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MacIntyre E, Braithwaite FA, Stanton TR, Burke ALJ. Waiting in Pain II: An Updated Analysis of the Multidisciplinary Staffing Levels and Clinical Activity in Australian Specialist Persistent Pain Services. THE JOURNAL OF PAIN 2024; 25:104446. [PMID: 38101527 DOI: 10.1016/j.jpain.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 11/17/2023] [Accepted: 12/08/2023] [Indexed: 12/17/2023]
Abstract
This study provides an update on multidisciplinary staffing and clinical activity in Australian specialist persistent pain services. Of the 109 services identified, 57 responded, met inclusion criteria and completed a study-specific questionnaire detailing service characteristics, staff resources, and clinical activities. Where possible, data were compared between the 'Waiting in Pain' (WIP) investigations (WIP-I: Dec'08-Jan'10, WIP-II: Jul'16-Feb'18). WIP-II found more pain services (Level 1 centres, rural services) and more full-time equivalent (FTE) staffing (overall, psychiatry, psychology, occupational therapy) than WIP-I. Although Level 1 centres employed more FTE staff (overall, medical) than Level 2 clinics, staffing was comparable when considered relative to clinical activity and this was stable over time for most disciplines. Clinical activity in metropolitan and rural services also remained stable, as did rural service staffing (type, FTE), suggesting that newer clinics replicated existing models. WIP-II highlighted greater diversity in group structures than WIP-I and an associated mean .02FTE allied health staff/patient seen (WIP-I = .03 FTE). Staffing (amounts, types) did not change significantly over time when considered relative to clinical activity, supporting the conclusion that these are workable clinical structures. However, changes in group format (duration, staffing) suggest a shift towards lower-intensity programmes that require less allied health staffing to deliver. PERSPECTIVE: This article presents updated data regarding multidisciplinary staffing profiles, clinical activity, and group programme structures within Australian specialist persistent pain services and examines changes since the original investigation. As the only published staffing profile for multidisciplinary pain services, this project provides critical information to inform service (re)design and care delivery.
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Affiliation(s)
- E MacIntyre
- IIMPACT in Health, University of South Australia, Adelaide, Australia
| | - F A Braithwaite
- IIMPACT in Health, University of South Australia, Adelaide, Australia
| | - T R Stanton
- IIMPACT in Health, University of South Australia, Adelaide, Australia
| | - A L J Burke
- The Australian Pain Society, North Sydney, New South Wales, Australia; Psychology Department, Central Adelaide Local Health Network, Adelaide, South Australia, Australia; School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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Radhakrishnan AK, Hunter JJ, Radhakrishnan D, Silveira JM, Soklaridis S. Adaptive Mentoring Networks and Compassionate Care: A Qualitative Exploration of Mentorship for Chronic Pain, Substance Use Disorders and Mental Health. JOURNAL OF CME 2024; 13:2361405. [PMID: 38831940 PMCID: PMC11146240 DOI: 10.1080/28338073.2024.2361405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 05/23/2024] [Indexed: 06/05/2024]
Abstract
This study undertook an exploration of how Adaptive Mentoring Networks focusing on chronic pain, substance use disorders and mental health were supporting primary care providers to engage in compassionate care. The study utilised the Cole-King & Gilbert Compassionate Care Framework to guide qualitative semi-structured interviews of participants in two Adaptive Mentoring Networks in Ontario, Canada. Fourteen physician participants were interviewed including five mentors (psychiatrists) and nine mentees (family physicians) in the Networks. The Cole-King & Gilbert Framework helped provide specific insights on how these mentoring networks were affecting the attributes of compassion such as motivation, distress-tolerance, non-judgement, empathy, sympathy, and sensitivity. The findings of this study focused on the role of compassionate provider communities and the development of skills and attitudes related to compassion that were both being supported in these networks. Adaptive Mentoring Networks can support primary care providers to offer compassionate care to patients with chronic pain, substance use disorders, and mental health challenges. This study also highlights how these networks had an impact on provider resiliency, and compassion fatigue. There is promising evidence these networks can support the "quadruple aim" for healthcare systems (improve patient and provider experience, health of populations and value for money) and play a role in addressing the healthcare provider burnout and associated health workforce crisis.
