Many pain clinics fail to offer multidisciplinary care, says audit

BMJ 2012; 345 doi: (Published 18 December 2012) Cite this as: BMJ 2012;345:e8577
  1. Jacqui Wise
  1. 1 London

Many pain clinics in England and Wales fall well below the minimum requirements for an effective multidisciplinary pain service, the first national pain audit has concluded.1

The audit was commissioned by the Health Quality Improvement Partnership in response to the chief medical officer for England’s report Pain: Breaking through the Barrier.2 The audit found high variation in patients’ access to multidisciplinary care—considered to be the essential requirement for specialist chronic pain services. Waiting times and access to key skills of multidisciplinary team members also varied considerably.

The three year study, carried out by the British Pain Society and the healthcare information analysts Dr Foster Intelligence, found that only 81 of 204 (40%) pain clinics in England were able to offer a fully multidisciplinary pain service, which includes a psychologist, physiotherapist, and physician. In Wales 60% of pain clinics were multidisciplinary. Given the high prevalence of anxiety and depression in patients with chronic pain, the report says that far better access to physiotherapy and psychology services was essential.

The report also found that pain services seemed to focus mainly on spinal pain and musculoskeletal pain, to the detriment of pelvic pain and non-musculoskeletal neuropathic pain.

The audit located 161 providers of specialist pain services. Some primary care trusts had several providers, but 28 trusts did not seem to have any pain services available to their patients. Only 91 clinics returned information on 9588 patients, who completed questionnaires about themselves. Of those, 4414 patients returned follow-up questionnaires at six months, of which 3192 were complete.

An estimated 11% of adults and 8% of children in the United Kingdom, around 7.8 million people, experience severe pain. The audit found that many patients with complex chronic pain disorders had a very low quality of life. However, half of clinics showed that on average their patients’ quality of life improved after six months, and three quarters of clinics showed improvement in specific pain related quality of life among their patients.

The audit found that many of the patients who used specialist pain services had mainly musculoskeletal pain and that many were of working age. The report urges a greater focus on the needs of people with pain who are seeking to return to employment.

Sixteen per cent of patients who responded said that before they started attending a pain clinic they had visited a hospital emergency department for additional help in managing their pain, despite having seen their GP. This compared to 9% of respondents needing to visit an emergency department in the six months after attending their pain clinic for pain related events. Two thirds of respondents had made more than three visits in the past six months to a healthcare provider.

Cathy Price, clinical lead for the national pain audit, said, “We were very concerned by the extremely poor quality of life endured by many patients. Although we were pleased that pain services are addressing this issue and, importantly, that patients are satisfied with their involvement in their care planning, we hope that future audits will build on our findings.”


Cite this as: BMJ 2012;345:e8577