adoption of this pathway, the management of complex pain problems in their early stages and general pain management should be clearer and more accessible and go some way to meeting this aspiration. Successful adoption of the pathway by a local community would require: •training of non-specialist staff through inclusion in the relevant curricula;•development of easy to use templates that allow a professional to follow the pathway;•research on risk assessment, management of the high-risk patient and optimal prescribing algorithms;•raising awareness of the approach that a non-specialist will take in the management of pain. The ‘Sheffield Aches and Pain’ website for back pain is a useful example of this;46Sheffield Aches and Pains Website, http://www.sheffieldachesandpains.com/ accessed 9 October 2013.Google Scholar•the further development and refinement of SDM aids relevant to pain management.Adoption of the pathway represents a significant challenge, and will require the support of policy makers and clinical leadership. While educational initiatives and research are an important start, the translation of knowledge into necessary skills and actions remain a challenge. A commitment to quality-improvement programmes in pain could achieve this. This could be achieved through a system of financial incentives based on clinical quality indicators (in the UK, relevant current programmes include the Quality Outcomes Framework, local Quality Premiums, Essence of Care benchmark, and NICE quality standards). This should place the emphasis on integrated care with proper registration, recall, and review systems put in place. Without such a structured approach, the current models of delivery are unlikely to support improved management of pain. Map of Medicine is widely available; however, a range of publications in a variety of formats are needed to raise awareness in the non-specialist community. Patient and professional organizations need to champion this pathway with non-specialists. The potential to enhance the quality-of-life for many suffering people should not be underestimated." @default.
• W2134691854 created "2016-06-24" @default.
• W2134691854 creator A5004845188 @default.
• W2134691854 creator A5018709711 @default.
• W2134691854 creator A5056427776 @default.
• W2134691854 creator A5091485693 @default.
• W2134691854 date "2014-05-01" @default.
• W2134691854 modified "2023-10-17" @default.
• W2134691854 title "Initial assessment and management of pain: a pathway for care developed by the British Pain Society" @default.
• W2134691854 cites W1518166510 @default.
• W2134691854 cites W1967833059 @default.
• W2134691854 cites W1978513912 @default.
• W2134691854 cites W1986073191 @default.
• W2134691854 cites W1986300170 @default.
• W2134691854 cites W1994295201 @default.
• W2134691854 cites W2002851739 @default.
• W2134691854 cites W202007523 @default.
• W2134691854 cites W2020229129 @default.
• W2134691854 cites W2023650955 @default.
• W2134691854 cites W2041927436 @default.
• W2134691854 cites W2045868248 @default.
• W2134691854 cites W2046615441 @default.
• W2134691854 cites W2056640727 @default.
• W2134691854 cites W2105525460 @default.
• W2134691854 cites W2121171305 @default.
• W2134691854 cites W2124572683 @default.
• W2134691854 cites W2146205177 @default.
• W2134691854 cites W2148475844 @default.
• W2134691854 cites W2152288824 @default.
• W2134691854 cites W2160769294 @default.
• W2134691854 cites W2167099771 @default.
• W2134691854 cites W2568896786 @default.
• W2134691854 doi "https://doi.org/10.1093/bja/aet589" @default.
• W2134691854 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/24638234" @default.
• W2134691854 hasPublicationYear "2014" @default.
• W2134691854 type Work @default.
• W2134691854 sameAs 2134691854 @default.
• W2134691854 citedByCount "18" @default.
• W2134691854 countsByYear W21346918542014 @default.
• W2134691854 countsByYear W21346918542015 @default.
• W2134691854 countsByYear W21346918542016 @default.
• W2134691854 countsByYear W21346918542017 @default.
• W2134691854 countsByYear W21346918542018 @default.
• W2134691854 countsByYear W21346918542019 @default.
• W2134691854 countsByYear W21346918542020 @default.
• W2134691854 countsByYear W21346918542021 @default.
• W2134691854 countsByYear W21346918542022 @default.
• W2134691854 crossrefType "journal-article" @default.
• W2134691854 hasAuthorship W2134691854A5004845188 @default.
• W2134691854 hasAuthorship W2134691854A5018709711 @default.
• W2134691854 hasAuthorship W2134691854A5056427776 @default.
• W2134691854 hasAuthorship W2134691854A5091485693 @default.
• W2134691854 hasBestOaLocation W21346918541 @default.
• W2134691854 hasConcept C1862650 @default.
• W2134691854 hasConcept C2778282284 @default.
• W2134691854 hasConcept C2983098980 @default.
• W2134691854 hasConcept C71924100 @default.
• W2134691854 hasConceptScore W2134691854C1862650 @default.
• W2134691854 hasConceptScore W2134691854C2778282284 @default.
• W2134691854 hasConceptScore W2134691854C2983098980 @default.
• W2134691854 hasConceptScore W2134691854C71924100 @default.
• W2134691854 hasIssue "5" @default.
• W2134691854 hasLocation W21346918541 @default.
• W2134691854 hasLocation W21346918542 @default.
• W2134691854 hasOpenAccess W2134691854 @default.
• W2134691854 hasPrimaryLocation W21346918541 @default.
• W2134691854 hasRelatedWork W1998511918 @default.
• W2134691854 hasRelatedWork W2006431016 @default.
• W2134691854 hasRelatedWork W2024559424 @default.
• W2134691854 hasRelatedWork W2312418344 @default.
• W2134691854 hasRelatedWork W2316139510 @default.
• W2134691854 hasRelatedWork W2331423233 @default.
• W2134691854 hasRelatedWork W2507809558 @default.
• W2134691854 hasRelatedWork W3089596156 @default.
• W2134691854 hasRelatedWork W4241636002 @default.
• W2134691854 hasRelatedWork W4302566267 @default.
• W2134691854 hasVolume "112" @default.
• W2134691854 isParatext "false" @default.
• W2134691854 isRetracted "false" @default.
• W2134691854 magId "2134691854" @default.
• W2134691854 workType "article" @default.