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Affiliation(s)
| | | | | | - Jose M. Silveira
- Department of Psychiatry, University of Toronto, Toronto, Ont, Canada
| | - Sophie Soklaridis
- Department of Psychiatry, University of Toronto, Toronto, Ont, Canada
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Themelis K, Tang NKY. The Management of Chronic Pain: Re-Centring Person-Centred Care. J Clin Med 2023; 12:6957. [PMID: 38002572 PMCID: PMC10672376 DOI: 10.3390/jcm12226957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/03/2023] [Accepted: 11/05/2023] [Indexed: 11/26/2023] Open
Abstract
The drive for a more person-centred approach in the broader field of clinical medicine is also gaining traction in chronic pain treatment. Despite current advances, a further departure from 'business as usual' is required to ensure that the care offered or received is not only effective but also considers personal values, goals, abilities, and day-to-day realities. Existing work typically focuses on explaining pain symptoms and the development of standardised interventions, at the risk of overlooking the broader consequences of pain in individuals' lives and individual differences in pain responses. This review underscores the importance of considering additional factors, such as the influence of chronic pain on an individual's sense of self. It explores innovative approaches to chronic pain management that have the potential to optimise effectiveness and offer person-centred care. Furthermore, it delves into research applying hybrid and individual formulations, along with self-monitoring technologies, to enhance pain assessment and the tailoring of management strategies. In conclusion, this review advocates for chronic pain management approaches that align with an individual's priorities and realities while fostering their active involvement in self-monitoring and self-management.
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Affiliation(s)
- Kristy Themelis
- Department of Psychology, University of Warwick, Coventry CV4 7AL, UK
| | - Nicole K. Y. Tang
- Department of Psychology, University of Warwick, Coventry CV4 7AL, UK
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Abstract
The opioid crisis in the United States (US) is one of the most high-profile public health scandals of the 21st century with millions of people unknowingly becoming dependent on opioids. The United Kingdom (UK) had the world's highest rate of opioid consumption in 2019, and opiate-related drug poisoning deaths have increased by 388% since 1993 in England and Wales. This article explores the epidemiological definitions of public health emergencies and epidemics in the context of opioid use, misuse, and mortality in England, to establish whether England is facing an opioid crisis.
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Affiliation(s)
- Antonia-Olivia Roberts
- Medical Sciences Division, University of Oxford, Oxford, UK
- Green Templeton College, University of Oxford, Oxford, UK
| | - Georgia C Richards
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Jain S, Jadwani V, Spogmy S, Walumbe J. Inequalities and inequities in the types of chronic pain services available in areas of differing deprivation across England. Scand J Pain 2023; 23:168-174. [PMID: 35503225 DOI: 10.1515/sjpain-2022-0015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/05/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVES In England, the prevalence of chronic pain is higher in more deprived compared to less deprived areas. Patients in such areas also experience more severe and disabling pain than those in less deprived areas. However, little is known about whether the distribution of services for chronic pain reflect these ranging levels of need. This study examines how the types of services available for chronic pain patients vary between healthcare providers in England, serving areas of differing deprivation. METHODS National guidelines regarding primary as well the 8 commonest causes of secondary chronic pain (in the United Kingdom) were used to compile a list of services that have been recommended for supporting chronic pain patients. After searching the websites of 63 randomly selected National Health Service (NHS) Trusts and contacting their pain receptionists and/or secretaries, it was recorded whether the Trusts were providing each of these recommended chronic pain services. Mean Index of Multiple Deprivation 2019 scores were used to compare deprivation levels of areas covered by each NHS Trust. RESULTS There was no significant difference in the overall number of types of chronic pain services provided by NHS Trusts serving areas of differing deprivation, but deprived areas were being disadvantaged with regards to specific services. These areas were significantly (p<0.05) less likely to have occupational therapy, return-to-work programmes, and hand therapy services. Areas with fewer types of professionals (≤3) in their pain multidisciplinary team were also significantly (p<0.05) more deprived than those with more types (>3). CONCLUSION There are significant differences in the provision of certain types of chronic pain services between areas of differing deprivation. Similar research across Europe is recommended to inform policy to combat the widespread chronic pain related health inequalities.
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Affiliation(s)
- Shrujal Jain
- Faculty of Medicine, Imperial College London, London, UK
| | - Varsha Jadwani
- Faculty of Medicine, Imperial College London, London, UK
| | - Sana Spogmy
- Faculty of Medicine, Imperial College London, London, UK
| | - Jackie Walumbe
- University College London Hospitals NHS Foundation Trust, London, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Laskawska MS, Hébert HL, Richardson C, Berlouis K, Cameron P, Colvin LA, Smith BH. The core minimum dataset for measuring pain outcomes in pain services across Scotland. Developing and testing a brief multi-dimensional questionnaire. Br J Pain 2022; 16:504-517. [PMID: 36389005 PMCID: PMC9644105 DOI: 10.1177/20494637221092907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background There is currently no agreed minimum dataset to inform specialist chronic pain service provision. We aimed to develop a Core Minimum Dataset (CMD) for pain services in Scotland and perform preliminary analysis to evaluate its psychometric properties in adults with chronic pain. Methods The questionnaire was developed following a review of existing relevant data collection instruments and national consultation. The CMD questionnaire was completed alongside a routine pre-clinic questionnaire by patients attending two pain services over 3 months. Concurrent validity was tested by comparing scores between the CMD and pre-existing questionnaires. Reliability was assessed by test-retest and discriminative validity via receiver operating characteristic (ROC) curves. Results The final CMD questionnaire consisted of five questions on four domains: pain severity (Chronic Pain Grade [CPG] Q1); pain interference (CPG Q5); emotional impact (Patient Health Questionnaire-2 [PHQ-2], two questions); and quality of life (Short Form Health Survey-36 [SF-36] Q1). 530 patients completed the questionnaire. Strong correlation was found with the Hospital Anxiety and Depression Scale (rs = 0.753, p < 0.001). Moderate correlations were found with the Brief Pain Inventory for pain interference (rs = 0.585, p < 0.001) and pain severity (rs = 0.644, p < 0.001). Moderate to good reliability was demonstrated (Intra-class Correlation Coefficient = 0.572-0.845). All items indicated good discrimination for relevant health states. Conclusions The findings represent initial steps towards developing an accurate questionnaire that is feasible for assessing chronic pain in adults attending specialist pain clinics and measuring service improvements in Scotland. Further validation testing, in clinical settings, is now required.
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Affiliation(s)
- Magdalena S Laskawska
- Chronic Pain Research Group, Division
of Population Health and Genomics, Ninewells Hospital and Medical School, University
of Dundee, Dundee, UK
| | - Harry L Hébert
- Chronic Pain Research Group, Division
of Population Health and Genomics, Ninewells Hospital and Medical School, University
of Dundee, Dundee, UK
| | - Cara Richardson
- Chronic Pain Research Group, Division
of Population Health and Genomics, Ninewells Hospital and Medical School, University
of Dundee, Dundee, UK
| | - Katherine Berlouis
- Chronic Pain Research Group, Division
of Population Health and Genomics, Ninewells Hospital and Medical School, University
of Dundee, Dundee, UK
| | - Paul Cameron
- Chronic Pain Research Group, Division
of Population Health and Genomics, Ninewells Hospital and Medical School, University
of Dundee, Dundee, UK
- Fife Health & Social Care
Partnership, Dunfermline, UK
| | - Lesley A Colvin
- Chronic Pain Research Group, Division
of Population Health and Genomics, Ninewells Hospital and Medical School, University
of Dundee, Dundee, UK
| | - Blair H Smith
- Chronic Pain Research Group, Division
of Population Health and Genomics, Ninewells Hospital and Medical School, University
of Dundee, Dundee, UK
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Wilson N, Beasley MJ, Pope C, Dulake D, Moir LJ, Hollick RJ, Macfarlane GJ. UK healthcare services for people with fibromyalgia: results from two web-based national surveys (the PACFiND study). BMC Health Serv Res 2022; 22:989. [PMID: 35922796 PMCID: PMC9347075 DOI: 10.1186/s12913-022-08324-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 07/12/2022] [Indexed: 11/12/2022] Open
Abstract
Background The UK’s “Getting It Right First Time” programme recommends that management of people with fibromyalgia should centre on primary care. However, it remains unclear as to how best to organise health systems to deliver services to optimise patient outcomes. Aim To profile UK healthcare services for people with fibromyalgia: provision of National Health Services (NHS) and use of non-NHS services by people with fibromyalgia. Methods Two online open surveys (A and B) incorporating questions about diagnosis, treatment and management of fibromyalgia and gaps in healthcare services were conducted between 11th September 2019 and 3rd February 2020. These were targeted to NHS healthcare professionals consulting with people with fibromyalgia (Survey A) and people ≥16 years diagnosed with fibromyalgia using non-NHS services to manage their condition (Survey B). Descriptive statistics were used to report quantitative data. Thematic analysis was undertaken for qualitative data. Results Survey A received 1701 responses from NHS healthcare professionals across the UK. Survey B received 549 responses from people with fibromyalgia. The results show that NHS services for people with fibromyalgia are highly disparate, with few professionals reporting care pathways in their localities. Diagnosing fibromyalgia is variable among NHS healthcare professionals and education and pharmacotherapy are mainstays of NHS treatment and management. The greatest perceived unmet need in healthcare for people with fibromyalgia is a lack of available services. From the pooled qualitative data, three themes were developed: ‘a troublesome label’, ‘a heavy burden’ and ‘a low priority’. Through the concept of candidacy, these themes provide insight into limited access to healthcare for people with fibromyalgia in the UK. Conclusion This study highlights problems across the NHS in service provision and access for people with fibromyalgia, including several issues less commonly discussed; potential bias towards people with self-diagnosed fibromyalgia, challenges facing general practitioners seeking involvement of secondary care services for people with fibromyalgia, and a lack of mental health and multidisciplinary holistic services to support those affected. The need for new models of primary and community care that offer timely diagnosis, interventions to support self-management with access to specialist services if needed, is paramount. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08324-4.
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Affiliation(s)
- Nicky Wilson
- Departments of Rheumatology and Therapies, King's College Hospital NHS Foundation Trust, London, UK.
| | - Marcus J Beasley
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Catherine Pope
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Laura J Moir
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Rosemary J Hollick
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Gary J Macfarlane
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, UK
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Medel J, Serrano A, Batet C, Lorente L, Bella S, Ferrandiz M, Monerris MDM, Boada S, Villoria J, Ribera MV, Montes A, Videla S. Advances and Pitfalls of Specialized Pain Care through Public and Private Health Care Providers in Catalonia and the Balearic Islands: A Physician's Survey. Pain Res Manag 2022; 2022:4077139. [PMID: 35637851 PMCID: PMC9148249 DOI: 10.1155/2022/4077139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 02/08/2022] [Accepted: 03/18/2022] [Indexed: 11/17/2022]
Abstract
Optimal diagnosis and treatment of pain require a multidisciplinary approach that demands considerable coordination and forethought. A cross-sectional physician survey based on an online questionnaire was carried out to assess the adoption of multidisciplinary working patterns, compare the public and private models, and provide an update on the resources and organization of specialized pain care in Catalonia and the Balearic Islands. Active pain practitioners identified through the Catalan Health Service and Pain Society databases were sent an invitation in December 2020. Of the 321 physicians contacted, 91 (28.3%) answered and 71 provided complete responses (commonly anesthesiologists, representing 92 different sites; some worked at public and private sites). Up to 78.7% reported working in pain management teams, but only 53.5% were regularly involved in teaching or research activities. Thus, the proportion of multidisciplinary sites lies somewhere in-between. Median wait times were significantly shorter and within the recommended standards in private practices (e.g., 15 vs. 90 days in public practices for noncancer patients). In turn, private practices were slightly less staffed and equipped, albeit the differences did not reach statistical significance. Respondents made a median of 530 regular and 30 emergency visits per year, of which 190 involved interventional procedures. They offered a wide range of pharmacological and interventional therapies, although psychotherapy and the most sophisticated procedures were only available in ≤50% of sites. Pain clinicians and facilities are reasonably available in Catalonia, but barely more than half are truly multidisciplinary. Public and private practices differ in some aspects; the latter seems to be more accessible, but it is restricted to patients who can afford it. Compared to previous reports, this update shows both advances and outstanding issues. Multidisciplinary care could be expanded by incorporating more psychologists and some interventional procedures. The public practices should reduce wait times.
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Affiliation(s)
- Javier Medel
- Pain Unit, Hospital Universitari Vall d'Hebrón, Passeig de la Vall d'Hebron 119, Barcelona 08035, Spain
| | - Ancor Serrano
- Pain Unit, Hospital Universitari de Bellvitge, Carrer de la Feixa Llarga, L'Hospitalet de Llobregat 08907, Spain
| | - Carme Batet
- Pain Unit, Consorci Sanitari Integral, Hospital de Sant Joan Despí Moisès Broggi, Carrer Oriol Martorell 12, Sant Joan Despí 08907, Spain
| | - Lluis Lorente
- Pain Unit, Institut de Medicina i Cirurgia de Barcelona, Carrer Bisbe Sivilla 46, Barcelona 08022, Spain
| | - Susana Bella
- Pain Unit, Hospital Universitari Sant Joan de Reus, Avinguda Del Doctor Josep Laporte 2, Reus 43204, Spain
| | - Marta Ferrandiz
- Pain Unit, Hospital Universitari de La Santa Creu i Sant Pau, Carrer de Sant Quintí 89, Barcelona 08041, Spain
| | | | - Sergi Boada
- Pain Unit, Hospital Universitari Joan 23, Carrer Dr. Mallafrè Guasch 4, Tarragona 43005, Spain
| | - Jesus Villoria
- Department of Design and Biometrics, Medicxact, Plaza Ermita 4, Alpedrete, Spain
| | - Maria-Victoria Ribera
- Pain Unit, Hospital Universitari Vall d'Hebrón, Passeig de la Vall d'Hebron 119, Barcelona 08035, Spain
| | - Antonio Montes
- Pain Unit, Hospital Del Mar, Passeig Marítim 25-29, Barcelona 08003, Spain
| | - Sebastian Videla
- Department of Clinical Pharmacology, Hospital Universitari de Bellvitge, Carrer de La Feixa Llarga, L'Hospitalet de Llobregat 08907, Spain
- Pharmacology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, IDIBELL, University of Barcelona, Carrer de La Feixa Llarga, L'Hospitalet de Llobregat 08907, Spain
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Alenezi A, Yahyouche A, Paudyal V. Patient Perspectives on the Appropriate Use of Prescribed Opioids in Chronic Non-Malignant Pain: Analysis of Online Forums Using Theoretical Domains Framework. J Pain Res 2022; 15:1567-1583. [PMID: 35668956 PMCID: PMC9166377 DOI: 10.2147/jpr.s357354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/10/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Aziza Alenezi
- University of Birmingham, School of Pharmacy, Institute of Clinical Sciences, Birmingham, B15 2TT, UK
| | - Asma Yahyouche
- University of Birmingham, School of Pharmacy, Institute of Clinical Sciences, Birmingham, B15 2TT, UK
- Correspondence: Asma Yahyouche, School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK, Tel/Fax + 44121 415 8798, Email
| | - Vibhu Paudyal
- University of Birmingham, School of Pharmacy, Institute of Clinical Sciences, Birmingham, B15 2TT, UK
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Keen S, Lomeli-Rodriguez M, Williams ACDC. Exploring how people with chronic pain understand their pain: a qualitative study. Scand J Pain 2021; 21:743-753. [PMID: 34331751 DOI: 10.1515/sjpain-2021-0060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/05/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES A fundamental principle of pain management is educating patients on their pain using current neuroscience. However, current pain neurophysiology education (PNE) interventions show variable success in improving pain outcomes, and may be difficult to integrate with existing understanding of pain. This study aimed to investigate how people with chronic pain understand their pain, using qualitative exploration of their conceptualisations of pain, and how this understanding accommodated, or resisted, the messages of PNE. METHODS Twelve UK adults with chronic pain were recruited through advertisements on online pain networks. Semi-structured interviews were conducted remotely, with responses elicited using the Grid Elaboration Method (GEM) and then a PNE article. Participants' grid elaborations and responses to PNE were analysed using thematic analysis (TA). RESULTS Three main themes were extracted from participants' grid elaborations: communicating pain, explaining pain and living with pain. These themes incorporated varied, inconsistent sub-themes: of pain as simultaneously experiential and conceptual; in the body and in the mind; diagnosable and inexplicable; manageable and insuperable. Generalised, meta-level agreement was identified in participants' PNE responses, but with doubts about its practical value. CONCLUSIONS This study shows that people understand pain through inconsistent experiential models that may resist attempts at conceptual integration. Participants' elaborations showed diverse and dissonant conceptualisations, with experiential themes of restricted living; assault on the self; pursuit of understanding pain and abandonment of that pursuit. Responses, although unexpectedly compatible with PNE, suggested that PNE was perceived as intellectually engaging but practically inadequate. Experiential disconfirmation may be required for behavioural change inhibited by embedded fears and aversive experiences. ETHICAL COMMITTEE NUMBER UCL REC# 17833/003.
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Affiliation(s)
- Sam Keen
- Research Department of Clinical, Educational & Health Psychology, University College London, London, UK
| | - Martha Lomeli-Rodriguez
- Research Department of Clinical, Educational & Health Psychology, University College London, London, UK
| | - Amanda C de C Williams
- Research Department of Clinical, Educational & Health Psychology, University College London, London, UK
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A national survey of publicly funded chronic pain management services in Ireland. Ir J Med Sci 2021; 191:1315-1323. [PMID: 34110583 PMCID: PMC8191436 DOI: 10.1007/s11845-021-02673-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/28/2021] [Indexed: 11/18/2022]
Abstract
Background Chronic pain management services have historically been under-resourced in Ireland. There is no agreed model of care for chronic pain management services in Ireland. Previous studies have assessed the extent of services in Ireland without examining waiting times for access to services. Aims This study aimed to quantify the extent of, geographical distribution of and waiting times for access to publicly funded chronic pain management services in Ireland. Methods Using the British Pain Society’s Core Standards for Pain Management Services in the UK (2015) and International Association for the Study of Pain (IASP) recommendations, a questionnaire was devised. Publically funded departments in Ireland were contacted and questionnaires completed. Waiting list data was publicly available and obtained from the National Treatment Purchase Fund website. Results There was a 100% response rate. Sixteen publicly funded chronic pain management services were identified. There are 27 chronic pain management consultants (16.6 whole time equivalents (WTE)) practicing chronic pain management, amounting to 0.55 specialists (0.34 WTEs)/100,000 of the population. There are 21 WTE for non-consultant hospital doctors (NCHDs), 26.5 WTEs for nursing, 8 WTEs for physiotherapy and 6.2 WTEs for psychology, nationally. A percentage of 93.75% of departments (n = 15) provide interventional therapies, 37.5% (n = 6) provide advanced neuromodulation and 43.75% (n = 7) are managing intrathecal pump therapies. There are five pain management programmes nationally. As of January 2020, ~ 25% patients on waiting lists for outpatient appointments were waiting > 18 months, with ~ 17% patients on waiting lists for interventional treatments waiting > 12 months. Conclusions Shortage of multidisciplinary staff is of particular concern for Irish services. Patient access is limited as evidenced by significant waiting lists. In order to improve access to care and bring services in line with international recommendations, increased resources are needed.
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12
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Twiddy H, Frank B, Alam U. A Consideration of the Psychological Aspects to Managing Patients with Painful Diabetic Neuropathy: An Insight into Pain Management Services at a Tertiary Centre in the UK. Diabetes Ther 2021; 12:487-498. [PMID: 33367982 PMCID: PMC7846618 DOI: 10.1007/s13300-020-00983-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/11/2020] [Indexed: 01/07/2023] Open
Abstract
Painful diabetic neuropathy (pDN) is characterised by both sensory and affective disturbances, suggesting a complex bidirectional relationship of neuropathic pain and mood disorders. Data on pDN indicate that neuropathic pain reduces quality of life, including mood and physical and social functioning. Depression and pain coping strategies such as catastrophising and social support predict pain severity. There is a significant and reciprocal relationship between depressed mood and increased pain. The key features of assessing people with neuropathic pain in relation to psychological aspects of their health are discussed in the context of management in a tertiary pain management centre (The Walton Centre, Liverpool, UK) including cognitive behavioural interventions amongst others to improve the quality of life in patients with pDN. We consider psychological issues as a factor influencing treatment and outcome in patients with pDN.
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Affiliation(s)
- Hannah Twiddy
- Department of Pain Medicine, The Walton Centre, Liverpool, UK.
| | - Bernhard Frank
- Department of Pain Medicine, The Walton Centre, Liverpool, UK
| | - Uazman Alam
- Diabetes and Endocrinology Research, Institute of Cardiovascular and Metabolic Medicine and The Pain Research Institute, University of Liverpool and Liverpool University NHS Hospital Trust, Liverpool, UK
- Division of Endocrinology, Diabetes and Gastroenterology, University of Manchester, Manchester, UK
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